USAID/Nepal’s Early Grade Reading Program (EGRP) has an emphasis on Social and Behavior Change activities, including advocacy, medium mass media, radio program and media orientation. This report was prepared by EAN, a Nepal communication agency that worked with EGRP. It documents the program, which was conducted in six districts in Nepal.
Another Option’s advocacy campaign conducted in six districts in Nepal for USAID’s Early Grade Reading Program was effective in increasing awareness and engagement on early grade reading. The data visualization shows the reach and frequency of the advocacy campaign conducted as part of the Social and Behavior Change component. Advocacy and media orientation were conducted to reach community leaders as well as parents to increase their understanding of the importance of early grade reading and how to help their children learn to read. Another Option’s implementing partner was Digital Broadcast Initiative, Equal Access. Support was also received from the Department of Education at the national and district levels. The campaign ran from 2016-2017.
Another Option has been working in early grade reading for four years in Africa and Asia under several USAID-funded awards. Research shows that barriers to education, parental aspirations, and societal norms are similar across the world and do not change that dramatically—whether you are in West Africa or South Asia.
As part of the USAID Early Grade Reading Program (EGRP) in Nepal, we’ve provided technical support in early grade reading Social and Behavior Change. We’ve worked closely with the Government of Nepal stakeholders including the Department of Education and the National Center for Education Development to design and develop materials for parents and caretakers, teachers, and education officers to support early grade reading. Developed resources including a peer education module for parents and an interpersonal communication toolkit for teachers to bridge communication gaps with students’ parents.
In Nepal, we worked very closely with the government of Nepal to design and create all of our materials. And, we’re really pleased that the teacher training guide has been accepted by the government of Nepal as part of its national teacher training curriculum.
Because the social mobilization and interpersonal communication have shown results in Nepal, we wanted to test these materials in Liberia to see if they could be adapted to the Liberian setting and its needs for our work with USAID Read Liberia.
With permission from the Liberian Ministry of Education to pre-test the peer education materials, we set out to answer three critical questions: do parents understand the content (particularly the graphics and illustrations); was the guide culturally sensitive; and would it resonate with Liberian parents of young readers.
We conducted an assessment with twenty-one parents-twelve women and nine men-in two communities – one urban and one rural—at Slipway Public School and King’s Farm Public School. We found that the barriers to education and aspirations were similar to parents and teachers in our Nepal-based early reading program. Parents we interviewed in both places cited factors related to economics, social norms, existing education infrastructure, and gender as real challenges in their attempts to ensure their children received a decent education.
The Liberian parents overall did relate to the illustrations that were developed for Nepali parents, and that the tools were able to generate insightful discussions about the roles of parents in the reading lives of their children both in and out of school. Parents at both of our focus groups said they could see themselves and their challenges reflected in the illustrations.
Parents also provided feedback on specific visual details that Another Option could do to make the resources more relatable to the Liberian context. For example, participants indicated that some of the hand gestures used in the Nepali context varied in their interpretation in Liberia and could confuse the user. They also asked for more illustrations bridging into the community and not just in the school setting to allow parents to see their roles as educators throughout their daily interactions with their children. Additionally, much discussion was held around the differences of the education setting in rural areas versus urban areas and how these could be better portrayed.
Based on these responses, we worked with local illustrators to improve the cultural resonance of the illustrations in efforts to make it more relevant to parents and caregivers in urban and rural communities in Liberia. Additional materials like flyers and posters will be developed for social mobilizers to use during community engagement activities promoting early grade reading. The final Liberian version has been shared with the Ministry of Education and we have received the go ahead to test it in the field across several counties.
With these changes, parents will have specific examples on what they can do to help their children learn to read. These include children reading aloud for ten minutes a day, children having a quiet place to read, and regularly going to school.
In both Nepal and in Liberia the support and guidance from the Ministries of Education were invaluable. The Nepal version is endorsed and carries the seal of the Ministry of Education, and we hope that the Liberian ministry also adds its endorsement to this early grade reading tool.
Rebecca Martinez, who wrote this blog post, is the Program Coordinator for USAID Read Liberia. She conducted the pre-test in partnership with local counterparts on the ground in Liberia.
You know someone loves their work when in their free time, they volunteer to do the same thing!
Rose Mary Romano, managing partner of Another Option, and who has more than thirty-years of work experience in public health and international development, spends part of her off-hours as an active board member of the Arlington Academy of Hope (AAH) that supports a Ugandan NGO.
The small NGO was started to support the educational and health needs of rural villages in eastern Uganda. Rose Mary was invited to join the AAH Board of Directors in 2016. In her role as a board member, she provides strategic direction to the NGO’s health and clinic programming.
Rose Mary has assisted the Uganda AAH health team begin to conduct data analysis of service delivery records and conduct a comprehensive quality control review of all staff training, facilities, equipment, and health commodities. These are daunting tasks for any donor-sponsored program. Thanks to her expertise in this technical area, Rosemary has significantly contributed to the NGO’s efforts on this front.
The NGO supports two clinics, one in Bumwalakani and the other in Buputo, Uganda. The clinic in Bumwalakani provides testing, treatment, and support for people affected by HIV and AIDS. The Buputo’s clinic specializes in maternal, newborn, and child health.
Speaking about her work with the health teams in Uganda, Rose Mary has said, “I’ve worked at the community-level for many years throughout Southern and Eastern Africa. My work with the clinics’ providers and working together to solve problems is rewarding… Working with AAH helps keep me grounded in my community-health roots, and it informs my work on our national and international programs.”
Learn more about the work of the Arlington Academy of Hope on their website: www.aahuganda.org
There are so many wonderful experiences from the USAID/Nepal Early Grade Reading Program that Another Option is working on. Applying the behavior theories and strategies we use in our health and energy being utilized in education and early grade reading to encourage parents (…and grandparents and older siblings) to read with their children is one exciting experience.
Research shows that the most effective way to change behavior is through one-on-one experience or interpersonal communication. I saw it in action last week (April 24 ) when I attended a parent meeting in Bhaktapur, Nepal. The parents could not stop talking about their children….and especially their desire for them to learn how to read and to achieve beyond what they as parents have.
The meeting was a parent (peer) education training session conducted by the program’s social mobilizers. Another Option developed the training guide the mobilizers are using to get parents to talk to other parents about the importance of Early Grade Reading and share tips on how they can go from desire for their children to read and excel to actually taking the necessary steps. The guide and other materials are available on our site.
It is powerful for parents to know that they are not doing this alone and that other parents are also trying to fit in time to read with their children with work outside of the home. Parents (peers) who have experience with reading at home share ideas and tips with parents such as relieving the child from some household chores to study and read each night and listening while the child reads for 10 minutes each day.
“My grandfather inspired me to read and always brought me books. Now when I travel, I always remember to bring back books for my children.”
Pushpa Basnet, CNN Hero 2016-17
The commitment and resolve of these statements reflect the focus of the media orientation workshop organized by the Department of Education (DOE) and the USAID-funded Early Grade Reading Program (EGRP).
Held on February 6 in Kathmandu, the workshop was the first opportunity for 28 Nepali print and broadcast media journalists to come together and understand the program and their role in strengthening the program. Using presentations and group discussions, Focal Person, Bishnu Adhikari, Deputy Director, DOE and EGRP Chief of Party, Edward Graybill along with other technical team leads, shared strategic ideas about the relationship between EGRP and the government’s National Early Grade Reading Program (NEGRP).
Further, participants received information packets with community mobilization and peer advocacy materials, developed and designed by the program, with the intention to facilitate better communication amongst beneficiary parents and between parents and teachers about children’s reading habit.
“In the 2014 earthquake, houses with strong foundation withstood the damage. Early grade reading is the foundation to improve our children’s future.”
Mr. Baburam Poudel, Director General, Department of Education (DOE)
Mr. Baburam Poudel, Director General, Department of Education welcomed the participants and opened the workshop by reiterating the critical nature of quality early grade reading and stressed all involved stakeholders to work in tandem to improve access, quality and management of primary education.
Education expert, Mr. Dhananjaya Sharma called for teachers and other stakeholders in primary education to encourage two-way interactions with students and to change classroom settings to make it child-friendly among others.
Special guests at the orientation included comments by Ms. Basnet, named as a CNN Hero in 2016-2017. She stressed the importance of reading in her own personal development from a shy student to a confident woman.
Deputy Director Mr. Adhikari spoke at length about the National Early Grade Reading Program (NEGRP) and raised issues about program’s implementation including ownership of the program, lack of technical resources and lack of commitment of policy making and implementation.
“Teaching is all encompassing – it is as cultural, social and familial process.”
Dhananjaya Sharma, Education Expert
A key message that came out of the interaction between the journalists and the EGRP and the government teams was that a strong sense of camaraderie and commitment to this important work was required from all stakeholders to implant the love for reading in Nepali children from the very early grades.
A similar workshop will be organized in Bhaktapur, Kaski, Banke, Saptari and Kanchanpur districts in February and March
This blog was prepared by Adheep Pokhrel, Communication Manager for USAID/Nepal’s Early Grade Reading Program managed by RTI International
Once the dust had settled following the devastating Ebola outbreaks in West Africa, it was discovered that deaths resulting from Ebola were disproportionately concentrated among health care workers. Based on some estimates, .11% of Liberia’s entire general population had died due to Ebola, compared with 8% of its health care workers. In Sierra Leone, the loss was 0.06% of the general population compared with 6.85% of the health workers, while 0.02% of Guinea’s overall population had died compared with 1.45% of all health workers, according to May 2015 data from the World Bank. It was this situation that partly led to the creation of a company called Kinnos, which invented a new substance to decontaminate health care and other potentially contaminated facilities.
Kinnos posited that regular bleach disinfectant was not always sufficient to protect all health workers from highly contagious viruses such as Ebola. Although bleach is recommended by the World Health Organization and other international health agencies as the best and most cost efficient disinfectant for surfaces contaminated by infectious disease, its effectiveness is limited by the fact that it is clear. This makes it easy to “miss spots” and leave gaps in coverage of disinfection. Kinnos created Highlight, a patent-pending powdered additive that colorizes disinfectants. This makes it easier to visualize, ensure full coverage, and adhere to surfaces. The color is only temporary, however; it fades once decontamination is complete.
Highlight is being used by the New York Fire Department and was a winner of the USAID Fighting Ebola Grand Challenge. It has also been field tested by health care workers in Liberia and Guinea. The new technology was spotlighted at TEDMED 2016, taking place this week in Palm Springs, CA.
One of the co-founders of Kinnos, Kevin Tyan, spoke to attendees about the company, which was founded by him and two others when they were undergraduates at Columbia University in 2014. Responding to TEDMED 2016’s overarching question to attendees, “What if?”, Tyan and his colleagues asked, “What if we could highlight invisible threats for our lifesavers?” The development of products such as Highlight could be part of the answer. Another component of fighting emerging diseases such as Ebola and Zika is detecting them early so that proper treatment and precautions can be taken. TEDMED 2016 speaker Charles Chiu, an infectious disease physician and researcher, detailed the development of a tiny next-generation sequencing device (from Oxford Nanopore Technologies) that could improve how quickly and effectively we can diagnose and respond to the next deadly disease. Chiu’s talk fed into the overarching theme of this year’s TEDMED – “What if?” – by posing the question, “What if next generation sequencing could help us diagnose mysterious infectious illnesses.” The device can “detect any infectious agent…no matter whether it is a bacteria, virus, fungus, or parasite” in a single test, and can do so in a matter of hours and in remote, low-resource settings, Chiu explained.
By working with a number of national and international partners, the researchers have been able to bring this instrument and its associated protocols and laptop software to remote areas around the world – Barbados, Brazil, Democratic Republic of the Congo, and Ethiopia – for diagnosis and surveillance of acute febrile illness from pathogens such as Zika virus, Ebola virus, and Plasmodium falciparum malaria. The way this technology works is like quickly finding a needle-in-a-haystack. Clinicians collect a sample – blood, spinal fluid, nasal swabs, or tissue – and generate hundreds of millions of sequence reads. They then diagnose infection by identifying sequences corresponding to all potential viruses, bacteria, fungi or parasites using a bioinformatics program called SURPI, which stands for sequence-based ultra-rapid pathogen identification. “SURPI can analyze 300 million sequences within hours, and is available on servers, the cloud, and even on a laptop,” Chiu noted.
This is warp speed compared to conventional testing, which often involves using cultures, where you grow the organism from days to weeks and can waste “precious time retesting limited amounts of sample looking for an endless array of potential agents,” Chiu explained. By implementing all of this in a single test, patients can obtain “targeted, timely, and effective treatment before it’s too late.”
In addition to testing the technology in other countries, in June 2016 Chiu and his colleagues launched a multi-hospital study on the “Precision Diagnosis of Acute Infectious Diseases.” Over one year, they will enroll 300 patients and compare the metagenomic next-generation sequencing test, which has now been clinically validated in a licensed diagnostic laboratory, to conventional testing. This demonstration project aims to establish the clinical utility and cost-effectiveness of this test for diagnosis of meningitis and encephalitis. Their efforts are particularly timely given that the FDA in May of this year released draft guidance for next-generation sequencing diagnostic devices.
“We are currently in the process of seeking FDA approval for this test, and hope that approval for tests such as these can be fast-tracked as soon as possible and made widely available to patients,” Chiu said. They are also working with NASA on potentially sequencing in space.
In August of this year, astronaut Kate Rubins reported for the first time a successful sequencing run in space on the MinION nanopore platform. “Ultimately, the goals of sequencing in space will include diagnosing infections in astronauts, environmental surveillance, and even the discovery of new life,” Chiu stated. To see these space-age goals realized, the populace will have to live long enough.
Another TEDMED 2016 speaker, Dr. Nir Barzilai, an Israeli internist, is examining a way to target the process of aging to help us live longer, healthier lives. He is spearheading a randomized controlled trial of a medicine, metformin, that aims to interfere with the aging process. Meformin, Barzilai explained, is a generic drug that has been used for over 60 years to treat patients with type 2 diabetes. It directly targets several important mechanisms of aging, and has been shown to extend the health and life spans in organisms including worms and mice. In humans, metformin prevents type 2 diabetes in those at high risk and has been associated with reduced cardiovascular disease risk. In patients who already have type 2 diabetes, metformin is associated with a 30% reduction in cardiovascular risks and death, and a 20-40% reduction in cancer risk. It is also associated with a decrease in cognitive decline and Alzheimer’s disease.
With those preliminary results as a backdrop, Barzilai and his colleagues have launched a study, Targeting Aging with MEtformin (TAME). They will be studying 3,000 elderly volunteers who will be assigned to either placebo or metformin. They will attempt to measure the time it takes for any of age-related diseases — cardiovascular disease, cancer, diabetes, Alzheimer’s disease and death – to manifest. Because the study aims to show how metformin affects the rate of aging, the researchers are working with the FDA so that the drug will carry an “anti-aging” indication if it is proven to be effective for that purpose. Gaining this indication will spur more companies to pursue the development of anti-aging medications, Barzilai stated. He is hopeful that the study will show that “metformin will probably add healthy years to life.”
But metformin is only the beginning: he predicted that next generation drugs will be better and better,” Even a “modest change in people’s health span,” he added, “will be translated into $50 billion in health care savings by the year 2050.”
TEDMED 2016 was held in Palm Springs, CA from 30 November through 2 December 2017. Visit www.TEDMED.com for more information
Guest blogger Tula Michaelides has 25 years of professional experience writing for a variety of audiences, predominantly in the fields of global and U.S. public health. She attended TEDMED 2016.
Another Option’s social and behavior change communication (SBCC) is designed to reflect target audiences’ personal motivations and beliefs and the cultural and environmental factors that influence them. SBCC strategies range from mass media and digital communication to social impact gaming. It also includes interpersonal communication (IPC) and peer education, and advocacy and public relations to affect policy change and cultural and social norms.
Creating an enabling environment that supports individual and societal change requires a strategic approach. Societal and cultural norms as well as policy and regulations are the barriers that prevent change. Advocacy activities range from strategic public relations, thought-leader meetings, and engagement or participation in problem solving.
Program design begins with data and Another Option has extensive experience in designing qualitative and quantitative research to offer insights and information about key populations and segment audiences and to design effective programs.
Under a World Bank-funded program, Another Option developed a social and behavior change communication program on rural sanitation in Lao PDR. Other donors include UNICEF, Plan International, and SNV Netherlands Development Organisation. Dr. Cecile Lantican led the Lao activity and following a field visit meeting with women in the communities and rural areas she captured her observations in the following blog.
What motivates women?
By Cecile Lantican, Ph.D.
From June 7-13, 2015 I joined the team of Another Option LLC, commissioned by World Bank under the Water and Sanitation Program in Lao PDR to observe people’s motivation to change and improve their sanitation practices. This is a new assignment for me after six years working in this country on changing people’s mindset and behaviors that put them to risk when they interact with their domestic animals and wildlife that carry zoonotic diseases.
I attended a ceremony hosted by the Pinh District government in Savannakhet to recognize villages that have made progress in addressing poverty and achieved improved sanitation status (declared Open Defecation free). I talked with Lao women and listened to their stories about their aspirations, needs and motivations that may have influenced their decision to seek for better status in life. I was amazed and fascinated interacting with Lao women from the south who I saw to be very hardworking, loyal to their families, hospitable and warm to visitors.
Outlining the situation of rural women in Lao
I have worked with rural and urban women in this country, but I noticed that there is limited scientific information about how Lao women make decisions that affect their lives. Ethnic, geographic, and ecological differences create variations in the Lao women’s way of life. Ethnicity persists through language and dress patterns.
Illiteracy among rural women is high, especially in certain ethnic groups where cultural attitudes hinder girls from going to school. Parents force them to drop out to assist with the farm or domestic chores. Their capacity to obtain employment and participate in decision-making is severely hampered by their low level of education.
Early marriage is common among rural women. Most of them marry at the age of 16 or 17 years. A UN report in 2012 revealed that almost twice as many women marry and bear children before the age of 18 in rural areas (43%) than urban areas (23%). The total number of children of women with no education is nearly three times greater than that of women with higher education1.
The majority of women, especially those in ethnic communities, suffer from poverty, food insecurity, and unavailability of health services. The Lao women carry a great responsibility in the family. Apart from housework, and child rearing, they are also engaged in generating income for the family through labor-intensive work like collecting non-timber forest products including wild animals, weeding in the rice paddy, harvesting, planting cash crops and selling these products in the local markets, tending their animals, weaving, and managing family food stores.
Rural women face complex decision-making when it comes to meeting their basic needs. Most often, they follow their elders’ advice. They feel restrained from expressing what they actually have wanted to happen in their lives.
The critical role of education for women
In Ban Sa-phang village, Mounlapamok district in Champasack province, a young mother of a three-year old boy married when she was nineteen. She did not finish primary school because she had to stop and help her parents on the farm. She married the first man who came into her life who promised her a better future since he was working in Thailand.
She was emotional when she sad, “I dreamt of living in a big house and wanted to earn money to buy food for my family, but that did not realize. My husband’s income from being a construction worker at the border, and most of the times seasonal, is not even enough for us.”
She recognized that lack of education hampered her from finding work outside the farm. Unlike other women in her village who had entered their first year of secondary school and worked as migrant workers, she could not find work off the farm.
Women supporting their families
Anecdotal evidence showed that an increasing number of undocumented Lao women migrate to Thailand as workers in service and domestic sectors, vulnerable to abuse, exploitation and human trafficking.
Madame Bunkhong, 55 years old, was one among the attendees of the ceremony in Pinh district. She married at twenty-two and had four children.
After college, she worked in a private bank. But after two years, she had to stop working to take care of her sick father and to help her mother manage a small food stall at home. “I gave up my desire of being an employed and earn money for myself because I needed to follow my family’s decision. If I had complete control of my life before, I wouldn’t give up my dreams.” She affirmed that she is happy with her own family now, but it could have been more self-fulfilling if she had decided for herself.
Making decisions to improve sanitation
Looking closely at rural women who chose to access improved sanitation, I approached a woman who attended the PSI and district Nam Saat-led sales event for latrines. Her name is Madame Tongkham, 30 years old. She has three children. She married at eighteen. Six months ago, her husband left them. She was aware that he may never comeback having heard that he has another woman. It was her third time attending the latrine sales event in the village. The village council members encouraged her to attend. Earlier, she could not decide for herself because she needed to consult her husband. During this event, she ordered from the sales agent the delivery of one latrine package worth LAK 500,000. She made a deposit of LAK 50,000. “I felt devastated when my husband left. I worry about my three boys, and my old and sickly mother living with us. I have no regular income. My family now only relies on my niece who works in Thailand,” she said. “I did not finish school. I can only do farming and sometimes go with neighbors to the nearby village to harvest coffee beans. From these activities, I earn some amount to buy food for the boys,” she added.
I asked if someone had discussed the health risk of defecating in the open with her. She replied, “ No one gave us briefing on the health risk. But I do remember that sales agent told us that having a toilet would give us convenience, safety and privacy.”
What made you decide to have the toilet this time?, I asked. “I have waited for my husband to decide.” She continued in her low voice. “ I need this toilet. I have fears when my boys defecate in the river along with other young boys. Many young boys have died of drowning in the river. My old mother needs it too,” she said.
Laotian women as community leaders
Laotian women’s confidence and self-esteem increase when they have greater knowledge, economic assets and income-earning capacity. Their low participation in decision-making is often due to stereotypes in their culture, which assign men the role of decision maker in the family and domestic affairs.
I met two Lao Women Union (LWU) community leaders at the ceremony. The district government recognized their unwavering support to uplift the living conditions and promote the role of rural women through training and participation in community affairs where their knowledge, skills and decision-making are essential.
The two women received training on various women-related issues from the national chapter of LWU that would empower rural women. Under the rural poverty reduction program of their district, they include provision of information on importance of education, sanitation and hygiene.
This travel provided me anecdotal evidences that rural women in Lao PDR can decide for themselves and their families. Under difficult circumstances, they can cope with their situation and can find solutions to their problems. They can improve their social status if given the opportunity of social support, correct information and networking.
1 Country Analysis Report: Lao PDR. Analysis to inform the selection of priorities for the next UN Development Assistance Framework (UNDAF) 2012-2015, UN in Lao PDR , Vientiane.
Word of mouth or peer education is still the most reliable way to get information. Making sure that information is correct or accurate is another story.
One of Another Option’s role under USAID/Nepal’s Early Grade Reading Program managed by RTI International is to create awareness among parents of children in grades one through three about the benefits of reading, and for children to read outside of schools at home, reading corners, and libraries.
With the Ministry of Education, we developed a peer education guide to encourage parents to talk to other parents. Our research showed that parents talked to other parents about maneuvering their way through the school culture and to assure parents received good advice on what to do for their children to succeed.
Approved by the Ministry of Education and USAID/Nepal, the guide is in English and Nepali with plans to translate into three other languages. The training kit consists of three components: trainer guide, participant guide, and wall hanging with recommended behaviors and activities for parents.
An electronic version will be posted for any to use. Please give credit to USAID/Nepal. Drawings and illustrations by Keshar Joshi.