Bihar JEEViKA COVID-19 Scale-up

In response to the COVID-19 pandemic, CSBC worked with Applied Wonder and X Billion Skills Lab on a rapid study to develop a behaviour change kit to promote COVID-19 vaccination, mask-wearing, social distancing, and handwashing amongst women who are a part of JEEViKA's self-help groups (SHGs) in Bihar.

Introduction

CSBC worked with partners to develop a behaviour change kit to promote (i) the uptake of COVID-19 vaccines, (ii) mask-wearing, and (iii) social distancing and handwashing in JEEViKA self-help groups (SHGs) in Bihar. This kit included training videos, a printed toolkit with a flipchart and leaflets, and edutainment videos.

We supported JEEViKA in monitoring the roll-out of the training to over 80,000 facilitators so they can implement the activities described in the behaviour change kit in over 10 lakh SHG group meetings. We also conducted surveys with a subsample to measure the change in vaccine coverage for SHG members in Bihar.

Due to COVID-19, we did baseline and endline surveys telephonically. The results indicate significant vaccine uptake after the introduction of our kit. However, there are limitations in our evaluation design, as there were several factors and government programmes running in parallel.

Key results

We found an increase in SHG members' vaccination rates and household vaccination rates between baseline and endline. There is a positive association between the implementation of the behaviour change kit and the number of vaccinated SHG women by the endline.

Description and methodology

CSBC identified the reasons for vaccine hesitancy and categorised the strategies based on the population's perception of the vaccine. These were:

• The Rational Approach: This approach leverages the empowerment JEEViKA promotes for women to make their own decisions based on correct information about the vaccine and the virus. A flipchart and leaflets are used to facilitate group discussions and activities in the SHG meetings.
• The Emotional Approach: This approach uses a short video of a relatable story about two SHG didis and how COVID-19 vaccination affected their lives. This is accompanied by a leaflet to guide the discussion on the importance of vaccination. Here is the video:

In addition to this, there are SBCC materials designed for mask-wearing, social distancing, and handwashing, like this video:

For the evaluation, we conducted baseline and endline surveys with 1,154 SHG members from 258 blocks and 22 districts. We were interested in understanding the behaviour change kit's effect on outcomes such as SHG member vaccination, number of doses, and household vaccination rates. We also studied barriers and motivators for vaccination.

Results and highlights

We found that

• SHG members' own vaccination coverage increased since the baseline survey. 81% of unvaccinated women at baseline received at least one dose by the endline.
• There is a positive association between the implementation of the behaviour change kit and the number of vaccinated SHG women by the endline. JEEViKA's recommendation was one of the top three reasons women stated for taking a vaccination dose by endline.
• Household vaccination rates increased from an average of 86% to 98% between baseline and endline. However, the increase in household vaccination rates was not linked to women's attendance at SHG meetings with the behaviour change session.

Discussion

As implications and key takeaways for vaccine promotion, we suggest reinforcing the need for a timely second dose. It is also important to correct misinformation around pregnancy, breastfeeding, and comorbidities and how they relate to COVID-19, as these were the top barriers among unvaccinated women. It is vital to note that there were high vaccination rates at baseline, which led to a small unvaccinated sample for research.

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