The Doll Solves Diarrhoeal Woes

State and Development partners

Bihar;

The Bill and Melinda Gates Foundation; BBC Media Action

Problem

Diarrhoea is a preventable disease, yet a leading cause of deaths among children below the age of five in India. Oral Rehydration Salts (ORS) with zinc are available and promoted but mothers are not usinp them. Caregivers, including mothers, do not recognise what diarrhoea does to the child's body because thhere is no way to see how the child's body is depleted because of diarrhoea. As per the National Family Health Survey-4, 35% mothers thought reducing fluids when their child is suffering from diarrhoea is the right solution. This is because they operate from a ‘leaky bucket’ mental model, wherein they liken a child suffering from diarrhoea to a leaky bucket, i.e., you don't put more water into a leaky bucket; it's bound to leak out. This can be fatal for the child.

Conventional Solutions

Mass media campaigns to prevent and cure the disease have been disseminated through television, radio, and door-to-door visits in almost every village in the country. Yet, the problem remains, not for the lack of trying but because these messages have not translated into practice when families are faced with the crippling disease. Child-ca re during diarrhoea needs further comprehension by mothers to equip them to manage the disease better.

Behavioural Insights Based Solutions

An interactive educational tool that vividly demonstrates how ORS and zinc help in stopping the body from getting dehydrated is required to fill this knowledge gap. Pari (Hindi for fairy), a plastic inflatable doll with two openings, one at the top and the other at the bottom, is one such tool used at Village Health Sanitation and Nutrition Days (VHSND). A frontline health worker (FLW) pours water into the top inlet to inflate the doll to show what a healthy baby looks like. Then she releases the water by opening the outlet at the bottom, which deflates the doll to demonstrate what diarrhoea does to the body: causes dehydration. When the FLW plugs the second opening and pours ORS into the doll, the water does not leak out. She explains that in order to solve the problem, it needs to be ensured that the outlet at the bottom has been plugged. When the child is administered ORS and zinc supplements, it acts as a plug to the bottom outlet thereby retaining vital fluids that can be absorbed by the body. This demonstration works because it plays into the leaky bucket mental model that the human brain can easily grasp. When FLWs are able to explain this concept by a vivid demonstration using Pari, the mothers are able to absorb, grasp, and retain this information. This is almost like a ‘Eureka moment’ for mothers, a moment of clarity when they understand why ORS and zinc is a ‘must-have, must-use’ product. Several women instantly demand for ORS sachets and zinc supplements after the demonstration.

Lesson

Pari has been used in Bihar for over two years across eipht districts at VHSNDs sites and 600 Primary Health Centers (PHCs). In 2018, the Government of Bihar committed funds to scale up Pari to all 38 districts of Bihar. Results showed that amonp women exposed to Pari, appropriate knowledge of diarrhoea management was three times hip her and the use of ORS and zinc was almost two times higher than women not exposed.

Source : Stories of Change from India's Aspirational districts - NITI Aayog publication