What is Design Public?
One of READ Alliance’s sub-recipients, PlanetRead is working to improve the reading levels of children using Same Language Subtitling. The project addresses two established findings:
- World over, children like to watch cartoons, and this is a well-known fact
- Much less known is a well-researched conclusion that a viewer who watches video content with subtitles, will try to read along inescapably and automatically, assuming a passing familiarity with the text
Through this project, READ Alliance and PlanetRead aim to integrate Animated Books (AniBooks) into the schools and lives of children in Grades 1-4 (between the age of 6-10), to support the development of reading skills. Before deploying digital content across their priority Hindi states (Rajasthan, Uttar Pradesh, Madhya Pradesh, Bihar, Jharkhand, and Chhattisgarh), they began a field test of these Anibooks with Grades 1 and 2 at a Government School in Pondicherry (Tamil Nadu).
The first session involved children (Grades 1 to 4) coloring animals that are part of their stories. The older children were asked to draw a river and all that they think exists around it.
Interesting observations from session 1
- One little child from Grade 1 could not write at all. Her coloring skills were good. (Team came to know that she had lost both her parents and so far has been struggling to hold a pencil correctly. She does not write yet. However, she has made progress with the help of her teachers).
- Some older children (Grades 3 and 4) wrote their names, class, and the date well. There were some others who were copying their names from the school ID card. Interestingly, there was one child who wrote a long word with the first and last letters matching his actual name, while the letters in between didn’t mean anything.
PlanetRead team conducted some testing activities (word search, rebus, choose the right sentence, pick the odd one out, categorize, complete the sentence (verb to be placed according to the subject) with the children to understand their levels of reading comprehension.
Shirley, a student of Grade 6 (Kendriya Vidyalaya, Pondicherry), watched the stories and understood them well. She could follow almost all the words in the story but needed help with activities that introduced new words (apart from the story) like the ‘bad and good qualities’.
Joanna, a little girl from Grade 3 (St. Joseph of Cluny), seemed to be a beginner in Hindi and could just about follow the stories thanks to the visuals. She needed repeated viewing to understand the story better. She couldn’t do the comprehension questions but was quick with picture exercises. Her letter and sound recognition was good so she could easily solve the ‘word search’ activity and enjoyed it.
Prachi, an eleven-year-old girl from the Sri Aurobindo International Centre of Education is not a student of Hindi. She is familiar with the script as she learns Sanskrit. She is exposed to Hindi so she can speak and understand the language quite well. She could do the activities well and faced small challenges doing word games like ‘word search’ as she was not so familiar with the format.
Overall, it was observed that the different age groups and backgrounds of the children mattered quite a lot for the time taken to do the activity. Using pen and paper, a little help and hints are needed, but digitally the children can master the same by playing the game multiple times.
The next session will include children watching movies and talking about it. Some new aspects of the story will be introduced through different media. For example, children will be shown a video of someone playing the flute and a real flute. Some images of rivers will be displayed. This will give them a clearer idea of some of the things they might not be familiar with. This session will also include an eye tracking exercise to pinpoint where the child’s gaze lands while watching a video.
In a recent discussion with my colleagues about evaluating reading interventions on the field, I was asked to share my thoughts about the various ways in which reading evaluations are done across the country.
The first step towards building an understanding about evaluation is to really understand different definitions of reading. Letter and word recognition, Reading comprehension & Fluency are some of the most commonly used words/phrases to define reading.
But, why is it so important to talk about the definitions? The answer lies in the fact that it reduces ambiguity and provides an important perspective for evaluating approaches. Most of the reading assessment tools include most of these parameters in the form of different exercises.
In some of the reading evaluations, children are called to read letters, sentences and paragraphs aloud. While observing a recent reading assessment of one child (Kapil), I saw that he simply refused to read aloud any text. Discussions with his teacher revealed that he could not read and has been a poor performer in the class, however, on being given an opportunity, Kapil silently read the entire paragraph and could correctly explain the meaning of the same. There have been other incidents also where children have scored well by reading aloud, but lacked in understanding meaning of the same.
Some of the questions in these evaluations test the reading comprehension levels of children, where they are given a paragraph followed by a certain set of questions based on it. To quote an example, I noticed a young girl of grade 3 (Harsha) who was trying very hard to find out the identical letters in the given paragraph so that she can copy those lines as an answer to the question. All her questions’ answers were almost right as she could read the letters and copied them very well.
She performed well, but, is that what we are measuring- ability to correctly copy lines as opposed to understanding what is written?
The role of the facilitator (who facilitates the test) is very crucial at the time of evaluation of the children. The facilitator guides the students with instruction to complete the test. According to the rule of the test the only guidance a child can get is the instruction by the facilitator. For one of the evaluations, where the objective was to ask the students to fill up blanks with the help of the picture given next to the question, the instruction provided was to identify the picture and write in the blank space of the exercise. Majority of students couldn’t correctly answer these questions, as the instructions were not proper and explicit.
In a diverse country like India when any program starts, organizations take culture, socio economic background and role of the stakeholders into consideration whereas while evaluating, the main focus is always on the tool and its training. Taking the previous example, the students wrongly identified the picture of a waterfall as a road, because these children belong to a water scarce area. These are just a few examples, but there are many like these, which bring to attention some very paramount questions-
- Is this the only approach we can use?
- Is it the most appropriate way to assess the students’ skills?
I don’t have concrete answers to these questions, but hopefully my field experiences will guide me in getting a clearer understanding of what really constitutes a reading evaluation.
This blog post is written by Divya Sharma, M&E officer @ READ Alliance.
*Photographs will be uploaded later due to technical problems.
Over the last few weeks the UCD for U5MR project has moved from working with secondary data in-studio, to kicking off a process of field inquiry. In the process, we have also decided to rebrand it as “Panch Paar”. Panch Paar in literal translation from hindi means- Crossing over five. The nomenclature apart from being catchy, also underlines the project’s focus on the first 5 year critical period.
The secondary research phase (http://tinyurl.com/qd5qtyn) helped us build a broad context and gave us a clear picture of the gaps in information we had and how those could be filled. Our approach deals with questions pointed towards unpacking knowledge, attitudes and practices that characterise the system beyond those that might have been captured from a clinical perspective. How is child care understood among communities in Bihar? What are the perceived relationships between Nutrition, Sanitation, Hygiene and Health? Who are the key players and influencers that may have a role to play in shaping these knowledge, attitudes and practices? Our field inquiry aimed to unpack these questions both from a household / community perspective, and from the perspective of service providers.
This initial phase of fieldwork, spanning 2 weeks was envisaged as a pilot through which field strategy and approach was to be refined. In collaboration with our design partners from M4ID, we framed a few objectives for the pilot listed below:
- Building and testing early concepts around vulnerability, and key peripheral themes: nutrition, sanitation & hygiene, child care.
- Conducting different types of research protocols with various user groups rather than covering ground and a large number of respondents
- Testing of various tools for research including questionnaires, visual tools and group activities
- Building a sense of familiarity with the field context and key stakeholders
- Start to identify and build relationships on field
This blog documents the preliminary reflection on how our learnings on field have informed our approach, and how it might evolve as field work resumes.
Pilot Field Work Overview
- Locations: Locations for the study were selected keeping in consideration their proximity (Some close and some far) to public health facilities and the socioeconomic conditions of the community. Fieldwork spanned over 12 days across three blocks in Samastipur district: Rosera, Dalsinghsarai and Bithan.
- Working groups: We would start early in the morning from our hotel aiming to spend between 3 to 6 hours on field depending on what kind of interactions were planned for the day and how far the villages were. At the village, we would distribute ourselves into teams and head out for our interactions.
- Regrouping and debriefs: We regroup later in the day and have a detailed debrief around the day’s findings and finalize the plan for the next day.
- 4 FGD’s- 2 Males + 2 Females (Households with cases of repeated illness)
- 8 Home ethnographies
- 9 Depth interviews- 7 FLW’s + 2 RMP’s
For our first day of fieldwork, the ASHA had arranged respondents for us for a group discussion. The idea was to conduct a focus group (FGD) and then follow up with home ethnographies of selected respondents. This approach did not work out well as FLW’s would typically recruit participants they are familiar with which resulted in cases of morbidity and mortality being inadequately represented.
We have now devised some recruitment strategies we will consider going forward. These are as follows:
- Self recruitment: While the FLW’s are invaluable in helping us make an entry into the village, from the point of view of observing vulnerability, it is more fruitful to identify and recruit relevant participants ourselves.
- Spot recruitment at vaccination days (VHSND): Gave us an opportunity to interact directly with the mothers coming in and also pre-screen them
- Village mapping: With the help of FLW’s we mapped the various communities living in the village and individual cases within these communities of morbidity and mortality. We will focus on such cases in the future.
Focus Group Discussions / Workshops
We envisaged FGDs as a way to capture community knowledge, attitudes and perceptions around four main themes: nutrition, sanitation & hygiene and care seeking. They were carried out through structured discussion guides paired with activities using visual tools that could help us probe deeper into the themes.
Learnings from our experience of conducting group discussions:
- Avoid a crowd: crowds become very difficult to manage. At times it’s better to park the car a little further away and walk to the location.
- Closed room FGD’s: Closed spaces like verandas reduce disturbances and help the moderator manage the group better
- Presence of FLW’s: Participant responses may be influenced by the presence of FLWs
- Improvise and conquer: It is easy to improvise a FGD as many people gathered around us. We have improvised many discussions with men groups that provided useful insights.
- Be alert to participants’ dynamics: in some cases the flow of the activities provoke certain types of responses and interactions. Researchers have to acknowledge that the setting of the activities influence the responses.
These interactions are long detailed conversations with participants inside their homes. They are loosely structured around defined areas of inquiry and last for about 2-3 hours each. There is a major visual element wherein the researcher takes a walk around the house recording artefacts and practices that explain their everyday life. We also drew floor plans of homes and marked routes and areas of utility and activity.
Learnings from our experience:
- Rapport building: Conducting home ethnographies with participants we have already informally interacted with is seen to be more suitable than conducting them with fresh participants due to increased familiarity.
- Distribution of roles: One researcher does most of the questioning and keeps the respondent(s) involved while the others capture visuals in and around the home.
- Guides are not set in stone: Researchers should take note of additional inquiry areas that emerge from the interaction (which go beyond the field guide) which helps us map the respondents life stories. These cues can also be incorporated for future interactions.
- Organic interactions: Walking around the house and questioning at the same time seems more organic to respondents and proved more informative than a seated interview like session.
- Visual ethnography: pictures and videos capture in the field tell a lot about nutrition and sanitation issues. It is important to capture the right material and devote time for the analysis of it. The person dedicated to visual ethnography looks at things different while going alone through the house and can come out with questions to formulate to the persons in the house.
- Certain topics are delicate: There is a need to build intimacy with the participants which requires space and time. Researchers have to ensure the environment in conducive for such an interaction (Male members/ neighbours etc. are not around). These topics can range from gender bias, financial constraints etc.
Interactions with Service Providers
These were structured in depth interviews with ASHA’s, AWW’s, ANM’s and RMP’s. Thorough visual documentation was carried out to capture all tools (charts, registers, forms and equipments) used by them to perform their roles. FLW’s also helped us to map villages and identify homes with cases of mortality, morbidity and good health for recruitment.
Learnings from our experience:
- Context building: After the first few interactions with FLWs we realised that we are often perceived as people who have come to test their knowledge and skills. The only way to overcome this, was to explain to them in detail the purpose of these interactions and our expectations.
- Appropriating their tools: We found that most FLWs maintained hand drawn maps of their villages. We used them to understand the distribution of household not only according to health status of children but also caste and economic status.
- Encouraging their involvement: FLWs seemed to enjoy doing this since it is highly interactive and gives them an opportunity to display what they know best; their village.
- Gaining their trust: if the team gain their trust, FLW might not follow in every household which allows for a more intimate conversation with the family.
Observation at Service Sites
We attended a FLW meeting conducted at a Health sub centre (HSC). This meeting is held once a month to review the work of all the ASHA’s and Anganwadi Workers in the panchayat (Village level governing body meetings). Through the meeting we understood the activities of FLWs and also identified areas they excel in as well as those where they face problems.
Projective exercises and visual templates were co-designed by Vihara and M4ID teams, keeping in mind the local context to ensure high engagement levels with the participants.
The pilot phase was a test run for these tools. Continuous iterations have helped us refine these tools and also in some cases, drop the ones which were not working out.
Projective tools are typically used to let participants respond to ambiguous stimuli to reveal hidden emotions and internal conflicts. We used them to capture deep seated perceptions around various actors and factors within the public health ecosystem. We planned to test 3 projectives with the objective to understand relatability and possible areas of optimization. They were as follows
- Animal associations
- Colour associations
- Nutrition cards
Some of the projectives worked very well, while some needed more contextualization. To ensure the participants understood the exercises, we started with a mock analogy of an unrelated category (using animal associations on various brands of motorcycles) at the beginning. The motorbikes worked well with the male participants. For females we were using cosmetics, detergents and other similar categories to build relatability.
Although the animal associations were relatively easy to grasp, it was not the same for colors. Since the interaction with colors is more abstract, it is difficult to map fixed attributes with them. The responses we garnered were relatively more ambiguous and not very conclusive. We are planning to drop it for now.
Visual Documentation templates
We had set out trying to understand a day in the life of the household by using a template of a large clock which could map the various activities in the household and the roles and responsibilities of each family member at different times of the day.
The clock template worked well as an instrument to record data in a systematic manner which can be repeatedly referred to during the course of our interaction. It provides a snapshot of what each family member is up to at various times of the day.
Another visual template that we created during the course of fieldwork is that of a floor plan. This is immensely useful in understanding the broad structure of the house and the logic behind different spaces. It also throws light on certain spaces that are perceived to be the highlight of the house and those that guests are discouraged from accessing.
With this field visit we embarked the primary research phase. It was an opportunity for us to better understand life in rural Bihar, pilot various approaches and research methodologies and test our visual tools and field guides. The visual tools supported collaborative research activities, some of them being more efficient than others. The field guides in general work well, but we needed to do some editions to make the narrative flow.
The experience has been enriching and we have a lot to take away from it to study further. We are planning the second phase of fieldwork in Samastipur and in Purnea from mid november onwards.
Research Summary of the paper, ‘Using Literacy Boost to Inform a Global, Household-Based Measure of Children’s Reading Skills’
The article, “Using Literacy Boost to Inform a Global, Household-Based Measure of Children’s Reading Skills” (Manuel Cardoso and Amy Jo Dowd) looks at UNICEF’s efforts at strengthening education data collection through household surveys with respect to children’s reading skills. In response to the Sustainable Development Goals’ (SDGs) call for a greater focus on inclusiveness, equity and quality in education, for which comparatively little data currently exists, UNICEF attempted to design an effective measure of learning outcomes in order to help monitor education-related SDGs.
Against this background, work began in 2014 on the development of a new measure to assess children’s reading skills. Consequently, UNICEF convened a technical advisory group composed of leading experts from various institutions (Pratham, Education for All Global Monitoring Report, Research Triangle Institute, Save the Children, South Methodist University and UNESCO Institute for Statistics) to provide technical advice and support towards the development of a methodology for capturing data on early reading skills among children aged 7–14 years as a new module of UNICEF’s Multiple Indicator Cluster Survey (MICS).
As a household survey, the MICS aims to capture learning outcomes for children in school, out-of-school and from primary and secondary level to assess the feasibility of the instrument in these different groups.
The technical advisory group studied the strengths and weaknesses of several options for a reading skill assessment that could be administered in a time frame of two minutes. On the basis of its findings, the group recommended measures along the lines of Save the Children’s Literacy Boost initiative. This resulted in a collaboration between UNICEF and Save the Children to investigate how well a streamlined version of the Literacy Boost practice can enable UNICEF to develop MICS for accurate measure of reading outcomes.
Save the Children’s Literacy Boost initiative aims to improve learning outcomes for primary-aged children in and out of school by focussing on 5 core reading skills: letter knowledge, phonemic awareness, vocabulary, reading fluency, and comprehension. Based on the secondary analysis of existing school-based assessments of reading at Grade 2 and 3 for Bangladesh, Burundi, India, Kenya, Lao People’s Democratic Republic (PDR), Philippines and Vietnam; taking into account the interview time constraints imposed by MICS and considerations regarding scoring in the field, UNICEF finalised 4 indicators for measuring reading abilities of children:
- Oral Reading Accuracy with a view to assess a child’s print decoding skills where a short story (60-70 words) is used to check a child’s oral reading accuracy (>= 90 % words correct).
Indicators 2 and 3 test Reading Comprehension abilities:
- Literal Comprehension tasks require a reader to recover information given in the passage
- Inferential Comprehension tests whether the child is able to connect facts in the text in order to answer questions
- Overall Indicator which calculates the percentage of children having achieved proficiency in all three tasks
Compared to Save the Children’s 8-10 question approach, the proposed MICS adopts a 2-3 question approach to identify, through the above-mentioned 4 indicator measure, whether a child is a reader with comprehension. The present study attempts to find out the level of agreement between the two approaches i.e., whether the results obtained from the proposed short MICS method is similar to the findings of the more elaborate Literacy Boost approach.
A comparison of the results of the two approaches, using the afore-mentioned multi-country data sets from the school-based assessments of reading at Grade 2 and 3, shows that an initially proposed 2-question (1 literal and 1 inferential) MICS method tends to overestimate the number of children identified as readers with comprehension. It was found that 81% of the children considered to be readers by ‘Save the Children’ approach were also identified this way by MICS. However, Save the Children’s more extensive measure could consider only 56% of those identified as readers by MICS 2-question approach as such. But when UNICEF re-designed the MICS to propose a 3-question approach (2 literal and 1 inferential questions) the level of agreement between the two approaches increased to a considerably satisfactory 75%. The overall results found a fair amount of consistency between the 3-question proposed MICS approach and its more extensive version, thereby making the streamlined approach acceptable.
Outlining the immediate next steps the researchers pointed to the need to develop general guidelines and specific tools to carry out pilot field testing of the proposed MICS measure in at least two countries; and following it up with evaluation studies for the same.
Read the full research paper here.
Dharam Singh, a young boy from Jodipai village (Kashipur Block, Rayagada district) of Odisha rose above his grim financial circumstances, overcame all odds and defied stereotypes to become a teacher.
Having studied in his local primary school up to 5th standard, Dharam wanted to get enrolled in a better and bigger school. However, his parents were ambivalent about the continuation of his studies as they wanted him to contribute towards the family income rather than waste his time studying.
“I knew that one day I will become a teacher. But studying was tough as I hardly understood the language they used in the classroom. My teachers never understood my tribal dialect either”, says Dharam. It wasn’t only Dharam who dropped out of school; there were many children like him, who left school due to language barrier, teacher shortage, and erratic school closures. Being a determined boy, Dharam persisted and finished his high school education from a school in Kashipur in 2004.
Due to his family’s dire financial condition, he had to take the practical decision of moving to Kerala as a migrant labourer. He worked there for four years, saved some money that he eventually used to support his family and his further education. He came back to Kashipur and completed his intermediate certificate course (+2).
A god send gift was an advertisement he came across in the newspaper for the post of a Shiksha Sathi for a Reading program run by Agragamee. The Creative Language Development Effort (CLDE) by Agragamee (supported by READ Alliance) is a collaboration for improving reading and language abilities in tribal districts of Odisha, where the community has no history of literacy or school education. The problem is compounded, as these first generation school goers receive little or no support for learning, either in the classroom or at home. This program is being run in about 20 Government primary schools across 3 tribal districts, through youth who are provided orientation, training and supportive Teaching, Language Material (TLM) to work as “Shiksha Sathies” or Support Teachers.
He missed no time to apply for this position, and was selected based on his outstanding performance in the written test. “I am so happy that I got this chance to impart education to children in their own language, as most of what is taught to them now, is beyond their comprehension. This moment is extra special, since I have struggled very hard to reach this point”, says a proud Dharam.
Dharam is a Shiksha Sathi in the same school where he started his education. He underwent rigorous training and capacity building to truly understand the various ways and techniques that can help students in his school to improve their reading abilities.
Since the day he joined the school, children have become very regular. Attendance rates have increased, there has been considerable improvement in children’s reading skills, and other teachers have become motivated. His family and villagers have high hopes from this determined young boy.
The smile on the faces of his students is testimony to his dedicated efforts of ensuring that not even a single child is left behind. Dharam Singh gives a knowing smile because he knows there are miles to go before his mission is accomplished.
Want to be a part of this transformational journey; don’t forget to write a line or two to us @ email@example.com.
Dr. Shailaja Menon’s area of research and teaching is Language and Literacy. Shailaja has worked for important national research centres in the United States, such as the Centre for the Improvement of Early Reading Achievement at the University of Michigan, and the Centre on Personnel Studies in Special Education at the University of Florida. Shailaja has her doctorate degree in language, literacy and learning disabilities from the University of Michigan, Ann Arbor, and degrees in human development and psychology from MSU, Baroda, and Delhi University, respectively.
Her main area of interests and focus are- How children learn to read and write in Indian languages; How teachers learn to teach literacy; Language and diversity in multilingual Higher Educational settings
READ Alliance recently got an opportunity to drop by the Azim Premji University campus to meet Shailaja Menon. Read excerpts from our conversation below-
You have done extensive research in this field of early literacy; can you share insights from the field and your years of research?
- At the outset, I want to clear that my research wasn’t interventionist; it was mapping the terrain because nobody in India has done a careful detailed and systematic mapping of these practices. Mine was a three year long project of ‘What is’ not ‘ what is actually happening’ to see if I can change it and make it better.
- It was a longitudinal study in Yadgir district (Karnataka) and Sonale district (Maharashtra). We went to government schools in both these districts and tracked 360 students twice a year to carry out detailed assessments of children’s foray into reading Marathi and Kannada. We weren’t looking for yes/no answers, but actually trying to understand where is the problem, what is the problem, what is going on etc., and we tracked the children’s progress on a variety of such indicators related to early literacy.
- This was one part of the project, the other part was classroom observations to know how are teachers transacting, their use of the curriculum, we did teacher interviews to understand teacher beliefs, teacher knowledge on early reading and literacy.
- Third part of the study deals with an analysis of the curriculum materials- Bal Bharti curriculum in Maharashtra and Nali Kali curriculum in Karnataka. We took marginalized children in each school and did a case study on how are these academically, socially marginalized children using this curriculum. Broadly this is the scope of the project.
- Some of the things we found out are things that people would already know, they would feel that, yes we know all of this, but it is the first time that it has been empirically tested in a research that is defensible.
- To talk about the first major point- Children are reading below expectations is not news for anyone, but in our exploration and examination of what is happening, we have found that particular aspects of the script in Kannada and Marathi use Alphasyllabic script (which for a common person is much easier to read and learn than English, we write exactly as we speak, pronunciation is simple, however, we use many more symbols in the Alphasyllabic script, we have ‘Matras’, we have ‘Samyukt Akshars’ and these are very challenging to read).
- We have over these three years documented children’s errors, and found that it takes far long for children to master even the ‘Mool akshars’ and the pace of our curriculum materials is not according to that. As per the curriculum, by first grade children should have learnt the ‘Mool Akshars’ and by sometime in the second grade they should have mastered the whole script- the ‘Matras’ ‘Samyukt Akshars’ among other things. By middle of second grade, children are given very complex passages. However, the reality is that well in to the third grade, children are still mastering these things. We stopped our study at the third grade, and I can very confidently tell you that children know ‘Mool Aksharas’ but there is so much confusion in ‘Matras’, ‘Jod Akshars’. To make matters worse, the curriculum material does not provide any revision practice. All of this is at the script level.
- We also found that there is a huge disconnect between the kind of logic of the curriculum and the worlds that these children come from. For example, the presentation of our materials has to be to teach the script, it doesn’t take the child’s oral language into account. They want to present words in the curriculum that have the least number of ‘Matras’ and ‘Samyukt Akshars’, because that’s the natural progression of teaching language to the children- you want to first teach ‘Mool Akshars’ then ‘Matras’ then ‘Samyukt Akshars’ and so on. So the curriculum uses easy words with no ‘Matras’ and ‘Samyukt Akshars’, but the language children use at home, i.e. their oral language is full of ‘Matras’ and ‘Samyukt Akshars’.
- There are many instances when the teachers teach the children to not use common words but rather uncommon yet simple words which have no relevance to their daily life. For example, children are taught to say ‘Gaj’ instead of ‘Haathi’, ‘Vaanar’ and not ‘Bandar’ as the kids have not been taught grammar till then. The words without ‘Matras’ and ‘Samyukt Akshars’ typically are sanskritized words which have no relation or resemblance to the everyday life.
- The child’s oral language, which is the richest resource they bring to language learning, is left at the door of the classroom. Instead these artificial words enter teaching script, which are strange and something a child can’t use to express themselves. There is no motivation for the child to wish to express themselves in this strange new system of learning symbols, there is no opportunity for the child to learn to communicate and express what is language, what is the aim of learning literacy, there is no relevance created in the child’s mind. The children are not made to understand why they are being taught what they are being taught, relevance and meaning is not established.
- Third thing which we found is that teachers use rote and repetition as a method of teaching and lack content specific knowledge and content specific pedagogy. Their teaching is guided by their own experience, and various researchers, who have given some new terminology like- constructivism, child-friendly, joyful, fearless. Between rote and repetition, which is from their experience, and these big terms, which sound very fancy; there is a whole gap on the knowledge required for a teacher to understand what language learning is, how literacy fits into early language learning and basically how to deal with different levels of children while incorporating the child’s background into teaching them.
- For example, if a child can’t read, the teacher only has one technique and that is- to make the child repeat till he or she can read fluently. They don’t have a repertoire of teaching pedagogy that comes with content knowledge to fall back on while teaching.
- Teachers believe that the aim of early literacy is script mastery, whereas there are many other aims and objectives of early literacy which are not being addressed. These include, establishing relevance of literacy, understanding what you read, reading and writing to communicate, to be able to critique, aesthetic engagement, all of these are missing as the focus is only on script mastery. But script mastery is also something they are failing at.
According to you, what the major bottlenecks in the Indian primary education sector?
- Teacher knowledge- it is not sufficient to give teacher general pedagogical tools without giving them a deeper and more meaningful understanding of literacy. Teachers just don’t need to be told- ‘Make your classrooms and teaching child-friendly’, instead they have to be taught and explained- what does it mean to be child-friendly, what is the meaning of constructivism in early language learning?
- Let me given an example- for teachers’ constructivism is using cards and fancy textbooks for teaching. While observing classrooms and Maharashtra, we found that 7-8 year old children are taught language by using index cards on child marriage which are written at college level. The children just couldn’t grasp anything through these cards, however, for the teacher; he/she had used a constructivist approach to teaching.
- While analyzing innovative curriculum, we found that mostly the logic used in these curriculums is based on script acquisition, it doesn’t go beyond. Our understanding of Indian script and the tendency to dismiss it as very easily acquirable is a bottleneck.
How do we overcome this? How do we ensure that there is sufficient teacher knowledge, so that maximum learning happens?
- I think there is a lack of awareness in early literacy, even amongst educators. If you read the latest draft of the National Education Policy, you will be shocked to find that the word ‘Literacy’ is used in the context of adult literacy or preschool programs, but even then it may not necessarily be called literacy. Early grade literacy is not understood, literacy is only seen as making our illiterate population literate by teaching them how to sign their names. To understand what literacy is, how it is foundational to school learning, to create awareness even among educators, NGOs, practitioners is an uphill battle.
- Articulating, networking, advocacy, creating visibility, linking it with already known concepts so that people don’t see this as an abstract but something more relatable can be done at one level to create awareness on literacy.
- That’s on one level, but there is no escaping teaching education. Efforts need to be made to make our teachers more effective, this can be done using technology as an aid but not as a replacement of teachers. Technology is nothing without someone to guide it, and to what extent is literacy being acquired in teacher less classrooms, how are children being taught critical thinking skills, how are we establishing the relevance of what the child is learning.
- There are no teacher education programs in our literacy courses; teachers are taught language learning theories, which explain how children learn. Something that is not very important as children join schools with oral language skills. How children learn language is not going to teach the teacher how to teach language in class. Creating courses which focus on teaching language and making these courses widely available is the need of the hour. Putting these courses in D.Ed and B.Ed curriculum are some ways to make our teachers better equipped to teach language in classrooms.
Reading is a habit, how do you think this habit can be inculcated amongst our teachers, children and other stakeholders in the early reading sector?
- Are we reading ourselves? Children can’t be socialized into practices that are not a part of the community. So if the community is not a community of readers, so from where will this child develop the habit of reading? Do our teachers have this habit? When we ourselves are not readers, what right do we have to ask our children to become readers? Children grow up in cultures, if the culture doesn’t seem to value reading as a habit, then children are not going to read.
- One of the things I have been trying to do is to get teachers to become readers. Let me tell you, it is not a quick-fix solution; I have to work intensively with a group of teachers, bring them together for professional development workshops. So it is a long journey which is sustained, slow yet intensive.
- If reading has not made a difference in my life, in what way can I expect it to make a difference in the lives of the children in my class? We have to genuinely realize the power of reading in our life. A good way is to bring teachers together, read short stories, discuss it from different angles, and then there may be instances when you would have that ‘Aha’ moment where a story connects with you. That’s when you will have no trouble passing this habit on to your students or other children.
- I always tell me students, if at any given day you aren’t able to pull out a book from your bag and discuss it in detail, you aren’t a reader. Become a reader yourself, before you try to inculcate this habit in your children.
This blog explores the understanding of ‘Under 5 Mortality’ (U5M) and risk factors present in Bihar. In-depth interviews were conducted with three pediatricians in Patna; two of them are retired government doctors currently practicing in their private clinics running out of their residence, and the other is a medical professor at a government medical institute in Patna who also runs a private clinic. All three pediatricians were interviewed in their private premises.
An expert guideline was prepared for these interviews, it was an open ended questionnaire aimed to capture perceptions of vulnerability and understand risk factors that perpetuate vulnerability. It further explored the challenges existing in Bihar in terms of providing adequate health services to beneficiaries.
Risk factors that come together to make children vulnerable in Bihar
- Bihar is one of the most vulnerable states in India for mothers and children. Children in Bihar are suffering from treatable diseases. Cultural and socio-economic barrier are much more evident in Bihar as compared to other states.
- Poor sanitation practices, impure drinking water and extreme weather conditions contribute to many infectious water borne diseases.
- Children mostly suffer from infectious diseases that affect the lungs (pneumonia), Brain (meningitis) and cause diarrhea. The lack of basic sanitation facilities and poor hygienic practices could be the causes of these diseases.
- Availability of proper drinking water and appropriate nutrition within a poor family is a challenge.
Dr. Kumar, who practiced in Begusarai district for a decade stated that
“ Hygienic practices are lacking in Bihar, uneducated families do not understand the importance of hygiene and proper sanitation. Open defecation is a common sight in villages and even in slums of Patna. Families that do have toilet do not use them on regular basis. There is no proper mechanism for discarding the leach pit toilets, open drains which run inside the houses are very harmful, they are water stagnation points and result in mosquito breeding”.
- Poor child care practices and lack of education among mothers plays a crucial role in making a child vulnerable.
Dr. Aggarwal, who is a medical professor stated that
“Mothers in poor families are uneducated, they all practice breast feeding but not exclusively. This results in exposure to infections. Mothers who work as daily wage workers, and have more than two children prefer feeding packaged or cow milk over breastfeeding. Elder siblings who themselves have not reached teenage are compelled to look after the youngest child of the family. Imagine the type of care a child receives, left to play in unhygienic conditions”.
- Improper complementary feeding and poor nutritional practices are prevalent among families in Bihar.
Dr. Nigam talked about the poor nutritional practices followed among families and how it impacts the health of a child.
“In Bihar, malnutrition is very commonly seen among children, they have weak bones, poor height to weight ratio and are prone to illnesses. It is more prevalent among females because they are neglected and not properly cared for. Female children are not adequately fed as compared to male children. Children mostly suffer from malnutrition in poor families that can just about afford two meals a day. They do not receive adequate nutrition and are susceptible to infection since their environmental surroundings are contaminated with human feces, stagnant water etc.” He further added that “once a child is suffering from a combination of malnutrition and infections, he/she is more prone to morbidity and mortality”
Clinical signs of vulnerability
“A child who is Malnourished is a child who is vulnerable” Said Dr. Aggarwal. Malnutrition is the underlying cause of all illnesses prevalent in children. Pneumonia, diarrhea, chikunguniya, malaria, typhoid etc are all opportunistic infections. When a child has a poor immune system, repeated biological insults further deteriorate his/her condition. A child who falls in the growth faltering curve of the Glasgow scale (WHO growth monitoring scale) needs immediate attention. Other dangerous signs that can be observed by a layman are:
· Child is lethargic, dull and not playful and is not taking appropriate feed
· Child has seeked medical help thrice over the last three months due to illnesses
· Presence of persistent diarrhea for more than 20 days in a child
· A poor household that is unable to provide an adequate number of meals in a day
· Fast breathing, child gets tired easily and suffers from continuous cough and cold
Cultural and social barriers influencing health seeking behavior
- Despite vaccination schedule recommended by the government which is available free of cost at government hospitals, acceptance of vaccination is poor amongst the community.
“When it comes to vaccination, Muslim families are not willing to bring their children, they have been misguided by their religious leaders that vaccinations are a mode of controlling fertility status of Muslim population” said Dr. Nigam.
Another quote from Dr. Kumar on religious barrier influencing health seeking behavior,“Yes, there are religious and cultural beliefs but enhanced parental education will help us overcome these lacunae”. He further added that “More than cultural beliefs it is the pain during vaccination or a minor illness after it, even among the educated, which delays or prevents them from coming back for the next dose”.
Dr. Aggarwal said, “The introduction of vaccines has reduced the incidence of diseases but the numbers of children who have received all the vaccines are a small population of them.” “The government of India allocates funds specifically to maternal and child health and more of it would be appreciated.” “Vaccines for Polio, Tuberculosis, Diphtheria, Pertussis tetanus, Hepatitis B, Measles and meningitis are mandatory and supplied free of cost to all children in the country. The coverage varies between each state and region in the country with an average of 60%.”
Other Challenges faced by medical practitioners
- There is a large presence of unqualified medical practitioners in rural parts of Bihar, who are unfamiliar with relatively simple life-saving medications, and prescribe antibiotics and other potentially harmful drugs.
- Rural public health facilities across the state are having a difficult time attracting trained medical professionals. One of the retired government doctors spoke about ‘jungle raj’ i.e. times of poor politics, jeopardized legal system and no safety & security in the state. He said “During our early practicing days doctors were threatened to pay ransom to political parties, and if failed to do so family members were kidnapped and tortured”. Such violent situations have resulted in higher migration of qualified professionals from Bihar to other parts of the country and world.
- In addition to the shortage of doctors, the system is plagued by poor involvement and participation of those who are employed. There have been several instances of pregnant women being treated by nurses and ward boys, who have very little or no knowledge of handling deliveries.
“Rural health facilities are poorly equipped, with no regular supplies and with high patient load . To work in such difficult conditions one needs a lot of patience and motivation”said Dr. Nigam, “Until and unless the government does not spend adequately in rural health infrastructure and manpower, things will not improve.” “Asking well-qualified doctors to work in such a system not only doesn’t cause any significant improvement in people’s health, but also wastes doctors’ education and skills”. Said Dr. Aggarwal.
- The Central and State governments make little investments in rural health systems and there are regular stock-outs of medicines, to add to already inadequate infrastructure.
Our interaction with pediatricians raises certain imperative questions which we need to address through our primary research. It is important to gain understanding of how risk factors manifest in Bihar and to explore areas of opportunities for saving children from vulnerability. How social and cultural factors are contributing towards vulnerability? What can be done to address the social evils existing in society? Where and what kind of interventions need to be designed and implemented? It is also necessary to understand the challenges faced by qualified providers and in what capacity they can be resolved?
Mrs Sarala frequently tells her students that “it doesn’t matter where you start in life, it matters where you finish.” Her own school serves as an ideal example. Once a school with dangerously low enrolment levels, Puzhal Panchayat Union Middle School (PUMS) was awarded the ‘best school’ by the District Collector during the Republic Day celebrations in 2014.
This school is located in Puzhal, a small town in Tiruvallur District of Tamil Nadu.
The problems facing PUMS mirror those facing many other schools in the country—things like poverty, unstable home lives, language barriers, and poor quality of teaching and infrastructure. Most parents in this area are construction workers, and daily labourers. Since the parents are not literate and don’t attach high value to education, the children often drop out of school.
To address attendance, and other needs intrinsic to the students’ environment, the Jain community in Puzhal stepped in. They decided to take matters in their hands, they have over the years, been instrumental in supplementing the schools with infrastructure, financial, and in-kind support.
It was indeed a proud moment for the school and the Jain community when their combined efforts were recognized and the school was selected to be among the 90 schools where the READ Alliance funded Karadi Path ‘Joyful Reading’ project would be implemented. Karadi Path methodology is an indigenously developed language learning process that is revolutionizing the way language proficiency is achieved in schools.
Recognising the need to go beyond supplementing the school with just infrastructure, the Jain trust decided to employ two full time teachers who would provide support to the existing staff to run daily classes and the ‘Joyful Reading’ project. The Jain trust has hired Mrs Shobhana and Aslin Mary from the local community on an honorarium. These teachers have been a great support to the trained Karadi Path teachers in leading the Joyful Reading classes.
A lot of government school teachers are burdened with extra government duties apart from teaching. Some also go on long leaves, leaving the school in utter chaos. But now, the situation has changed for the better. You will hardly find students loitering around in the corridors, enrolment has improved considerably, and dropouts reduced. But this change wasn’t sudden, it has been a consistent and slow change brought on by the tremendous support of the Jain community trust.
It’s not just the members of the trust who provide support, but also the housewives from this community, who prepare colourful and pretty uniforms for the children of this school. “It is the best kind of public-private partnership, where the community has taken ownership of improving the education levels of their own. Puzhal Panchayath union has also recognized this school as a Showcase/model school”, says Arockia Selvaraj, Sr. Trainer and Product Specialist, Karadi Path.
Teachers and the community also feel that they have more of a stake in the school and more opportunities to contribute. All of the teachers had long been asking what they could do for the kids outside of the regular classroom. With the ‘Joyful Reading’ program, there are more opportunities to make change. The core methodology of a ‘Joyful Reading’ class is based on the idea of learning English in the same manner the mother tongue is learnt. This natural language acquisition process has boosted the confidence of the teachers and they view the Karadi Path classes as a springboard to upgrade their level of English. When educators are no longer burdened by making sure their students’ basic needs are met, they are free to enrich their lives in other ways.
Since it is a project which is whole-heartedly supported by the community, there is greater awareness and acceptance amongst the parents as well. In fact a lot of parents whose wards aren’t enrolled in school have made extensive enquiries about the ‘Joyful Reading’ program and have shown interest in getting their children enrolled in the school.
“It’s not one person or one program that demonstrates such success, it’s a collective goal. It’s about everybody coming together inside and outside of the school. That’s what makes a strong community”, says Mrs Sarala, Head Mistress, PUMS. The teachers aim to create joyful learners who can read, communicate and dream big.
The scale of ‘Under 5 Mortality’ (U5M) in Bihar is huge: 58 deaths for every 1000 live births, nearly 45 percent of all under five children are underweight and 49 percent of them are stunted. The disturbing figures of U5M may reflect the poor state of human development indicators but the numbers don’t tell the whole story. The UCDU5M project is funded by the Bill and Melinda Gates Foundation and is being pursued by Vihara Innovation Network (us). It is approaching the problem of child mortality through User Centered Design wherein it aims to identify challenges and create solutions by Interacting with the rural populace; understanding their perspective of the health system and observing behaviours and interactions within the given environment. It has three phases i.e.
- Building an understanding of vulnerability for children in Bihar
- Identifying opportunities and design interventions,
- field testing and prototyping interventions to ensure scalability.
The first phase which is primarily dedicated to knowledge building is currently in progress.
After two workshops framed around the question of “vulnerability” to develop a framework to systematically understand the word in context of children in Bihar, about a month spent on reviewing literature and after long exhaustive sessions of brainstorming with our partners M4ID (all the way from Helsinki!)- we came up with some tools that would help us identify the underlying problems and causes. These were refined to a set of four intensive activities that would comprise the third workshop.
These activities were built around some pertinent question that emerged from the previous workshop; How does risk manifest in Bihar? What Environmental, Systemic and Cultural factors perpetuate vulnerability and how? How do people make decisions around care seeking? What are the markers of health and vulnerability? The activities were designed such that they would allow the transfer of knowledge from our health partners CARE in Bihar without requiring us to analysis hoards of data that they have collected on field.
We arrived at Patna, on the damp rainy afternoon of 6th September, with templates of the activities and a list of prospective participants but with everyone’s busy schedules it would be impossible to sit all of them down at the same time and place. We soon realised that we would have to conduct the activities with smaller groups.
The first round of the workshop happened at the Vihara office in Patna with three enthusiastic participants from CARE; a State Programme Manager and two of his District Officers.We started off at 11:00 am after brief introductions and casual chit chat over tea.
Activity 1- Distribution of Mortality and Risk
The objective of the first activity was to understand the distribution of mortality through different stages of life up till 5 years of age and to identify the risk factors (mostly clinical) that surface at each stage as well as to recognize the preventable and non-preventable ones among them. For this purpose we provided the participants with a graph that contained one axis for the timeline of upto 5 years against the other one a mortality scale. We then asked them to draw “a mortality curve” on this graph which we had thought they would create off the top off their heads but wait! Our participant, apart from possessing immense knowledge and experience from field, were men of facts and numbers. They pulled out their laptops, opened a gazillion excel sheets and started marking points on the graph. After a jarringly long 20 mins we had a spot on, accurate mortality curve.
Our literature review showed that in Bihar mortality load is highest in the first twenty eight days of life. A child who is born preterm with low birth weight is more susceptible to infections and diseases like pneumonia and neonatal sepsis. The curve that was the product of this activity consolidated that and more.
After this the participants had to list out risk factors that perpetuate mortality at different stages of the curve. The results that emerged from this exercise seemed to be somewhat synchronized with what we had gathered during literature review, while at the same time adding to it a lot more detail. However, at the same time it also failed to address certain themes from the literature all together.
We were able to create a table that contained the risk factors we identified from the literature segregated into 5 categories of risk; Clinical signs, Maternal health history, Child case history, Familial context markers and Socio-demographic markers. This table was not presented to the participants during the activity but we drew a comparison after they were done listing out risk factors under each stage. Most of the factors from the activity matched those on the clinical signs category of our table. Apart from these a few matched those under the socio-demographic category. However factors emerging from maternal health history and familial context were largely left untouched. The participants showed an inclination to discuss clinical and socio-demographic factors owing to the evidential knowledge they have developed at their field of work.
Activity 2- Routes of risk
The second activity was designed to form an understanding of how risk manifests in Bihar. We had created four scenarios of children succumbing to mortality and/or stepping into morbidity. The age of the children along with some details of their symptomatology was provided to the participants.They were each asked to map out the journeys of at least two of the four cases by adding details of the child’s socio-economic, cultural and familial background and build on maternal history, delivery and birth, interactions with the health system etc. These journeys were to be created on the basis of their experiences and common observations on field.
About an hour later we had seven elaborate journeys in front of us. Each journey was unique in its own sense but they also shared common strains. For example, the first case provided was…
“A boy child who died at 8 months of age. His clinical symptoms started 72 hours before the time of death. He suffered from very high fever, hiccups and his chest was drawn inwards.”
For this case the following inputs were made to this journey by all three participants individually.
- Delivery was at a PHC but mother and child left the facility within a few hours.
- Mother was anaemic
- No sanitation in household
- Water source: low bore handpump
- OBC family
- Family ignored initial symptoms
- First point of care seeking: RMP (Rural Medical Practitioner)
- Repeated treatment from RMPs
- Delay in care seeking from qualified doctor
- Referred to PHC (Public Health Center) from RMP as severity increased
- Referred to DH(District Hospital) from PHC
- Child was either not taken to DH or taken back home from DH within 24 hours
- Death occurred at home.
These patterns had also emerged during our analysis of the latest NFHS data where we were looking for indicators of risk at community level. We hope that as we continue to conduct this activity with more participants these common routes of risk will become clearer and stronger.
Activity 3 – Care Seeking Pathways
The third activity intended to uncover the practices of rural beneficiaries and the decision making involved that explains their behaviour. This required the participants to collectively add to a list of “actors” that are the people that make (or influence) decisions related to child health care and “factors” that are situations and conditions that in turn affect the decision making. We had provided them with 15 green cards with actors and 8 blue cards with factors (based on secondary research and observations from previous field visits) and some blanks in both colours for them to create various other actors and factors.
One new actor card, three new factor cards were created. They started by mapping the decision making involved in a case where a child survives. It pointed out the strongest actors in the process and the predominant factors affecting decisions also became clear here (some of them were from the set of new cards). Factors like money, transport and distance play a huge role in decision making and some of them have been addressed and worked on by the government (for example 102 ambulance service).
However, when we wanted to move on to cases where the child succumbs to death or slides into morbidity the participants hesitated. They expressed that the ideal route of decision making that saves a life is simpler to understand but the ones that fail to save lives are extremely varied and that it wouldn’t be fair to generalise. Men of facts and numbers like we said earlier! However they offered to share verbal autopsies from the field that we could use to complete the activity.
Activity 4 – Health System Mapping
The fourth activity was designed to understand the health ecosystem through a mapping exercise, particularly to gather knowledge around the interplay and individual characterization of the public and private health systems. This group activity began with the participants mapping out the layers of the public and private systems using a bottom-up approach, from the village level to the state level, including their complex interactions at various stages. The participants were able to thoroughly explain and traverse around the systemic structures of Bihar’s complex health ecosystem.
As an extension to this activity, we had also created a template depicting the SWOT Analysis for the public and private systems. Based on their knowledge and experience, the participants were able to identify the strengths, weaknesses, opportunities and threats in both the systems (public and private). The activities provided meaningful outcomes as all participants contributed willinging to provide a better understanding of the health ecosystem in Bihar. The strengths and weaknesses of the health system stimulated conversations on how the public and private system is perceived by the participants in particular, and the community in general. Brainstorming on opportunities and threats opened possibilities of new interventions and triggered ideas around the existing interventions in the ecosystem.
The results of this workshop with CARE participants resonated with the direction we are pursuing and added perspective to it. Numerous research questions had emerged from the literature review and previous workshops which were continuously addressed through these activities. While some hypotheses were validated, others are being explored as we continue doing these activities with various other participants from CARE and Abt Associates. Every day our minds are buzzing with new questions to explore more innovative ways to examine this problem!
This workshop helped us go beyond the facts and the figures- it helped us to tap into that which is sometimes of even more value- the instinct of these experts. These practitioners who have been on the field for years, they’re instinct is rooted in experience which is indispensable. The new knowledge that was gathered during this workshop was an explicit byproduct of the ‘facts and figures’ that backed the outcomes of most exercises. May it be the mortality curve, the personas or the hesitation behind elaborating on the care-seeking pathways in cases of morbidity and mortality. In addition, this knowledge will enable us to better understand CARE’s existing data and identify possible opportunities of interventions.
As we attempt these activities with different group of experts, the outcomes will change pertaining to their knowledge, experience and expertise. It is interesting to see the similarities in our data with that of the traditional learnings. Despite the slight differences, the nuances, the gaps, there also exists an underlying understanding of vulnerability, of children under 5, in Bihar. We believe this common knowledge around vulnerability holds scope for exploration and consolidation. Let’s see if we can draw an evident pattern based on our future learnings.
The members from the Vihara Team who conducted the workshop, co-created this blog and are still analyzing and collating outcomes are Bhavya Joshi, Nida Yamin and myself.