Quotes from Participants Illustrating Program Features Contributing to its Success
| Themes | Illustrative Quotes |
|---|---|
| Constant field presence of staff | “Now if the community does not see me for one day, next day I get a call—where are you? Sometimes the community people even directly come to our center to inquire where I am. (Male field staff, 27 years, employed with SNEHA: 1.5 years) “If anyone requires, we give our mobile number so that they can call us when they need any guidance or help. I had given my mobile number to her so she can call me if she has any problem—even in the night. She does not have a proper family support system.” (Female field staff, 34 years, employed with SNEHA: 2 years) “They are here only. They keep coming. They had visited here yesterday only; they gathered several women to explain to them … actually there was a meeting.” (Mother, 30 years, housewife, Muslim, 6 children, youngest girl, age 2 years, was severely wasted, recovered) “They mostly come quite often in a week, like they were here 2–3 days ago. They ask how we are. (Pregnant woman, 28 years, housewife, Christian, 2 kids) |
| Information-sharing with the community through reinforcement and as a tailored process | “… but doctors telling is different, their telling is different. Doctors are always in a hurry. They are under pressure because of patients, so they tell in shortcuts, some of it I understand and some I don't. These people (from SNEHA) are free, they tell us freely, each and everything, that you do this way. Then they come next day and ask whether we did the way we were told. Then we tell them that yes, we did. Then they again ask us after 1 week whether it was beneficial or not. It happens like this. And what will the doctors say, they just tell, whether we do it not, only we and our children are responsible. This is how doctors do it. And these people come and ask us regularly, ask us again after 1 week about whatever happened, whether the child is eating or not, whether the child is liking it or not, they ask us all of these. (Mother, 24 years, Muslim, 4 kids, 2 younger kids were severely wasted and 1 was on medical nutrition therapy) “SNEHA believes in giving messages, and individualization of messages was very important. So when you do home visits, there are 2 or 3 things which would help. Firstly, it was like you know a message for a particular person only, secondly you come to know the home situation also because there are times when the home situations are interfering with the actual process.” (Senior staff, other details masked to protect identity) “Today in the morning I visit one house. I found some bad smell was coming. So I will not tell immediately. First I will observe how that woman is. I will see the cleanliness in the house. While talking with her we see all how is kitchen maintained.” (Female field staff, 40 years, employed with SNEHA: more than 3 years) |
| Persistence of field staff and collective persuasion | “When she asked about the registration at that time she told that no, her husband has no time to pick up her to hospital. So she asked her father's mobile number. But they don't have that also. Then SNEHA frontline health worker asked for the neighbor's mobile number. The lady said okay. Then the next day, the SNEHA frontline health worker called her neighbor and spoke to her husband: ‘what is the reason why you did not register her for a pregnancy checkup?’ Then the program officer also called her husband and explained about the importance of the registration, medicine, everything. The next day the SNEHA frontline health worker, the ICDS frontline health worker, and the health post frontline health worker all went to her house and explained jointly. Then her husband took her to the hospital and did the registration. The continuous visits helped the family.” (Case study of a pregnant woman, age not known, Hindu, 3 children) “One family was not ready for immunization. Not even at a private clinic, since one of their relatives died after immunization, they said. The SNEHA frontline health worker spoke to the mother again and again. She agreed but her mother-in-law did not. We all went several times—me, the program officer, ICDS frontline health worker, and even our doctor visited to tell them. We all went together and told them. Then they agreed. (Female field staff, 35 years, employed with SNEHA more than 3 years) |
| Holistic case management | “When the SNEHA frontline health worker first identified the child, he was 3 months old. She oriented the mother regarding SNEHA and its work. The child had a cleft palate. The SNEHA frontline health worker spoke to the mother regarding her feelings for the child, ongoing treatment, and her difficulties faced while feeding the child. The mother replied that they had recently shifted to Mumbai as her husband worked here and mainly for the child's treatment. She did not know any hospital and was looking for one. While talking, she was upset and in tears. She said that all her relatives blame her for her child's condition and they say that he looks like a mouse. The SNEHA frontline health worker counseled her that it was a birth defect and can be successfully treated with surgery. She referred her to the hospital and screened the child. The mother fed breast milk to the child with a bowl and spoon. Sometimes the mother did get irritated, too, she shared, and felt bad and angry when other people came home to see the child and gave suggestions. When the mother shared her concerns, the SNEHA frontline health worker could feel her helplessness. The SNEHA frontline health worker asked the mother to calm down and said she understood her feelings. The SNEHA frontline health worker inquired about the father and the mother replied that he was nice, but due to family pressure, he also felt it was the mother's fault. The mother cried a lot. In the hospital, the doctors advised an operation. After the operation, the child could feed better. The mother started top feeds and the child gained weight. (Case story of an 8-month-old boy, cleft palate, migrant population, mother's age not known.) “The woman was mentally disturbed. She had a 3-month-old girl. She could not feed the child breast milk and so it was on top feed. The SNEHA frontline health worker visited her house many times and told her not to take stress. The woman said she had a problem with her family and her in-laws; and they were not accepting her. She wailed loudly—‘I am suffering because my husband is not accepting me,’ and she used abusive language. Our concern was that her small daughter will suffer because of this. This case was referred to the prevention of violence against women and children in SNEHA. The program counseled the entire family repeatedly. Now her family has understood and given her permission to live separately with her husband. (Case story of a new mother, 23 years, with a 3-month-old baby girl) |
Abbreviations: ICDS, Integrated Child Development Services; SNEHA, Society for Nutrition, Education and Health Action.