In just two generations, Nepal's demographics have vastly changed. More people are educated, live in urban areas, have sources of income other than agriculture, and are exposed to the outside world through visits for employment, education, or tourism. For example, 93% of new mothers have completed high school. This is a dramatic 86% higher than the grandmothers as only 7% of them have completed high school. Half of families are nuclear, and 32% of mothers are raising their children alone as their husbands have migrated abroad for employment. With migration comes remittances and greater purchasing power. According to a January 2022 survey, 73% of mothers have access to a mobile phone, and nearly 58% of those with mobile phones have access to internet. These changes will impact how development programs are delivered in Nepal. This presentation will highlight the changing demographics of Nepal and the evolving media preferences that have impacted development programs, including in health and nutrition. Taking insights from the USAID-funded Suaahara II Good Nutrition program in Nepal, the session will reflect on the program's adaptation of communication approaches and challenges, specifically by adopting digital media and leveraging the power of mobile technology and social media. In particular, the session will focus on the challenges of developing a mobile application targeted to communities with lower digital literacy, slower internet bandwidth, and higher data cost.

Building on the Covid experience in Uttar Pradesh, India, in the year 2021, a phone-based counselling system (Hello Didi 2.0) was established to accelerate rehabilitation of Severe Acute Malnourished (SAM) at home and increase the demand and utilization of maternal nutrition services. This covered six blocks of three aspirational districts affected by array of social and gender equity issues. A new mix of digital platforms-including telephonic counseling, SMS (Short Message Service), entertaining WhatsApp videos and audio-books- was harnessed for rescuing SAM children and Pregnant Women during the pandemic.
With caregivers from last mile population at core, trained tele-counselors engaged simultaneously with Frontline Functionaries (FLFs) and the caregivers. A combination of information & counseling; problem solving; and entertainment education approaches were used.
A visible change in food and feeding practices among the most vulnerable families has been seen. Comparison of feeding practices between first and fourth call shows consumption of food groups increased to four or more food groups (14 percent to 46 percent) and meal frequency (four meals or above) increased from 10.2 percent to 22.5 percent.
Digital penetration is quite high globally and this experience can be replicated by public, private and social sector for accelerated gains in multiple development outcomes.
Keeping in view the importance of scale, diversity and equity issues, it is recommended to Institutionalize digital capacity within public sector; Enhance public-private partnership; Adopt mix of conventional (like community platforms) and digital platforms; Engage more with women SHGs & federations and Nudge men through digital platforms.

SBCC interventions have struggled to reach "the last mile." We developed the Wanji format using basic cell phones with interactive voice technology to reach marginalized communities who have less access to education, limited literacy, and/or limited digital access. Drawing from social cognitive theory and research about interactive narratives, we have developed interventions on topics including financial savings, sexual and reproductive health, agricultural practices, public health, and COVID-19 prevention. We employed a series of mixed methods studies including a field experiment in Uganda, a laboratory experiment in Cambodia, and audience tracking in Mali. The results support the promise of interactive phone technology using basic mobile phones for social and behavior change. In the field experiment, there was evidence suggesting the possibility for participants to learn more from interactive, narrative than from static content that is simply read over the phone. Moreover, we addressed the important question of how much exposure to an intervention is necessary to affect change. Intervention designers must balance the importance of repetition for learning and behavioral change against the possible consequences of decreasing enjoyment and boredom. Finally, we found that new interventions using interactive mobile phone technology could be rapidly deployed during COVID-19, reaching large audiences with limited access to technology and health information. 

In response to the global COVID-19 pandemic, Vietnam introduced strict measures to control transmission, including social distancing and lockdown. During these unsettling times, people living with HIV and key populations (KP) were a vulnerable group, requiring adapted support and focused information on COVID-19 and COVID-19/HIV prevention. Understanding these needs, the USAID/PATH Healthy Markets project crowdsourced ideas from the community to rapidly offer online HIV services. This included setting-up an Online Risk Calculator whereby clients can self-screen for their HIV risk, order an HIV self-test (HIVST) kit, and contact a KP-clinic to receive follow-up counseling and care. In addition, the project launched the "#Stay Home. #Self Test." campaign, co-created and promoted by KP-influencers across various online platforms, and boosted COVID-19/HIV communications across TikTok, YouTube, gay dating apps, and other online channels. 


From April 2020 – February 2022, more than 2.8 million people have viewed the #Stay Home. #Self Test. campaign, helping 2,265 self-screeners access and use the Online Risk Calculator and directly resulting in 1,230 HIVST kit orders and 668 bookings for pre-exposure prophylaxis (PrEP) services for HIV prevention. At large, these innovations have contributed to the rapid scale-up of digital media in Vietnam's HIV response that is pivotal in increasing connection with communities that are at risk for HIV and improving service uptake.