 So, it's been about a year or so, we have now started using health-spoken tutorial pedagogy. What we have done, in Nandurbar we had trained 1000 people, but basically IIT Bombay team had trained 1000 people. What we realized that it is very, it's not sustainable to train so many people by one team. So, what we have decided or what we've been doing actually with Nashik and Vashem and many other districts that we have created this health-spoken tutorial pedagogy where we select people, you know, so I will go through that pedagogy and you know, I will also discuss our experience of the results after undergoing this pedagogy at district level. So, what we do is basically, we give district about a month to plan and prepare, you know, we need some data from each and every healthcare worker, so we get that data, we get data for safe application, you know, so that we can do online exams. Later about a month or so when we have all the data with us, we give them basic content, these are online 3-hour health-spoken tutorials and some of them are from NPTEL, we give them 3-hour content, all of them they watch this content in a group seating and during that time we ask all the healthcare workers including Department of Health and ICDS to adopt 3 babies each, you know, because we want to see how those baby 2 or how they are using this knowledge content which they have learned through online in the field, it's more of a DIY, do it yourself. After 2 weeks of 3-hour content, we give them exam, okay, this is online exam also called Familiarization Test and after the test online exams, we give them 6 hours of more content, okay, the content is pretty much what you're going to see but we select which content to be given to all the healthcare workers, most of these districts have anywhere between 3000 to 7000 healthcare workers, okay, so smaller district has smaller numbers, bigger districts have bigger number but basically we do this add-on content for 6 hours, we ask them to watch it in a group setting, after giving this add-on content we give them 4 weeks to watch it, some of them they may like to watch it again at home so we give them access to online watching also but our focus is that they should come in a group setting and watch the 7-6 hours tutorials, after that we do selection, screening test, so we do, we give them another exam, 100 mark exam, online exams and then we select basically we have created a formula and depending upon, you know, a cadre, we give different weightage to different cadre and we select about 250 people, okay, now this 250 best performing people, after about selection of this 250 people, we train them on Q-dwell application, another really good application that, you know, one of our vendor has created but IT Bombay has given lot of technical input, you know, and what we do is, you know, we call this 250 people in the batches of 40 and we train them on hands-on skill, you know, so we do breastfeeding, you know, workshop, we do complementary feeding workshop, we do protein calculation workshop, we teach them how to plot growth charts, right, so we do that, we also teach them learning action protocol which you will learn in this course, so we teach them a lot of this, you know, practical workshop, we take them to hospital, district hospital, we teach them how to breastfeed or how to counsel mothers, you know, different holes, specifically cross cradle hole, my favorite hole, after that, we also actually during training, we train them on Q-dwell application, how to use it, what all forms to fill, it is a mentoring application, they learn through Q-dwell application, you know, what exactly is wrong with the baby, why baby is not gaining weight, what is to be done, which with totals to be shown, which clip to be shown, what advice to be given, everything we teach them through Q-dwell application, okay, after about, you know, a face-to-face training, we give them one week of practice time to work on Q-dwell application, so we give them simulated data, they can practice on Q-dwell and after about a week or so, we ask them to adopt 10 baby, mother baby died, okay, this adoption is very, very important because if they are adopting babies, they will know actually whatever that they have learned from tutorials as well as from other things, you know, like workshop, we will able to know whether they are learning or they are applying that knowledge in the field or not, okay, and there are different categories that they have to adopt, first category is of course, 7 month pregnant mother, because they will be teaching her protein calculation, they will be teaching her what food to take, which are high in protein, we will also tell them to adopt 5 babies between 0 to 7 days of age and postnatal babies between 5 and half to 6 months of age, okay, this is a complementary feeling babies, and we also during training, we also talk about self-care, so we do teach them adult nutrition also, which you will learn in this course, and because we want to make sure that they understand their own health, while they are taking adopting these babies, they also go through 30 hour in-betel model, which you are going through, so they do go through 30 hour model to understand more detail about all these, you know, tutorials, and here then they adopt these babies, they growth monitor, they go through LAP protocol, learning action protocol, and after 3 months, what we do, we take the test, we take the theory exams, okay, which are from 30 hour module, we also assess all those babies that they had adopted, we assess whether babies have done well or not, okay, and one month after that, we select 50 supers 50, we call it super mentors, and we go back again, IIT Bombay team go back to the district and train those 50 mentors to be trainers, so we make them very confident, you know, so that they can teach other health care workers, now these 50 super mentors are basically, they are an asset to the team, a district team, so they can basically teach, you know, or train other people in the district, okay, so this is our HST pedagogy, we have been working very well, we are also kind of improvising with every district, lot of learning, you know, and these are all the criterias of which babies to adopt, what to do, you know, so these are all quite detailed, you know, that they go through, and of course we do recommend THOs and CDPOs and medical offices to go through our NPTEL course, because as you know, that it is quite in detail, and you know, they learn a lot, and obviously we want them to learn more in detail through NPTEL, so that they can guide, you know, triplets, okay, so this is our pedagogy, so here is our experience with the Nashik, once Nashik went through this health spoken total pedagogy, and we created master mentors, okay, so we created about 60 mentors, they went through really grueling six months to be selected as master mentors, we also selected 30 facilitators, co-facilitators, because they had done pretty well, and rest of the people who had not performed so well in the field, we kind of eliminated, okay, so just wanted to show you some of the results that we found in, you know, in the babies that they had adopted, so here is wait for age measure for children born to mothers who are just in the A&C stage, so some of this, so two mothers that they were supposed to adopt in seven month pregnancy, okay, so for almost two months they taught mother every two weeks on protein-rich food, so we wanted to see like how, what was the weight at birth, so mothers who were adopted by mentors, who were super mentors, you can see that the percentage of, you know, SUW, MUW, and underweight at birth means low birth weight babies were much lower, so only 6% children are, they were born low birth weight, okay, and some of these babies were even kind of followed up through and, you know, that LBW, the underweight reduced from 6% to 4.5%, okay, here is wait for age co-facilitators, so you can see that, you know, all those babies who were born to co-facilitators, there was no low birth weight babies, okay, wait for age for other learners, again, you know, at birth, you can see 71 mothers were adopted, so low birth weight rate was 11.27% and basically, of course, these learners had not performed well, so they could not teach mothers how to breastfeed, you know, technicality of breastfeeding, so you can see that, you know, when these babies were checked again, that, you know, underweight increased from 11% to 16, 17%. Unfortunately in India, we have so much of growth faltering occurring because of not teaching proper breastfeeding techniques that you can see over here, so if you teach mother proper technique, not only, of course, because of good nutrition during pregnancy, underweight rate is low, but if you, again, teaching those babies who underweight proper technique, you can still decrease, you know, and of course, these babies were seen within two or three weeks, so we don't have much time, if you would have taken this baby's weight, say, after one month, two months, three months, you would have seen even better results, okay, here is basically, you know, data collected by trained healthcare workers, so birth weight, you know, like a number of mothers who adopted by mentors, you know, this all different data, I will not go so much in detail about that, here is weight for age for children, zero to five months of age, so these were the babies who adopted as new bonds and they were followed by mentors and they all had followed LAP protocol, learning action protocol and, you know, so some of them followed these babies for one month, some of them had followed babies for two months, some of these babies had followed for more than three months, okay, so here we wanted to see if they followed babies for, say, more than three months using our protocol, how did this baby fair, okay, so here this 168 babies that they had adopted at the time of birth, you can see at the time of birth, you know, basically low birth with babies about 31%, okay, but literally within three months that 31% reduced to 8%, you know, it's just by teaching them correct techniques of breastfeeding, okay, these are the same super 60 mentors, if they adopted babies for just two to three months and not continued monitoring those babies, we wanted to see how they performed within two months what happened, so again, low birth with babies from 30%, it came down to 7%, so there's a remarkable reduction, you can see at CW reduced, you know, MUW reduced, even over here, you know, when they were adopted for more than three months, from 14.8%, it came down to 2.3%, okay, so this is the data of Nashik, here, you know, if babies were adopted only for one to two months, okay, so here also you can see there is a reduction, not much, because it takes some time to improve their weight, okay, so here 55% children were born, you know, kind of low birth weight, but it came down to only 44% because babies were not monitored for more than a month or two, okay, similarly you can see other areas MUW and SCW also, these are the children who were followed by co-facilitators, okay, these are newborn babies, they have done well, but not as well as mentors, okay, so here you can see co-facilitators when they adopted babies for more than three months, their percentage at the time of birth, they have almost 29% low birth weight, which was reduced to 20%, babies were SUW at birth, you know, they were reduced basically when they were adopted or when they were monitored for more than three months, you can see the reduction, remarkable reduction in latest weight, right, same thing for if co-facilitators adopted babies for two to three months, you can see some reduction, you can see SCW reduced by almost half, almost, you know, underweight, reduced from 32% to 19%, and babies who were followed only for one to two months, even in that you can see reduction in, you know, from underweight 12% to 6.25%, okay, that is your co-facilitators data, weight for age measured for children 0 to 5 months followed by other learners, now these are the learners which were, we had not selected because they had not performed, they had not followed our protocol, they were not teaching mothers correctly or something was missed, so here you can see even those people who adopted mothers for more than three months babies, you can see some reduction, not as much as I would like but there is still some reduction, here also you can see now if babies were adopted only for two to three months, you can see that it is increasing, you can see the growth faltering occurring in all three areas, and over here two other learners list babies followed for one to two months, again you can see increase in growth faltering, except for SCW, so this was a reason that they were not selected as super mentors, now we wanted to see if you adopt babies say in a complementary feeding stage, so what would happen if you adopt those babies in complementary feeding stage, so here you know if for mentors you know those super 60 people look at the data, I was really really surprised to see that at five and a half month of age when they started adopting these babies after the training, 35 percent children under weight means 35 percent children or 30 yeah 35.38 percent children they were already had growth faltering right because they were not taught proper breastfeeding, but even this children if we taught mothers proper complementary feeding you know not only improving the breastfeeding but teaching them protein how to make protein rich powders at home what to do, you could see the reduction in underweight from 35 percent to 6 percent you know percentage of MUW from 21 percent to 4 percent okay and percentage of SUW at five and a half months from 13 percent to 1.5 percent, so that's a very significant reduction in stunting, now stunting takes sorry this is weight for age, so this is weight for age data, so you can see you know they improved remarkably in weight, here this is length for age, so we wanted to look at the length you know for children more than three months of age, so stunting also reduced remarkably you can see 32 percent children were stunted at the time of adoption, so that is reduced to 7.69 percent, there's a reduction in severe stunting as well as modest stunting okay, there is not much change light change in other learners even co-facilitators you know not much change but mentors they did remarkably well with you know reduction in stunting okay, now this was for wasting wasting means weight for length okay, so here we wanted to see if children if they were adopted at more than five months of age you know what happened when they were they were seen for more than three months, so you can see reduction of stunting remarkable reduction of stunting in this children sorry wasting, you can see remarkable reduction in wasting in this children and that wasting reduction is there in pretty much all the categories okay, so children were coming out of wasting pretty quickly just by showing the correct techniques of breastfeeding okay, so here I am going to stop this is our experience in Nashik, we are now working in various districts Madhya Pradesh we are working in seven districts you know we are starting hopefully in Goa also, so now we are working more at the state level but of course every district and every state has more learning it's more and more learning and we are improvising our pedagogy as we we're going through it okay, so thank you so much and see you next time