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No claim for originality of the programmes is made by HETV. We acknowledge our gratitude to the many people and sources whose work has been drawn freely upon. We thank them all.

Programmes will be supplemented and supported by booklets, leaflets, posters and informational guides in Marathi and English, and made freely available at health worker stations, hospitals, schools, and more.
 

Behaviour change techniques, including social marketing, community mobilization, motivational interviewing, communication, and education, to increase awareness of the link between contaminated water and disease and the benefits of safe water, and to influence hygiene behaviours including the purchase and proper use of the water storage vessel and disinfectant.

Protect against diseases through the promotion of clear guidelines about proper feeding practices and the benefits of immunity. Promote the practice of providing colostrum to the child within the first half hour after birth, exclusive breastfeeding during the first six months of a child’s life, with appropriate complementary feeding from six months and continued breastfeeding for two years or beyond, with supplementation of vitamin A and other micronutrients as needed.

Oral rehydration therapy, if properly practiced, can cut infant and child mortality rates by at least half and obviate the need for countless millions of costly visits to hospitals, health centres, and clinics in all countries.  But is this feasible? Packets of oral rehydration salts (ORS) are not universally available and the simpler sugar-salt solution can have dangerous effects if it is improperly mixed or administered.  Cereal-based ORT can overcome both of these disadvantages by providing yet another option for oral rehydration therapy. 

40% of both mothers and children in Maharashtra, India are chronically undernourished, and under-five mortality occurs at 58 deaths per 1000 live births, or 1 in every 17 children. A very large number of these deaths are caused by dehydration from diarrhoea, the most easily preventable cause of childhood mortality.

Health workers will inform mothers, especially those with limited education or who cannot read, using this series of washable, easily transportable, and simple-to-use health guides. These handkerchiefs with drawings, diagrams, and graphs, contain useful health information, and will be distributed to health care providers throughout Maharashtra.

Complementary feeding means giving foods in addition to breastmilk. Malnutrition can result from suboptimal breastfeeding practices, poor quality complementary foods, detrimental feeding practices, and contamination of complementary food and feeding utensils. The second half of an infant's first year is an especially vulnerable time because infants are learning to eat and must be fed soft foods frequently and patiently. If nutritional intake is inadequate, the consequences persist throughout life.

Experience shows that food should not be withheld from infants and children with acute diarrhoea. Depending on their feeding status, children should receive breast-milk or diluted milk feeds; in cases of dehydration, these should be offered as soon as initial rehydration therapy has been completed. Appropriate locally available foods (cereals) should be offered as soon as the appetite returns. After the diarrhoea ceases, more than the usual amount of food should b given for a short period. The routine use of any special infant formula (lactose-free products) for diarrhoea cases should be strongly discouraged as they are only rarely necessary and are costly.

Define and Promote Home-Made Solutions--define clear definitions for home-made solutions (tea, rice water with extra rice, etc.)

The first-level health worker, a community health worker who has a crucial role to play in disseminating knowledge and skills for the management of diarrhoea, as regards the use of both home remedies and ORS. ORS packets should be available in adequate supply at this level and throughout the entire health system. If this is not possible, maximum efforts should continue towards this end and, in the meantime, as complete a formulation as possibly should be used, recognizing its limitations. When potassium is a missing ingredient, patients should be encouraged to drink fluids that are rich in potassium (fruit juices). Increased fluids and Preparation of home-made and packaged solutions. For the preparation of ORS solution the safest water should be used.

Intended to target mothers’ confusion and lack of understanding about how to recognize, assess the degree of, and treat diarrhoeal dehydration. Mothers will be taught the crucial need for immediate fluid replacement, increased fluids and food, how to correctly prepare home-made and packaged ORS, cereal-based ORS, when and why to use it, and continuous feeding, including breastfeeding.

Enhance the current knowledge of diarrhoea management by facilitating lectures and training courses which will allow for dialogue and interaction of hundreds of people simultaneously. Key health issues will be taught and discussed by doctors, medical specialists, medical students, and health care providers at the existing 100 virtual learning centres in Maharashtra with video conferencing facilities linked by satellite.

This 13-month calendar, corresponding to the 13 Facts for Life messages, makes life-saving information easily available to everyone. It presents important health information about an issue or concern that every family has a right to know. The messages are simple, and people in Maharashtra can act on them. The calendar will also indicate state health days, and health educational mass media events.

For those without Internet access, all these resources will be available on a CD which will be freely distributed to health care providers, educators, reference libraries, doctors, schools, universities, and hospitals in Maharashtra.

Reduce incidence of diarrhoea by promoting measles vaccination within the first year of a child’s life. 100% immunization coverage against measles is the programme goal.

Correct the confusion created by years of mixed messages regarding measurement of the ingredients in rehydration solutions. Mothers will receive a plastic one-litre bottle, with a label about how to recognize signs and degrees of dehydration, how to prepare home fluids for rehydration, and how to mix and prepare home-made and packaged ORS. Additionally, they will receive a 2-sided spoon to correctly measure salt and sugar.

Provide a monitored, consistent, and expedited health worker training process, including a certification program, for the Mother Child Protection Card. The CBT will accelerate the current pace of training to health workers by using over 1,000 computer literacy centres throughout Maharashtra. This will provide a better learning experience through interactive computer exercises, and, when necessary, give the option to complete an individual training module at a modified pace.

Skilled attendance during pregnancy, childbirth and the immediate postpartum period. Mothers will be provided with training for breastfeeding from the nurse or midwife, encouraged about the importance of providing colostrum within the first half hour after birth, and advised about other questions they may have about their newborn or postpartum period.

The portal hetv.org provides a comprehensive set of resources relating to health education. Materials can be downloaded for offline research or printed for easy dissemination.

Educate all school children, especially young girls before child-bearing age, about important health information. A partnership between the Ministries of Health and Education in Maharashtra will include the teaching of proper health practices within the curriculum.

Educate the general public and mothers about health issues through an informal dialogue in various radio formats (interviews, documentaries, quiz shows). The radio programmes will educate with the same messages as the TV broadcasts, but will reach a wider audience.

If mothers could recognize and treat dehydration early on at home, the great majority of children would not need additional medical care. While only 41% of mothers in Maharashtra can correctly identify symptoms suggesting a child needs medical treatment for dehydration, 77% take a child with diarrhoea to a health facility. In this way, better practice and education would save mothers the trouble and expense of traveling to the health centre (and also prevent them from spending money on unnecessary drugs), and it would release some of the burden on health facilities, allowing better treatment for children who are severely ill.

Water quality interventions that employ simple, inexpensive and robust technologies appropriate for the developing world. The objective is to make water safe through disinfection and safe storage at the point of use. The basis of the intervention is:

Point-of-use treatment of contaminated water using sodium hypochlorite solution purchased locally and produced in the community from water and salt using an electrolytic cell;

Safe water storage in plastic containers with a narrow mouth, lid, and a spigot to prevent recontamination;

Behaviour change techniques, including social marketing, community mobilization, motivational interviewing, communication, and education, to increase awareness of the link between contaminated water and disease and the benefits of safe water, and to influence hygiene behaviours including the purchase and proper use of the water storage vessel and disinfectant.

Educate school children about health issues in descriptive messages, cartoons, and animation printed on their notebooks. Young school-children will see these key health messages almost every day to encourage them to become health conscious members of society, and to convey important information to their families and the community.

Educate and encourage young boys to be health conscious members of society, and to convey important health messages to their families and the community. The Boy Scouts will partner with the government of Maharashtra, attend school events and public fairs, organize rallies and fundraisers, create and distribute handouts.

Disinfect soiled water with this free and easy technique using solar radiation. This simple process of filling transparent containers with water, and exposing them to full sunlight for about five hours, destroys pathogens in the water.

Educate the entire community about health issues through documentaries, commercials, news programs, public service announcements, and other TV programs. The broadcasts, linked to the Facts for Life Calendar, will advertise health days and other monthly TV health shows.

Encourage the culture of having children later in life and having a child at least 24 months after a previous birth. Reduce health risks for children born to mothers under the age of 18 by educating about the importance of timing births as it relates to the dangers of diarrhoea.

Encourage and contribute to developing the necessary partnership between the state of Maharashtra and the Government of India’s programmes to establish toilet facilities in all schools. The Indian government has launched a focused campaign to increase the households in the country that have toilets by 2010. Additionally, we will target the urgent need for separate toilets for boys and girls, together with a hand-washing facility in every school in Maharashtra.

Promote the habit of Hand Washing with Soap and Water to decrease episodes of diarrhoea. To ensure the sufficient availability of soap, partnerships with local manufacturers will be used to promote this practice.

Treat soiled water and prevent the spread of disease by promoting the practice of boiling water and the usage of chlorine, iodine, or even household bleach, to conduct home water disinfection. Health workers will be trained to use these practices, and will convey the techniques to mothers.

P&G Health Sciences Institute scientists have been looking for new ways to purify drinking water since 1995. Much of this work has been in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). This research has led to the development and testing of an affordable and simple-to-use in-home water purification product, PUR Purifier of Water. This new product visually clarifies the water and reduces pathogenic bacteria, viruses, and parasites to result in drinking water that meets World Health Organization guidelines for potability.

Point-of-use treatment of contaminated water using sodium hypochlorite solution purchased locally and produced in the community from water and salt using an electrolytic cell.

Online health education videos for mothers, health care providers, medical specialists, doctors, and students. These videos can be easily transferred for news, TV, or radio broadcast.

ORS and Zinc : Treatment of diarrhoea is now more effective

Prevent deaths from diarrhoea and decrease child susceptibility to diarrhoea after episodes by educating all health-care providers and mothers about zinc supplementation. Through focused and integrated campaigns, and through partnerships with local manufacturers, we will increase availability of zinc supplements.