TCi FIELD NOTES are a blog series for current TCi Scholars, Fellows, and TCi staff to share experiences, insight, and stories stemming from TCi-funded fieldwork throughout India. Lua Wilkinson is current TCi Scholar pursuing a Ph.D in the Division of Nutritional Sciences at Cornell. This is the second of three posts written by Lua about her exploratory fieldwork trip in preparation for her dissertation work. Read the first post here.
Difficulties coordinating and retaining community health workers (CHW) has been problematic in India since the 1960’s. The recent news of a polio-free India, however, coupled with new policies incentivizing village practitioners starting in 2005, has led to an increase in optimism of impact that CHWs are capable of there.
In some of the more remote areas, however, challenges remain. First, it can be hard to find individuals, particularly women, who have the education qualifications (often 8th grade or above). Second, it can also be problematic to keep those involved motivated, although this is improving. Third, the ratio of provider to people can be quite large and job duties can easily become overwhelming.
One of the more novel approaches that Digital Green and VARRAT, in collaboration with SPRING, have taken in a few village blocks of Keonjhar is the mobilization of agricultural educators called “Community Service Providers.” These CSPs are helping to improve nutrition practices by mediating nutrition messaging to women’s self-help groups (SHGs) via video dissemination. In this way, they become a bridge of information between the community and the CHWs.
Most CSPs had no nutritional training prior to the initiation of the project last year. They were given extensive instruction by nutrition experts involved in the program, and continue to have follow up sessions every two weeks where they are able to raise questions and concerns that they confront. They use the DG model when disseminating video messages: there is as much discussion during the video as their is content. The CSPs I spoke with explained that during moderation, they find that some of the women already have a deep understanding of some of the video topics (such as hand washing and breastfeeding) which helps with the participatory nature of the program.
Many explained that there is a general appreciation now of the concept how having healthy mothers can lead to healthy babies, and why continued work in maternal and child nutrition is so crucial. For example, misconceptions of negative effects of taking iron pills are starting to change, as are certain food taboos.
Using CSPs as disseminators of nutrition information to village blocks makes sense in many ways.
- First, they are already well known by the communities they serve. In Keonjhar, they have been working and living in the community for years.
- Second, because of their relationships to the communities, they are trusted sources of information. The CSPs involved in the nutrition project have also been working with DG and VARRAT on agricultural video dissemination since 2009.
- Third, people tend to see a natural connection between agriculture and nutrition. Community agriculture educators are often the go-to people for questions on food.
- And finally, CSPs are involved in the process from beginning until end, making them crucial to the monitoring and evaluation of programs.
While any hard data on how effective these CSPs are have not been tallied, it is clear that they are an enormously powerful resource for communities which have a good ratio of connected agricultural educators to people. No one assumes the CSPs will take over the important role of frontline healthcare workers, but they can bridge a critical gap between farmers and providers in areas where the CHWs may be overworked.