Formative Research for Assessing Exposure and Effectiveness of - - PowerPoint PPT Presentation

Formative Research for Assessing Exposure and Effectiveness of IEC/SBCC Interventions Implemented by IEM Unit of DGFP

Study Conducted by Department of Population Sciences University of Dhaka, Dhaka-1000 Dissemination Seminar of the Study Findings

• n

29 August 2018, Venue: Multipurpose Hall, BIAM Foundation

Presentation Outline

• Background
• Methodology
• Findings
• Exposure of Different Communication Channels
• Effectiveness of the Communication Channels
• Cost-Benefit Analysis of the IEC Activities
• Policy Recommendations

• Bangladesh has achieved considerable progress in reducing fertility through

increasing contraceptive prevalence, and reducing maternal and child mortality.

• Still there are many areas of family planning, maternal and child health where

greater attention is needed to achieve the various targets set in the 4th HPNSDP:

• To increase CPR to 75% (62.4/2014)
• To increase the contribution of LARC in CPR to 20% (8/2014)
• To reduce TFR to 2 per woman (2.3/2014)
• To increase ANC (at least 4 visits) to 50% (31.2/2014)
• To increase delivery by SBA to 65% (42.1/2014)
• To reduce NMR to 18 per thousand (28/2014)
• To reduce U5MR to 34 per thousand (against 46/2014)
• To reduce MMR to 121 per one hundred thousand (176/2015)
• However, achieving these targets are very challenging due to various sociocultural

factors existed in our society.

Background

• Information,

education and communication (IEC) programs are being implemented to address these sociocultural issues as IEC aims to increase awareness, change attitudes and bring about a change in specific behaviours.

• IEC means sharing information and ideas in a way that is culturally sensitive and

acceptable to the community, using appropriate channels, messages and methods.

• In the area of family planning, IEC can help us in the following way:

(a) creating public awareness about the need for family planning; (b) increasing knowledge about the use and risks of family planning methods, or where to obtain contraceptives; and (c)motivating couples and individuals to use family planning services.

• There was time until when it has been proven that IEC programs have played

pivotal role in achieving the health and family planning related targets along with continuous political commitment, innovative program approaches, and commitment of the field-level functionaries.

Background (contd.)

• There is a growing understanding that behaviors are grounded in a particular

socio-ecological context and change usually requires support from multiple levels

• f influence which has resulted in an expansion of the communication approach

to become Social and Behavior Change Communication (SBCC).

• The GoB has adopted a comprehensive SBCC Strategy in 2016.
• SBCC for health and family planning is a research-based, consultative process that

uses communication to promote and facilitate behavior change and support the requisite social change for the purpose of improving outcomes.

• SBCC is guided by a comprehensive ecological theory that incorporates both

individual level change and change at broader environmental and structural levels.

• SBCC works at one or more levels: the behavior or action of an individual,

collective actions taken by groups, social and cultural structures, and the enabling environment.

• SBCC programs include a wide range of interventions that fall into three broad

categories: mass media, interpersonal communication, and community mobilization

Background (contd.)

Trends of IEC/SBCC Exposure (BDHS)

46.5 42.2 41.5 44.4 38.4 32.8 30 42.1 36.3 24.9 24.3 12.5 2.9 1.4 40.1 32.8 19.7 14.1 19.6 13.7 18.8 17.2 19.9 28.7 33.8 31 24.4 19.2 9.4 5.5 6.4 8.1 9.9 5.5 4.9 5.9 3.1 2 1.2 3.4 5.3 5.1 4.6 3.6 3 2.9 5 10 15 20 25 30 35 40 45 50 1993-94 1996-97 1999-2000 2004 2007 2011 2014 Percentage of Respondents At least one FP message Radio Visits by FP workers Television Billboard/Poster Community Event Newspaper/Magazines

• This formative research aimed to provide a comprehensive understanding on the

exposure and effectiveness of SBCC interventions through exploring the causes and potential remedies of relatively lower exposure of SBCC interventions among people.

• However, the specific objectives of this formative research are:
• To revisit and identify what SBCC interventions including channels/medium did

work well and what did not, and why?

• To carry out cost-benefit analysis revealing to what extent the SBCC interventions

contribute to increasing CPR and lowering TFR.

Objectives of the Formative Research

• Formative research is such kind of research which is used as the basis for

developing effective strategies, including communication channels, for influencing behavior change. It helps researchers identify and understand the characteristics - interests, behaviors and needs - of target populations that influence their decisions and actions. Formative research is integral in developing programs as well as improving existing and ongoing programs.

• Formative research is research that occurs before a program is designed and

implemented, or while a program is being implemented to help “form” or modify a program.

• Formative research should be an integral part of developing programs or

adapting programs, and should be used to help refine and improve program activities.

What is Formative Research?

• A cross-sectional research design with mixed methods approach was used in this

study.

• Both primary and secondary data were used.
• Both qualitative and quantitative data has been collected as part of primary data.
• The secondary data has been collected from the Bangladesh Demographic and

Health Surveys (BDHS).

• The cost related to SBCC activities has been collected from the relevant OP

documents for cost-benefit analysis.

Methodology: Study Design & Data Sources

Methodology: Study Area

Division Category District Upazilla Union Sylhet Rural Habiganj Madhabpur Adair, Bahara Urban Moulvibazar Sadar Ward No. 1, 7 Slum Sylhet City Corporation Ward No. 10, 21 HTR Sunamganj Derai Karimpur, Rajanagar Khulna Rural Jhenidah Kaliganj Bara Bazar, Niamatpur Urban Jessore Sadar Ward No. 2, 5 Slum Khulna City Corporation Ward No. 21, 24 HTR Bagerhat Sharonkhola Dhansagar, Royenda Brahmanbaria Rural Sarail Noagaon, Shahbazpur Urban Sadar Ward No 3, 7 HTR Nabinagar Sreerampur, Paschim Nabinagar

• The quantitative data has been collected from newlywed women or women with
• ne or more children aged 15-24 years and their husbands through face-to-face

interview using structured questionnaire.

• Focus Group Discussion was conducted among the newlywed women or women

with one or more children aged 15-24 years; husbands of the newlywed women

• r women with one or more children aged 15-24 years; adolescent girls aged 13-

19 years; and adolescent boys aged 13-19 years.

• In-depth interviews were conducted among:
• program managers (divisional director, deputy director-FP, UFPO & MO-MCH-FP);
• service providers (FWVs, FPI, and FWA);
• elected representatives (UP Chairman, and women members);
• community and religious leaders; and
• school and madrasah teachers.
• KIIs were conducted at national level among policy makers, development

partners working in HPN sector, media people, and NGO representatives.

Methodology: Study Population & Methods for Data Collection

• 𝑜 = (1.96)2× 𝑞 1−𝑞 ×(𝑒𝑓𝑔𝑔)

𝑓2 ×𝑠𝑠

• n= total sample size
• p= the proportion of women who are exposed to any SBCC related activities in

the last month (p=0.30)

• e2 = Margin of error (.05)
• rr = Response rate (95%)
• deff= Design effect (1.75)
• Total sample 594

Methodology: Sample Size

Methodology: Distribution of Sample Size for Quantitative Study

Division Category District Upazilla Sample Size Wife Husband Total Division Sylhet Rural Habiganj Madhabpur 100 50 150 600 Urban Moulvibazar Sadar 100 50 150 Slum Sylhet City Corporation 100 50 150 HTR Sunamganj Derai 100 50 150 Khulna Rural Jhenidah Kaliganj 100 50 150 600 Urban Jessore Sadar 100 50 150 Slum Khulna City Corporation 100 50 150 HTR Bagerhat Sharonkhola 100 50 150 Brahmanbaria Rural Sarail 100 50 150 450 Urban Sadar 100 50 150 HTR Nabinagar 100 50 150 Total 1100 550 1650

Methodology: Distribution of Sample Size for Qualitative Study

Division/District District/Upazila Type of Study Area KII FGD Khulna Bagerhat Hard to reach 9 5 Khulna Slum 4 2 Jhenaidah Rural 11 4 Jessore Urban 9 4 Brahmanbaria Nabinagar Hard to reach 8 3 Sarail Rural 15 5 Brahmanbaria Sadar Urban 17 6 Sylhet Moulovibazar Urban 7 2 Sunamgonj Hard to reach 14 4 Habiganj Rural 12 4 Sylhet Slum 10 3 Total 116 42

• The data entry process of the quantitative data started soon after collecting the

data.

• Quantitative data were entered by using CSPro program and analysed by using

SPSS version 21.

• Descriptive statistics have been used to analyze the quantitative data.
• Qualitative data were in audio-taped.
• Audio-taped were transcribed.
• Thematic analysis have been performed for qualitative data analysis.
• Data have been presented in the context of study area: urban, rural, slum and

hard-to-reach areas

Methodology: Data Entry, Data Processing, and Data Analysis

Findings

94 93 91 96 94 89 96 99 100 63 89 73 49 75 62 30 53 44 8 1 2 55 18 11 2 9 6 1 4 5 1 2 3 1 2 4 Rural (N=450) Urban (N=450) Slum (N=300) Hard to Reach (N=450) Total (N=1650) BDHS 2014 (N=17863) Mobile phone Electricity Television Solar panel Computer/Laptop Radio/Betar

Household Possessions of the Respondents

Exposure to BTV and FP Related Messages through BTV

99 99 99 97 99 57 66 58 58 60 46 50 44 42 46 9 8 13 7 9 8 6 10 7 7 2 2 4 1 2 5 2 5 4 4 Rural Urban Slum Hard to Reach Total Ever watched BTV Heard that FP program is broadcasted by BTV Have ever watched any FP program broadcasted by BTV Have watched FP program broadcasted by BTV within last 30 days Know 'Shukhi Paribar' as FP program broadcasted by BTV within 30 days Know exact broadcasting day of 'Shukhi Paribar' Know exact broadcasting time of 'Shukhi Paribar'

Differential Distribution of Watching FP Programs in BTV in Last 30 Days

6 15 9 8 13 7 5 7 15 5 8 10 11 11 9 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to Private TV Channel in Last 30 days

48 56 48 23 43 36 46 38 14 33 12 14 14 8 12 7 10 15 8 10 12 12 10 3 9 8 8 14 5 8 7 13 10 3 8 8 11 6 6 8 6 7 11 5 7 5 4 11 2 5 3 6 9 2 4 3 3 2 2 3 2 4 2 1 3 Rural Urban Slum Hard to Reach Total Star Jalsa Jee Bangla (ZEE) Jalsa Movie ATN Bangla Sony 8 Samay TV Channel I NTV RTV ATN News Sony Max Ten Sports Star Plus

Distribution of Respondents by Their Daily Mostly Watched Private TV (National & International) Channels (First Choice)

38 40 31 18 32 6 7 12 3 6 3 6 6 4 2 3 6 3 3 2 3 2 3 3 2 3 1 2 2 3 2 1 2 2 1 2 2 1 2 Rural Urban Slum Hard to Reach Total Star Jalsa Star Plus Duranta TV Islamic TV SA TV Channel 24 My TV Banglavision

Distribution of Respondents by Their Daily Mostly Watched Private TV (National & International) Channels (Second Choice)

25 29 21 8 21 6 9 11 4 7 5 4 4 4 4 4 4 1 2 3 2 3 3 2 2 2 3 3 1 2 2 3 3 2 2 4 2 2 2 1 4 1 2 1 2 2 2 2 Rural Urban Slum Hard to Reach Total Jee Bangla (ZEE) Star Jalsa Jalsa Movie NTV ATN Bangla Sony 8 Samay TV RTV ATN News Channel I

Distribution of Respondents by Their Daily Mostly Watched Private TV (National & International) Channels (Third Choice)

7 4 4 1 4 3 3 2 2 3 1 3 4 2 2 2 4 2 1 2 1 1 4 1 2 Rural Urban Slum Hard to Reach Total Sony 8 Jee Bangla (ZEE) Star Jalsa Jalsa Movie ATN Bangla

Exposure to FP Related Messages through Private TV Channel

5 14 19 7 11 2 7 8 2 4 Rural Urban Slum Hard to Reach Total Have ever watched any FP program broadcasted by Private TV Have watched any FP program rbroadcasted in Private TV in last 30 days

Distribution of Private TV Channels where Respondents Have Watched FP Programs in Last 30 Days

0.2 1.6 1.3 0.4 0.8 0.2 0.9 2.3 0.2 0.8 0.2 2.0 1.0 0.8 0.2 1.6 0.3 0.5 Rural Urban Slum Hard to Reach Total Channel I ATN Bangla Jamuna TV RTV

Differential Distribution of Watching FP Related Programs in Private TV in Last 30 Days

1 10 2 7 8 2 2 10 1 2 5 7 7 4 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to Bangladesh Betar and FP Related Messages through Betar

63 75 76 72 71 28 30 27 34 30 21 23 22 25 23 3 5 1 2 Rural Urban Slum Hard to Reach Total Ever Listened Bangladesh Betar Know that Bangladesh Betar have FP programs Ever Listened FP programs in Bangladesh Betar Listened FP programs in Bangladesh Betar in last 30 days

Differential Distribution of Listening FP Related Programs in Bangladesh Betar in Last 30 Days

1 4 3 5 1 1 2 3 2 1 2 2 3 2 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to FM Radio and FP Related Messages through FM

29 20 14 24 23 9 21 31 17 19 1 4 7 2 3 Rural Urban Slum Hard to Reach Total Don't Listen FM Radio Ever Listened Any FP Programs in FM Radio Listened Any FP Programs in FM Radio Within 30 Days

Distribution of FM Radio Channels where Respondents Have Listened FP Programs in Last 30 Days

1 1 4 2 1 1 1 1 1 1 Rural Urban Slum Hard to Reach Total Radio Furti BBC Bangla ABC Radio

Differential Distribution of Listening FP Related Programs in FM Radio in Last 30 Days

1 7 1 4 7 2 1 2 6 2 2 4 4 4 3 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to Newspapers/Magazines and FP Related Messages through Newspaper

49 60 51 42 51 18 28 22 13 20 9 18 18 9 13 2 4 5 2 Rural Urban Slum Hard to Reach Total Ever read any Newspaer/Magazines Know that Newspaer/Magazines publish any FP related information Ever read any FP related information in Newspaer/Magazines Read any FP related information in Newspaer/Magazines in last 30 days

Differential Distribution of Reading FP Related Information in Newspapers/Magazines in Last 30 Days

1 5 2 4 5 1 1 5 2 1 2 7 2 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to Poster and FP Related Messages through Poster

84 78 89 77 81 18 22 45 24 26 Rural Urban Slum Hard to Reach Total Ever seen any Poster related to family palnning Seen any Poster related to family palnning in last 30 days

Differential Distribution of Reading FP Related Information in Poster in Last 30 Days

22 33 18 22 45 24 21 23 33 22 20 28 27 30 26 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to Billboard and FP Related Messages through Billboard

71 68 83 63 70 22 28 43 26 29 Rural Urban Slum Hard to Reach Total Ever seen any billboard related Family Planning Seen any billboard related Family Planning in last 30 days

Differential Distribution of Reading FP Related Programs in Billboard in Last 30 Days

16 54 22 28 43 26 16 18 56 28 22 26 31 37 29 Wife Husband Rural Urban Slum Hard to Reach 15-19 20-24 24+ Poorest Poorer Middle Richer Richest Total

Exposure to FP Related Messages through AV Van

26 9 4 9 13 1 1 1 Rural Urban Slum Hard to Reach Total Ever seen any AV Van on family planning Seen any AV Van on family planning in last 30 days

• Awareness creation about the advantages of small family and changes of

perspectives on ideal number of children

• Knowledge on PPFP/realizing importance of birth spacing
• Creation of knowledge regarding different methods
• Awareness about the suitability of methods
• Awareness about the symptoms of side effects
• Capability of decision making regarding method change
• Practice of discussion regarding family planning with spouse
• Adoption/acceptance of contraceptive methods

Contraception Related Behaviour Change after being Exposed to Different SBCC Channels

Effectiveness of Communication Channels for Delivering FP Related Information

• The effectiveness of the communication channels were categorized in

the following way:

• ≤5% respondents reported as effective were considered as least

effective;

• >5% but ≤ 40% respondents reported as effective were considered as

moderately effective; and

• >40% respondents reported as effective were considered most

effective.

76 53 60 66 64 Rural (N=450) Urban (N=450) Slum (N=300) Hard to Reach (N=450) Total (N=1650)

Most Effective Channels of Communication for Getting FP Related Information: Family Planning/Health Field Worker

Why Family Planning/Health Field Worker Are Most Effective Communication Channel?

• Easier accessibility to family planning/health field workers as their services

(contraceptive methods, information, referrals, suggestions etc.) can be rendered at the doorsteps of the couples.

• Follow up visits of family planning workers.
• Fruitful discussion sessions regarding their needs of services in their own

household.

• Better ecology for both service providers and receivers than health care service

centres.

• A wide range of topics can be discussed rather than only being confined to the

family planning methods’ discussion.

25 23 24 24 16 10 4 38 33 34 32 19 10 8 34 27 36 29 25 2 6 31 38 24 17 21 4 4 32 31 29 25 20 7 6 NGO Workers Bangladesh Television Billboard Private TV Channels Poster/Leaflette Through Mobile/Message Newspaper/Magazines Rural (N=450) Urban (N=450) Slum (N=300) Hard to Reach (N=450) Total (N=1650)

Moderately Effective Channels of Communication for Getting FP Related Information

• Infrequent visits of NGO workers.
• Payment for receiving services especially from poor and rural people.
• Perceived lower quality of services where unskilled workers are providing

services.

• Over commercial attitude resulting into less acceptance of NGO workers as a

source of information and as service providers,

• Lack of NGO workers in different areas resulting into lack of service provisions,
• Perceived unimportance of NGO health workers because of the presence of

family planning/ health field workers in particular areas

NGO Workers: Reasons for Being Moderately Effective Communication Channel

• Reasons for being Moderately Effective Communication Channel:
• Inappropriate timing of the program.
• Household engagements at the time of programs being telecasted.
• Tendency of viewers of not watching BTV now a day after the huge availability of

dish channels.

• Unattractive and traditional pattern of the programs.
• Lack of advertisements of the programs on health and family planning issues

resulting people not knowing about the timing and content of the programs and not watching those.

• Religious constraint resulting not watching television at all.
• Viewers’ reluctance to watch health and family planning related programs in BTV

leaving sports, movies, and serials in other channels.

Bangladesh Television

• Scopes for Development:
• Changing the current broadcasting timing of the health and family planning

related programs preferably at night time.

• Increasing health and family planning related advertisements.
• Reducing the number of other advertisements while telecasting health and family

planning related programs.

• Diversifying the programs:
• Creation of different magazine programs to be telecasted about health and

family planning related issues.

• Increasing the amount of drama on family planning and telecasting it at least

twice in a week.

• Inclusion of celebrity (famous actor-actress, political figures, sportsman, etc.)

in the programs related to family planning and health issues.

• Creating live discussion programs with the involvement of married couple.
• Creation of programs on especially the popular contraceptive methods etc.
• Increasing the telecasting time.
• Use of better audio-visual tools.

Bangladesh Television

• Reasons for being Moderately Effective Communication Channel:
• People’s lack of interest to watch contents of billboards resulting into the

contents not being noticed.

• Billboards being situated mostly in urban areas and very few in rural areas

resulting rural people’s less access to the contents of billboards.

• Women especially in rural areas not being exposed to the billboards as they don’t

spend time much in public places are the reasons.

• Torn condition of posters.
• Re-sticking other posters on the posters related to health and family planning

information.

• Hazy and unclear printing of the posters, concentration of maximum posters in

hospital and other health care centres and not in usual public places.

• People not paying attention to the small posters especially to those which are

containing health and family planning related information (mostly in rural areas according to the respondents).

Billboards/Posters

• Scopes for Development:
• Increasing the number of posters and billboards and placing these posters and

billboards mainly in the places where people gather on a daily basis (for example local markets, bus stations, railway stations, union Parishad office, schools etc.).

• Providing more pictorial presentation on health and family planning issues.
• Providing easier and interesting messages regarding family planning aspects.
• Using celebrity people as model in posters/billboards so that people can be more

influenced.

• Enlarging the size of posters so that people can understand the message clearly.
• Using quality papers for the posters and build quality billboards so that those

cannot be damaged quickly.

Billboards/Posters

• Reasons for being Moderately Effective Communication Channel:
• Less programs on health and family planning related information telecasted in

private TV channels.

• Very little advertisements on family planning methods.
• Preference of viewers to certain kind of programs such as daily serials, news,

sports rather than watching family planning or health related programs in dish channels,

• Preference of watching foreign channels (especially Indian channels where daily

soaps are very popular) due to low quality programs of the local channels.

• Not having television.
• Absence of dish connections especially in rural areas,
• Dissemination problems (such as very tiny letters of scrolls where information

regarding health and family planning issues are being shown.

• Too fast running of scroll.
• Lack of permission from family.
• Not having electricity at the time of telecasting.

Private TV Channels

• Scopes for Development:
• Inclusion of popular figures in disseminating health and family planning related

information.

• Increasing the amount of programs for telecasting.
• Producing daily soaps on health and family related issues and advertising about

this soap operas in other programs.

• Increasing informative scrolls with a slower pace while showing.
• Making more advertisements on health and family planning issues.
• Providing family planning related advertisement in between popular programs

such as sports tournaments and reality shows,

• Decreasing the amount of other advertisements during telecasting family

planning related programs.

• Creating different talk shows regarding health and family planning issues.

Private TV Channels

• Reasons for being Moderately Effective Communication Channel:
• Lack of people’s perception about audio visual vans due to absence of

advertisements.

• Infrequent visits of Audio visual vans/ Absence of audio visual vans’ program in

many rural and hard to reach areas.

• Inappropriate timing of the show when male is busy in their professional works

and female are involved in daily household activities.

• Preference of TV channels over these types of show even in rural areas.
• These vans not having a fixed and proper time schedule.
• Low quality of the video.
• Use of AV Vans for personal and official purposes.

AV Vans

AV Vans

• Scopes for Development:
• Increasing the number of vans and associated human resources, provision of at

least one van for each district.

• Ensuring regular visits of audio visual vans especially in rural and hard to reach

areas (after every three or six months preferably),

• Providing a proper fixed schedule of shows to the people so that people can

manage their time for these shows.

• Arranging different shows for each time and not showing similar content again

and again.

• Separate provision for female to provide them greater accessibility to these

shows.

Messages Through Mobile Phone

• Reasons for being Moderately Effective Communication Channel:
• A large number of people’s inability to open messages and read especially in

cases of rural women and women of hard to reach area.

• Perceived unimportance of the received messages regarding health or family

planning issues/avoiding tendency to read SMS.

• Not getting any messages regarding contraceptive methods’ information and

information about where to get them.

• Messages bearing no meaning to the illiterate people.
• Language barriers (in cases of messages which are sent in English language).

Newspapers/Magazines

• Reasons for being Moderately Effective Communication Channel:
• Lack of accessibility of illiterate people to the news and information provided

regarding health and family planning related issues.

• Less availability of newspaper in households of rural and hard to reach areas.
• Existence of a portion of people both in urban and rural areas without the habit
• f reading newspaper,
• Tendency of people to read only main news and to avoid advertisements

regarding family planning methods and other related news.

• Avoiding tendency/reader’s shyness to read family planning methods and other

related news in presence of others.

• Household engagements of female participants and other work-related

engagements of male participants.

Newspapers/Magazines

• Scopes for Development:
• Wider coverage of the newspapers on a continuous basis especially in rural and

hard to reach areas,

• Providing news regarding health and family planning issues in easier and more

understandable way.

• Publishing family planning related advertisements and news on the first and last

page of newspaper so that people can easily see those.

• Providing detailed discussion on a weekly basis on every contraceptive methods

available in market for both male and female.

• Publishing

special supplements featuring different advertisements and information on family planning products.

• Involving popular models in health and family planning related advertisement

published in newspapers.

• Providing family planning related news in the local newspapers of every area so

that mass people can have greater access to the information and news provided.

Least Effective Channels of Communication for Getting FP Related Information

8 5 3 3 5 1 4 4 7 4 3 6 4 3 Rural (N=450) Urban (N=450) Slum (N=300) Hard to Reach (N=450) Total (N=1650) Workshop/Seminar Bangladesh Radio FM Radio/Community Radio

Respondents Opinion Regarding the Preferred Channels of Communication for Getting FP Related Information

62 36 45 56 50 7 5 13 8 8 3 14 6 7 8 3 9 3 3 5 3 5 6 3 4 3 4 3 1 3 6 1 2 2 3 1 7 1 1 2 2 1 1 3 2 1 2 5 2 1 2 1 3 2 Rural (N=450) Urban (N=450) Slum (N=300) Hard to Reach (N=450) Total (N=1650) Family Planning/Health Worker BTV (Advertisement/Scroll) NGO Field Worker Private TV Channel (Advertisement/Scroll) Billboard Pharmacy/Medicine Shop Upazilla Health Complex District Hospital Satelite Clinic/EPI Outreach Friends/Relatives Do not know

Cost Benefit Analysis

Row No. Cost Benefit Analysis Data Source/Calculation/Estimation 2011 2014 1 Total Married Women 31460385 31496402 Census 2011 and ASMR (BDHS ) 2 CPR 61.20% 62.40% BDHS 3 CPR User 19253756 19653755 Calculated (1*2) 4 Effect of SBCC on CPR 4.93% 3.643% Logistic Regression (Estimated) 5 CPR User due to SBCC 948877 715929 Calculated (3*4) 6 Pregnancy Rate (who are not using contraception) 16.56% 14.57% BDHS 7 Number of Pregnancy Averted 157105 104311 Calculated (5*6) 8 MMR Averted 305 204 Calculated (7*MMRatio) 9 Infant Mortality Averted 6756 3964 Calculated (7*IMR) 10 Child Mortality Averted 1728 834 Calculated (7*CMR) 11 C-section Averted 26708 23887 Calculated (7*C Section Rate) DALYs 13 YLLs lost due to maternal death 15940 10958 Calculated (8*(e0- Mean Age of Motherhood)) 14 YLLs lost due to Infant death 459510 276278 Calculated (9*(e0- 1)) 15 YLLs lost due to child death 115821 57329 Calculated (10*(e0- 2)) 16 Years Saved from Hospitalization 679 615 Calculated (7*Mean days of hospitalization due to delivery) 17 Total DALYs 591950 345180 Calculated (13+14+15+16) Economic Benefits 19 DALYs*GDP per capita 39579639563 28751878856 Calculated (17*GDP) 20 Cost of Delivery Averted (in BDT) 809470026 656336204 Calculated (7*Cost of Delivery (BDHS)) 21 Total Benefit 403089109859 29408215060 Calculated (19+20) 22 Total Cost (Expenditure) in BDT 166463000 215652000 DGFP (IEM Unit) 23 Cost to Benefit Ratio 243 136 Calculated (21/22)

Policy Recommendations

• Family planning workers or health workers were appeared as most effective channels of SBCC
• intervention. Therefore, more emphasize should be given on the coverage of family planning workers.

This can be done through:

• Filling up the vacant positions
• Reducing the workload of the FWA through creating/recruiting more FWAs
• Providing refreshment trainings on various aspects of family planning issues including inter-

personal communication and counselling

• Strengthening the monitoring system of the field level activities of the FWAs
• The current broadcasting timing of Bangladesh Television for telecasting health and family planning

related programs must be changed.

• The Government should introduce a condition in the terrestrial license agreement so that private

television channels are telecasting health and family planning related programs compulsorily as part of their CSR commitment.

• The coverage of AV Van should be increased and vehicle tracking system should be introduced and

used for proper monitoring of AV Vans.

• Numbers and visibility of posters and billboards should be increased through placing the posters and

billboards mainly in the places where people gather on a daily basis (for example schools, colleges, local markets, bus stands, railway stations, Union Parishad office, etc.).

• Health and family planning related programs communicated through workshop/seminar, Bangladesh

Betar, and FM Radio should be reconsidered.

• Audience segmentation must be considered in developing effective communication strategy for all

channels.

Thanks!!

• Research Team
• Mohammad Bellal Hossain
• Dr Mohammad Mainul Islam
• Sanjit Roy
• Shafayat Sultan
• Md Zakiul Alam