In February 2011, CKS worked with WHP (World Health Partners) on a project that aimed to promote better rural health practices in Bihar by introducing Telemedicine Provision Centres (TPCs) around the state. TPCs allow rural health care practitioners, who may not have a lot of formal training and education, to connect remotely with more qualified doctors in other cities, in order to better provide health care information and advice to the beneficiaries. The project aimed to assess rural healthcare practices in Bihar, in order to develop a new communications strategy to promote TPCs.
We began with ethnographic research focused on understanding health behavior related to four major diseases – tuberculosis, childhood pneumonia, Kala Azar and diarrhea. The team approached people in three districts of the state to gain an understanding of beneficiaries’ knowledge about the diseases, their health seeking practices, the forms of media and communication that are most widely accessed, and their reception to technology-based information such as the internet and mobile phones.
It was found that the beneficiaries’ choice of healthcare service for treatment is usually influenced by availability, accessibility, affordability, familiarity, and trust. People most often rely on Rural Health Practitioners (RHPs), who are a part of the community and hence are affordable and accessible, but not necessarily very educated or well-trained. Beneficiaries sometimes also access Public and Private health centers, but these tend to be more impersonal, and harder to access due to distance and affordability. RHPs, despite their lower levels of training, are integrated deeply in the community, and therefore most trusted, and their advice tends to be most deeply heeded. Therefore, they are one of the best means to gain access into the community, and with a little more training and support, can be the most impactful in transforming health seeking behavior in rural Bihar.
With regard to people’s awareness towards the target diseases, it was found that the beneficiaries most often mistake signs and symptoms as the cause of a disease. For example it was believed that “T.B. khansi ki wajah se hota hai”. The beneficiaries’ lack of awareness about preventive measures, causes and consequences of illness in all three districts often increases the severity of easily preventable diseases. Awareness about TB and diarrhea was found to be highest, while beneficiaries had the least knowledge about Kala Azar. For example, beneficiaries in all three districts were aware that TB spreads from an infected person’s cough, sneeze and spit, and that the blood in the sputum is its most common symptom.
Exploring media and communication channels, we found that the print media, paint media, and electronic media were accessed in all three districts. The efficacy of different communication channels was gauged on the basis of their accessibility, reliability, preference, and recall and thereafter various communication strategies were proposed for educating beneficiaries of four targeted diseases and for the promotion of TPC services. It was proposed that popular newspapers and magazines could be an appropriate means to target male beneficiaries who are the key influencers in the family. In order to ensure greater visibility and recall of information, local news was seen as a viable channel of communication since people tend to trust information delivered over news rather than through advertisement.
The project holds a lot of potential since it engages with the existing trusted resources, that is RHPs, in order to make them more efficient with the help of technology, to address the health care situation in a better way.