Transformative Pedagogy: Classroom vs Field – What works? Learnings from Nutrition India Program

Our 10 years experience designing, training & implementing Science & Math learning solutions1 in classrooms across the country earned us an invitation in April 2019 to join the Nutrition India Program2 (NIP) as Design Specialists in the learning space.

Started in April 2019, NIP is a 5 year initiative to improve nutrition behaviors 1,77,000 pregnant women and their children in over 1000 tribal villages across Maharashtra. It is a multi stakeholder partnership between members with different expertise:

Sno Stakeholder Partner
1
Government Public Health officials
Govt of Maharashtra
2
Corporates looking for CSR initiatives;
Reckitt Benckiser, India
3
Researchers and Technical Experts;
Vihara Innovation Network
4
Teaching-Learning Aid Designers;
Butterfly Edufields Private Limited
5
Grass-root Implementation and Evaluation specialists;
PLAN India
6
Technology partners;
Dure Technologies

It is in lock step with Government of India’s POSHAN ABHIYAAN3 program announced in December 2017, committed to make India malnutrition free by 2022. According to 2013 UNICEF report on “Improving Child Nutrition – The Achievable Imperative For Global Progress”4, India has one third of under nourished children and an estimated 61 million of them are stunted due to chronic under nutrition (Severely Acute Malnutrition (SAM) & Moderately Acute Malnutrition (MAM) cases).

The context of NIP was given to us in the form of a 150 page, technically dense Nutrition Manual that was ostensibly prepared to train Community Nutrition Workers (CNW), locally chosen to be the catalysts for positive behavior change regarding nutrition in the community. These CNWs were 10th pass young women with little exposure & skills to navigate much less learn and then disseminate the information given in the manual.
(https://drive.google.com/open?id=18YfNoKz6cStLsUKFQL6ts-QlshOgCs8w)

Experts also shared the following information:
(Dr. Raj Bhandari – Pediatrician)

Our target groups were:
Community Nutrition Workers (CNWs)
Expectant mothers through Community Nutrition Workers (CNWs)

Objective:
Create learning aids to support CNWs in their task of mobilizing, monitoring and coaching the community (expectant mothers) to adopt positive health care behaviors in nutrition.

Knowledge & awareness about the following points has to be imparted to the target groups:
First 1000 days (from conception to end of 2 years) of a child’s life are the foundation of a child’s future life & well being. Hence it is very important to address adequate nutrition and care to expectant mothers throughout this period.
Exclusive breast feeding for the first 6 months for the infant,
Timely initiation of adequate complementary feeding from 6 months to 2 years for the baby
Reinforcement of Good and Bad Practices and also busting of myths

So, what did we do?
We needed information and insights about existing nutrition & health practices in these communities. Our team visited several villages in Nandurbar & Amravati districts which are hardest hit by malnutrition. Rather than quizzing the inhabitants, they used a checklist to observe, and let the people share their thoughts, feelings, myths and stories. Majority of the data that was captured was visual.

Nutrition Project | Butterfly Edufields
Empathy Map5 tool was used to gain deeper insights about the community
Nutrition Project | Butterfly Edufields
Field visit & interactions checklist
To create a customized CSR program in Education sector
Nutrition Project | Butterfly Edufields
Meal plate of an expectant mother

Using this data along with the information & understanding gleaned from our team’s visit, we set aside the manual and started the process of designing the Nutrition Kit, keeping the focus on the end-user’s needs and points of view. This is human centered design6.

While designing the kit, we were mindful that delivery of knowledge & awareness should be done in a fun, interactive and engaging way; in effect, we should gamify learning. This approach provides a supportive environment that will enable the users to initiate & sustain positive behavior. Research suggests that learning tools add value to a community’s social behavior change strategies regarding nutrition7. Our kit passed through several iterations with inputs from subject matter experts to arrive at suitable modules for content and field testing for acceptability with end user usage.

The Nutrition Kit has 5 modules, the details of which are given in the table below:
Sno Module Name Learning Objectives
1
Good And Bad Eating habits
Differentiating good and bad habits related to food. Sensitizing healthy eating habits.
2
Nutrimania (Level1 and level 2)
Helps to educate on basic nutritional values present in each food items.
3
Make my Meal Plate
To enhance the basic food items required for a balanced diet.
4
Hygiene – Hand wash Kit
How do germs spread, Parts of hands usually left unwashed – leading to correct steps of hand wash, Hand wash Pledge activity
5
Nutri Talkies
A hand held projector with rotating slides having images on different themes, importance of breast milk to complementary foods, etc. covering 7 important themes

Table 1: Nutrition Kit modules

Nutrition Project | Butterfly Edufields
Nutrition Project | Butterfly Edufields

Armed with this kit, we returned to villages in Amravati and Nandurbar where the CNWs were on the last day of a 10-day training program. We were given 3 hours to introduce the Nutrition Kit to the CNWs and train them in its usage. For the last 10 days, they had been subjected to bombardment of theoretical information, case studies and oral assessments.

At the beginning of our session, we found the CNWs overwhelmed, uncertain, anxious, defensive and fearful. Half an hour into the session, the thaw set in. With their hands busy assembling, experimenting and playing with the kit modules, their minds freed up sufficiently enough to trigger curiosity. This could be gauged from an outpouring of questions; lively interactions with each other and with the facilitators. The shift from a theoretical, teacher centered teaching approach to a practical, learner-centered learning had taken place. The pre & post assessment of our training program is testimony to this shift.

To create a customized CSR program in Education sector
Nutrition Project | Butterfly Edufields

Attendance Sheet for training conducted to CNWs at Amravati village on 13th July 2019

Nutrition Project | Butterfly Edufields

Facilitator showing usage of “Infant Food” module kit

Nutrition Project | Butterfly Edufields

Volunteers using the “Meal Plate” module kit

Nutrition Project | Butterfly Edufields

Pre & post assessment answer sheet of one CNW Ms Pramila

Sno Themes Pre Post Delta
1
Food for the Child -- Birth to 2 years
37%
70%
33%
2
Balanced Diet & Importance of Nutrition
18%
34%
16%
3
Importance of Breast Feeding
26%
60%
34%
4
Tool for discussion about 7 key themes
50%
82%
32%
5
Identification of Nutritious Foods
35%
48%
14%
6
Examples of Nutritious Foods
55%
49%
-5%
7
Dos and Don’ts During first 1000 Days
19%
41%
22%
8
How germs spread?
56%
84%
28%
9
Use of Soap for hand wash
55%
83%
28%
10
Steps of hand wash
22%
25%
3%

27% Improvement in average scores between Pre and Post Assessment

This is an ongoing program, where evaluation is done every quarter and we’ll present first 2 quarter results in the conference.CNW Volunteer showing “Spread of germs through Hand Shake” using the kit

Sample feedback from the CNWs
Nutrition Project | Butterfly Edufields
Nutrition Project | Butterfly Edufields

CNWs sharing their feedback post the training session at Amravati (see appendix for video link)

Conclusion
Learning in the classroom is different from learning in the field. This is probably why learning peters out once students step out of cloistered academic environments into the real world. But this is detrimental, for students have to leave the classroom someday and step into the real world. And honing 21st century skills demands that we be dedicated to lifelong learning. It is important to create & foster an environment conducive to learning all the time. Perhaps, we have to revisit classrooms & see how best we can achieve this.

What works in a classroom doesn’t always work in the field.

Taking it further
A similar human centered design approach to drive Social behavior change was taken in 2015 – 2018 for the Banega Swachh India program under Swachh Bharat mission of government of India. The aim was to bring a change in attitude towards Hygiene and Sanitation & convert the same into lasting habits among children who will then drive the change in the community through their parents & teachers. The program has reached over 5000 schools & covered over 26 lakh children in rural areas of 8 states to date.

A compact kit was designed containing 4 modules to enable teachers to impart this learning in an innovative & fun manner. See appendix for details.

Solutions for other pressing social problems like Menstrual Hygiene awareness, Solid Waste Management, Disaster Management etc… can be sought using Experiential Learning Aids.

Policy makers and those deciding IEC budgets will do well to think about better delivery of information and awareness, if they want their programs to achieve the desired goals.

Report Authors
V Lakshmi Rau, Mentor – Innovation & Design, Butterfly Fields
T Sarath Chandra, Program Manager, Butterfly Fields
K Sharat Chandra, Founder & CEO, Butterfly Fields

References
ButterflyFields – A brief https://www.butterflyedufields.in/about-us/
Launch of Nutrition program to reduce malnutrition in Maharashtra https://www.outlookindia.com/website/story/business-news-through-our-nutrition-intervention-programme-in-nandurbar-amravati-we-are-investing-in-the-future-reckitt-benckisers/328100

https://poshan.outlookindia.com/story/india-news-what-is-the-colour-of-your-food-today-reckitt-benckiser-spreads-nutrition-message-through-innovative-plates/332046
Poshan Abhiyaan – India’s flagship programme to improve nutritional outcomes http://poshanabhiyaan.gov.in/#/
Improving Child Nutrition – The Achievable Imperative For Global Progress, 2013 UNICEF report https://www.unicef.org/nutrition/files/Nutrition_Report_final_lo_res_8_April.pdf
Updated Empathy Map by Dave Gray https://medium.com/the-xplane-collection/updated-empathy-map-canvas-46df22df3c8a
IDEO’s Field Guide to Human Centered Design https://www.ideo.com/post/design-kit
Play Together, Learn Together – Book by Melanie Rice https://www.amazon.co.uk/Play-Together-Learn/dp/0753403978

Acknowledgements
We wish to thank our partners in NIP program for inviting us to join them in this endeavor, and providing us this opportunity to explore new dimensions of learning.
Project Funding: Reckitt Benckiser (RB), India
Project Partnerships: Mr. Ravi Bhatnagar (RB) – Director External Affairs
Innovation Strategy Direction: Divya Datta (Vihara)
Research Advisors: Dr. Raj Bhandari, MBBS, MD(Paed), Advisor Health and Nutrition, Maharashtra Village Social Transformation Foundation Member, NHPM, Niti Aayog

Appendix

Nutrition Project | Butterfly Edufields

Module 1: Good and bad habits for the first 1000 days
1st Phase – first 9 Months
2nd Phase – Birth to 6 months
3rd Phase – 6 month to 24 months
For the first 1000 days, the mother follows the good habits and avoid the bad habits to get a healthy baby.

Nutrition Project | Butterfly Edufields

Module 2: Nutrimania
•Trump card game to Explore the relative Nutrition values across different food items
•Two levels covering a variety of food items across food groups

Nutrition Project | Butterfly Edufields

Module 3:a) Make your meal plate
•Prepare your meal plate as a balanced diet for 3-4 meals during the day.
•Ensure that all food groups are appropriately covered
•Nutrimania cards can be referred to create additional awareness

Nutrition Project | Butterfly Edufields

Module 3: b) Food for the infant from birth to first two years
Food for the infant for:
0-6 months – Exclusive breastfeeding
6-24 months – Breastfeeding + Complementary foods

Hand Washing Nutrition Talkies | Butterfly Edufields

Module 4: Hygiene – Hand wash
•How germs spread?
•Areas missed while hand washing
•Steps in hand washing
•Hand washing Pledge

Nutrition Talkies | Butterfly Edufields

Module 5: Nutrition talkies
Hand held projector with rotating slides having images on different themes, importance of breast milk to complementary foods, etc. covering 7 important themes

To create a customized CSR program in Education sector
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