Safal Shuruaat ('Successful Beginning')

The programme's formative research included 800 face-to-face computer-assisted personal interviewing (CAPI)-assisted quantitative surveys with parents of under two years, along with 70 qualitative activities with key influencers and enablers, including extended family members, village heads, and field-level workers (FLWs). Findings showed that parents broadly considered children's health issues to be beyond their span of control and an unavoidable part of their life. Such beliefs were underscored by social norms discouraging individualistic behaviour (emphasis on collectivism) and gender stereotypes/patriarchy. Childcare practices were mostly governed by prevalent social beliefs, norms, and rituals, which potentially contributed to the low uptake of suggested practices, even though promoted by FLWs.

Thus, the programme's communication strategy is based on the insight that "every parent wants their child to be successful and lead a better quality of life than them". The idea is to inspire young parents to adopt those behaviours that will ensure proper growth and development of the infant to be school-ready, with the age appropriate physical, mental, and emotional skills.

Many parts of UP lack exposure to traditional media, so the programme focused on spreading critical health and hygiene information by using mobile technology to share reminders on immunisation, HWWS, nutrition, childhood development, and interspousal communication. Short films and gamification further mobilised communities to take action. The strategy was meant to be highly engaging and included the use of audio-visual aids.

Specifically, the programme takes parents of children under two years on a journey through a series of village events, home visits, and a group encounter at the rural childcare centres and school. Key elements of programme design include:

• District launch - Designed to create awareness among key government stakeholders, to build systematic ownership, and to emphasise the need for collective action.
• Village launch - Designed to introduce the project at the village level, to pave an entry of the Safalta Coach (a male and female duo - the field staff), and to garner support from key opinion leaders, elected representatives, and FLWs.
• Home visits - Household-level contact sessions that address barriers to behaviour change at different levels of the socio-ecological system, using learning through demonstration, tools, technology, and recognition to help build knowledge, self-efficacy, and, eventually, change practices.
• Anganwadi centre activity - Contact sessions with young mothers and the family gatekeeper (the mother-in-law) at the Anganwadi centre, delivered by the Safalta Coach along with the FLW, expanding a traditional health service delivery post at the village level, to discuss and trigger health behaviours.
• School contact programme - School contact sessions, exposing young children to key behaviours, through a range of fun and interactive activities.
• Male engagement activity - A contact session specially focused on fathers of 0- to 2-year-old children to sensitise and mobilise them to embrace and support early childhood development. Messaging emphasises the role of men in childcare activities, making the shift from man as the provider to man as the protector. Under the umbrella of successful parenting, fathers learn about the importance of both parents contributing to childcare, including infection prevention.

Immunisation and Vaccines, Health, Children.

In Uttar Pradesh, India, over 1,000 children die every day from preventable diseases such as diarrhoea and pneumonia.

In two initial pilot districts, the incidence of handwashing post defaecation was as low as 13% at the baseline and showed a rise of 53% within 6 months (after 3 programme visits), with the percentage of people never washing hands post defaecation dropped from 86.1% to 29.3%. The incidence of HWWS by mothers before breastfeeding a child rose from 2.7% to 14.8%.

The mother and child protection card (MCP card) is a tool designed to inform and educate the mother and family on different aspects of maternal and child care. The programme stresses the importance of using the MCP card and keeping it safe. Monitoring after 3 programme visits showed an increase of 12 percentage points from the baseline (85.2%). The compliance for three priority vaccines relevant for children under the age of two - rotavirus, measles-rubella (MR), and pentavalent - grew by 45%, 35%, and 20% points, respectively.

Awareness of key parenting behaviours, including the understanding of the need to bond with the child, ensure adequate nutrition, and maintain hygiene behaviours, increased by 18%, 23%, and 11% points, respectively. With respect to washing own hands with soap and getting the child immunised, there were positive trends - with a 2% rise in vaccination and 11% in handwashing reported.

The data were analysed to examine differences in the cohort exposed to specific programme visits with access to assets distributed vis-à-vis the others. For example, the more exposures to the programme visits, the higher the proportion of "always washing hands with soap post defaecation". An immunisation calendar was given to parents to facilitate reminders around immunisation dates. The ones who received the calendar showed 12%-point higher compliance for pentavalent vaccine, 11%-point higher compliance for rotavirus vaccine, and 15%-point higher compliance for MR vaccine as compared to the cohort that did not receive it.

Other results of the impact evaluation:

• Knowledge around the timely routine immunisation schedule improved by 2.8 percentage points.
• Awareness regarding diarrhoea and pneumonia being vaccine-preventable diseases significantly increased, by 6.0 percentage points and 6.8 percentage points, respectively.
• The association of successful parenting with timely immunisation and handwashing with soap significantly improved, by 11.4 percentage points and 6.1 percentage points, respectively.

As of 2021, Safal Shuruaat  had reached more than 2.5 million people across 14 districts of UP. Over 1.5 million edutainment-style mobile audio messages on child survival were shared with parents. Messages were also adapted for COVID-19 prevention.