From ‘Seed to Kulcha’: Our Remote Journey to Create a Locally Relevant Social Behavior Change Campaign for Maternal and Child Health in Tajikistan

In late 2020, Changeable was hired by Abt Associates as part of the USAID Healthy Mother Healthy Baby (HMHB) Project in Tajikistan. HMHB is a new, expansive project that aims to improve maternal nutrition and child health in a country we had never stepped foot in, and ultimately never would due to the COVID-19 pandemic. Our task was to develop a resonant SBC strategy that would motivate and enable families in the country’s Khatlon region to adopt improved maternal and child health practices. 

We were excited to dive in even as key questions loomed: How would we begin to understand the hearts and minds of Tajik mothers and families remotely? Would a local project team feel comfortable owning and implementing this new strategy? How would we receive important feedback not only with a language barrier but with 6,000 miles between us and our target audience? 

We didn’t have all the answers, but we got to work. The first steps in our process were to research and learn everything about the country’s context and identify local experts on the ground to guide us. 

 

Understanding The Context From Behind a Screen

Tajikistan has some of the highest rates of stunting in Central Asia and the world. Eighteen percent of all children between the ages of 0 and 59 months have stunted growth, and Khatlon had some of the highest stunting rates in the country.

One of our most valuable resources became a local behavior change expert, Rano, who joined our team as a consultant. She helped us understand the context further; young children in the Khatlon region were fed suboptimal nutrition, partly due to the fact that men and women – similar to many places in the world –  simply did not plan money, meals, or their hopes and dreams for their families together.

Additionally, we found there were knowledge gaps among our key target audiences: pregnant women and mothers of young children, their male spouses and mothers-in-law. We discovered that folks had lots of information about healthy food, but less understanding about how to prepare it in tasty, culturally acceptable, and convenient ways – especially to reduce the workload for overworked moms and caregivers. Additionally, misinformation was prevalent, for example, concerns that nutrient-dense foods like eggs cause developmental problems for young children if consumed.

 

Focus group. August 2021.

The Campaign

Our client asked us to create two campaigns to complement their current health systems and their planned community work: 1) A campaign on joint decision-making in the home and 2) A campaign on how to plan, prepare and feed children locally available, nutritious foods. 

These two campaigns aimed to: 

  1. Increase awareness of recommended practices and their benefits to children and their families.
  2. Build skills and self-efficacy for improved nutrition, and joint decision-making practices among family members. This was done by demonstrating easy-to-adopt behaviors.
  3. Create an enabling environment by improving social support in the household and community. The support would encourage mothers and caregivers to adopt specific Maternal, Newborn and Child Health (MNCH) and Infant and Young Child Feeding (IYCF) practices, and inspire others to do the same. 
  4. Improve social and gender norms for joint decision-making and planning among families and their communities

Building On Resonant Beauty

Having worked for years in nutrition SBC, we knew there was a lot of work that had already been done, that we could look to for inspiration. Due to the social distance and travel limits imposed by the pandemic, we had to come up with a strategy that did not rely on in-person meetings and access to the field. 

We like to use the frameworks of ‘consumer journeys’ and ‘life stage approaches’ to frame how we view client needs, barriers and facilitators. We were especially inspired by a maternal and child health campaign from another USAID-funded project in Tanzania, called Siku 1,000 (translation, 1,000 Days). This particular campaign used the growth process of a sunflower as a metaphor for the early stages of a baby’s development. We took this concept and adapted it to the Tajikistan context. 

Campaign Inspiration from Tanzania: Siku 1,000 (1,000 days)

 

Sunflower. Child growth and nutrition through four stages over the first one thousand days.

 

Our Creative Concept: ‘Seed to Kulcha’

Instead of using a sunflower, we initially thought to use the growth stages of wheat since it is a common crop in Tajikistan. Rano and our local Tajikistan team added an important local twist; instead of depicting the end of the growth process using a wheat bushel to signify a grown child, she suggested using the ‘kulcha’, a beloved traditional bread. Just like the careful steps one takes to make a delicious ‘kulcha’, raising a healthy child requires loving care. 

Rano helped us understand how the ‘kulcha’ is commonly featured in Tajikistan nursery rhymes. Her insights helped us build a story that would allow us to package messages about the key life moments for babies in a locally resonant way.  

For our ‘Seed to Kulcha’ concept, we compared the critical stages of a young child’s life to the stages of creating a delicious kulcha from wheat. At each stage, the ‘seed to kulcha’ concept identifies target behaviors families should take, to ensure their young children reach their optimal health and growth. Each of these Life Moments is defined by a set of recommended MNCH practices proven to improve maternal and child health and aligned with the Tajikistan government’s national communication framework. 

The 5 Life Moments we highlighted were:

  1. Pregnancy
  2. The first seven days of a child’s life
  3. Days 8-40 of a child’s life
  4. Day 40 to 5 months of a child’s life
  5. 6-23 months of a child’s life

Target Audiences

After careful consideration, we decided on three priority audiences in the project’s 12 target districts: a) pregnant women and mothers of young children, b) male spouses of pregnant women and young mothers, and c) mothers-in-law. Instead of solely focusing on mothers, we took a holistic approach that included their spouses and mothers-in-law, due to their influential roles in the household.

We created audience archetypes and made these segments the priority focus of all key messages and community-based activities. Once we came up with draft materials, Rano led our testing and local focus groups to ensure communication messages resonated with each group. We also took extra steps to ensure the local team had opportunities to provide input at every step of the way. For instance, we created a campaign mood board and provided options for illustration styles to ensure our materials were visually appealing and culturally appropriate for the local audience. 

The resulting brand and campaign extend seamlessly from print to screen, using a cohesive system of photography, illustration, graphics and colors that bring vibrancy to every piece of communication material. 

 

 

Audience Archetypes

Pregnant Women/ Mothers of Young Children

She’s 23 years old, has some secondary education and has been married for approximately three years. She has one other young child at home and hopes for more. She lives at home with her husband and his family in rural Khatlon. Her days are busy with doing most of the housework, and she worries about either appearing to have too many needs, being seen as lazy, or being ‘too much trouble’ by her in-laws. She has heard she should breastfeed and give her child healthy food, but she doesn’t always know what that means or how to do either of those things well while still doing all that’s expected of her in the family. 

Spouse of Pregnant Women/ Mothers of Young Children

He lives in rural Khatlon and is a migrant worker. He’s the primary breadwinner for the family and is aware of the importance of good nutrition for pregnant women and young children but doesn’t have much detailed information about what that actually means. He gets information from his mother and his friends, but the information is not always reliable or accurate.

Mother-in-Law of Pregnant Women/Mothers of Young Children

She is in her late 50s and is married. She works with her husband as a farmer. She lives in a rural area with her extended family, including her son and daughter-in-law. She’s considered the informal head of the house when her son is away or doing migrant work.

Campaign Mood Board

A mood board helped guide our creative team through the process. The aim was to capture the details such as preferred colors, patterns and textiles.

Implementation

Throughout the course of the project, we organized virtual meetings with the Tajik team and local partners since we were unable to travel in person. Rano helped to facilitate buy-in among stakeholders for our social behavior change approach which is relatively new to Tajikistan. Along the way, she built trust and helped key stakeholders see the benefits of SBC.

Ensuring a smooth roll-out on the ground

Along with regular calls and routine coaching, we produced implementation guidelines including detailed campaign kick-off kits and action plans. Rano was able to conduct in-person local workshops and training to ensure a smooth roll-out.

Drama Production Guide – Campaign Kit.

To date, the feedback received after the initial implementation has been overwhelmingly positive. The campaign has been embraced by the target audience, local stakeholders and the national government.  In early 2022, the national government launched the campaign videos on television stations across the nation. One local community manager shared, “The materials you’ve developed and provided are fantastic and we enjoyed the day-to-day learning and integrating them into our daily activities. I hope to see you someday in Tajikistan and show you the fruits of the tree you have planted.” 

While the pandemic didn’t make this easy, we loved the challenge of finding remote ways to merge ideas and mindsets – across cultures, continents and computer screens – to create a successful campaign that has resonated with our local audience. And of course, we hope to visit Tajikistan in person one day.

Campaign visibility in public spaces (mock-up).

 

National Campaign Launch, February 2022