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Saturday, 21 December 2013

LRB meets with David and Fran Korten

In December 1975, LRB was nearing the end of his PhD at Columbia University. He had completed his research, and expected to finish writing his thesis in a few months. Around this time, he met with David and Fran Korten, who were then on the faculty at Harvard University. David worked at the Harvard Institute for International Development on a Ford Foundation project to strengthen the organization and management of national family planning programs. David and Fran, fortuitously for us, summarized their meeting with him in December, 1975 in a 5-page report for what seems some kind of newsletter.  This note is historically very rich from the perspective of the Reconstructing LRB project. It gives a nice summary of LRB's research, shares impressions of LRB and provides an invaluable insight into the future directions LRB hoped to take this research after returning to India, especially in terms of writing cases and possible future collaborations. The note is interesting in one other respect - it makes no mention of the Emergency that had been declared in India a few months ago - an event (and regime) that would leave a permanent scar on family planning in India. 

Meeting with Labdhi Bhandari

We met for about 2 hours with Labdhi Bhandari, a doctoral candidate at Columbia in the marketing area working under Farley. His thesis, based on data collected in India, seeks the application of marketing research techniques to the design of family planning program strategies. The purpose of our meeting was to outline a series a cases that might be developed from his thesis research. We were very impressed with him and see his research as representing a major breakthrough in the use of research for the design of family planning persuasion campaigns. His both bright and committed to working in family planning, both in India and elsewhere.

His research uses techniques developed at UCLA for generating value hierarchies and influence patterns. He decided that of the various methodologies, this was the best one available for cross-cultural use as it uses open-ended questions and does not force pre-established categories or assumptions on the respondent.

To determine the value valence of various objects, he asks questions such as "What is a good thing that can happen to you?" Many variations are possible such as "...to your children?", "...in your work?" etc.

To get at influence patterns he tasks the answer to one of the above questions and ask, "Who is likely to bring this about?" In rural India this elicits a lot of responses about God. Or he asks, "If this happens who is likely to approve?", "Who is likely to disapprove?"

He eventually begins to relate valued outcomes to family size by questions such as the following. "You say that a good thing that can happen is to have children who turn out to be worthy. How does having many children relate to this outcome? Help? Hinder?" In this general manner, he eventually gets to attitudes and practices related to family planning.

The analysis of the interview responses requires the organization of the responses into relevant categories. He was concerned that the groupings reflect the categories which were meaningful to the people he was interviewing rather than his own categories derived from a Western educational experience. (He in fact was from the area he was working in and knows the local language.)  Thus he used local people to group together the responses which they saw as being essentially similar. He observed that their groupings were quite different from those he would have used and found this in itself a rather powerful insight into the value patterns of the culture.

For purposes of relating his data to the design of program themes, he segments the population into four groups:

1. Those currently contracepting.
2. Those who do not practice, but have an intention to.
3. Those who do not intend to practice, but who do approve of family planning.
4. Those who do not approve of contraception and do not intend to practice it.

He is not particularly concerned with group 1. For group 2, he concludes that an information-oriented message relating more to birth control than to family size is appropriate. While knowledge of their values would be used as a backdrop, knowledge of value orientations is less important for this group.

He suggests that messages for group three should be derived from their values. This is the group to which values oriented messages would be directed. In this group the ideal family size is lower than actual family size and the idea of a small family is OK in their view. The also feel it is okay to do something about it. But they may feel that the methods are anti-religious. They tend to have a strong religious-moral orientation. Or they may be concerned that the methods weaken the body. This is often a concern with tubectomy and vasectomy. There is a belief that those who have had the operation are unable to do hard physical labour and are more often ill.

Group four does not approve of any effort to limit fertility. They do not want to fool with God at all.

He finds attitudes cluster around two subjects--family size and birth control methods. The target group can be differentiated as to whether their resistance relates to one or both of these cluster or concerns. Generally the non-users generate a whole cluster of values much more strongly oriented to the traditional than do the users.

Bhandari noted that often the bad associations with sterilization arise from the poor administration of the progress of the program reflected in inadequate training of personnel and very limited follow-up. The operations are performed and the people forgotten. You only need a few causes of peole getting infections or even dying and you have real image problems. He commented, "One doctor who was doing sterilizations told me himself that he was not well enough trained to do the operation."

In general when people in groups three and four are asked to relate birth control and many children to other outcomes they see only the negative associations with family limitations. They don't connect with the positive valences. The important need is to build positive relationships within the context of their particular value system.

When they talk about the good things that can happen they want to own a house or make progress on their farm. Progress on their farm usually means to have land of their own. Less than a quarter of those from the negative group who mentioned this saw achievement of this aim as related to having fewer children. For group four the number one value is progress in their occupation--on their farm. Actually the negative associations with this group are mainly with the method. In fact, children as such are on the whole not seen as either helping or hindering with achievement on their aims. Only 19% of the fourth group saw having more children as negative. But on the other hand, only 23$ saw it as positive. Thus for most likely there was simply no association between family size and welfare.

His research indicates that there are two major economic arguments in the literature (the one that children are seen as an expense and the other that they are seen as an economic asset) are both myths. At least among the groups studied, the thinking about children is not in relation economic welfare.

The relevant values that do come out very strongly are concern for the welfare of the children. Family harmony is very highly valued. They are concerned about health and about meeting family responsibilities in terms of taking good care of both their children and their parents. They are very interested in having a good agricultural year. It is not a good life or getting ahead kind of thing. It is a matter of survival. And it is largely in the hands of God. Another very important value involves seeing that the children are married of well.

All of this means that one must understand the intricacies of family values to be able to approach the family meaningfully. The people who write the mass media and guide the field motivators have to be better trained in the nuances. Most of the prevailing approaches are based on assumptions regarding who the people think and what they value. The concerns about providing food and hospitals for the growing population are concerns of the national administration. Appeals to these concerns have no meaning for the common people unless they have developed an identification with national needs. Now what does have tremendous meaning for this is the division of land. They see it and they can understand it.

Bhandari noted that there are implications in this type of analysis for the kind of people you assign and for the type of training you use. Also for the methodology of the work. One part of the training of the field workers might involve getting them to categorize the statements collected from such interviews and have them compare their groupings with the groupings actually made by the local people, as a means of developing understanding of the local value system.

In India it is almost universal that the health post staff are not local. Even the janitors tend to commute to work.

The field work was done in Jodhpur, the western most large city in Rajasthan. The rural sample was collected in 8 villages in the region, including a mix of agriculturally well off and agriculturally poor. During the course of the research, Bhandari learned a lot about the program and how it works and how it was perceived by the people. When he gets back he will attempt to get the results to the local officials. He might also develop a project at Ahmedabad. He is getting copies of the messages being used in the program and will work on how they should be adapted, at least for this area.

Another concern he has is with how the program could be more marketing strategy oriented. He has a lot of information pointing up how the family planning effort simply does not use a marketing approach. Nirodh is completely administrative  separate from the rest of the program up to the very higher national level. Thus though the clinics have Nirodh, it is not their program. It is not part of their targets and they don't push it, even though they know that their own product is not well received. The religious perceptions vary by method. The concern is against tampering physically with the body. This is what is anti-religious in their view. Not taking a pill.

IT is interesting that villages have said to Bhandari quite unprompted, "If only there were a pill that we could take." The economists calculate that sterilization is the most cost effective method, ignoring the issue of acceptability. If the program were looked at as a marketing problem there would be more concern for product mix and with how attitudes toward the product are influenced by values. IT is also necessary to learn to think of the price in terms of what the consumer gives up align with the direct costs to the government. Another problem is that since the system has no accountability to the consumer, consumer acceptance is given much less concern.

More attention needs to be given to the dai. The dai are extremely influential in India on all birth related ailments and on female illnesses. At present India has auxiliary nurse midwives coming in from a different culture. They are perceived as an economic and social threat by the midwives, who as a result do everything in their power to make them ineffective. Bhandari commented, "Now obviously you wouldn't appoint someone without influence in the community to sell Chevrolets. Why do it to sell birth control?"

Being from outside the area the ANM's don't understand the people, even if they know the language. They don't know the nuances. He was in a village with an ANM where the villagers were making fun of the ANM with nuances in the language she couldn't understand.

He has data on sources of information relied on by the villages, but not on the actual social structure and organization of the villages. He would like to develop this when he gets back to logk further into the issues of how to use these structures.

We discussed three case themes which he hopes to develop in the near future base don the data and observation described above.

1. RESEARCH BASED PLANNING FOR MASS COMMUNICATION THEMES.

The directly reflects the theme of his dissertation and would probably be the first case to be completed. To simply clearance, the case will probably be written from his point of view as a researcher. Once he gets back to India and tries to sell his concepts it might be possible to add an actual decision maker perspective. The case will briefly explain the methodology and purpose of his research and will summarize the relevant findings. It will also present data on the themes currently being used in Indian family planning mass communication campaigns in the area he studied. HE must evaluate the adequacy of the existing themes, based on his data, and make recommendations for appropriate changes. We might actually want to follow it with a short B case presenting his own recommendations which can then be used as a basis for review.

2. COMMUNICATION AT THE VILLAGE LEVEL.

This second case would focus on the issues related to the various field workers and the person-to-person contacts at the village level. IT would be oriented to issues of the selection and training of field workers, to the way in which they make contact with the village, whom they approach, what messages they communicate, and how they might work through village social structures. Much of this can be built from the data Bhandari already has. His research finding would be an important input, but this case would also require much more contextual data on the community and the field workers than would the mass communications case. He would probably need to develop some additional data on the village social structures and might want to make more observations on field worker contacts. A first cut at this case could be usefully done before returning to India with a plan to fill in some of the gaps after his return.

3. A NATIONAL MARKETING STRATEGY for A FAMILY PLANNING EFFORT.

While this isn't the right title, it reflects the thrust of the anticipated case. Essentially the case will be an overview of the Indian national family planning effort providing the data required for an overall program analysis from a marketing perspective. It would probably be used follow the previous two cases and would bring in issues of product mix, market segmentation, selection of distribution channels, coordinating mass communications and point of contract promotions, and a whole range of related marketing concerns. He intends to write a brief conceptual note describing the basic marketing concepts and their applications in other settings which would provide guidelines of the case analysis. While this can be outlined before he returns to India, it will probably also require more field work. A more interesting decision-maker focus might also be introduced if he is successful after his return in getting some top-level attention for his concepts.

Action Issues: We think that we should be exploring a variety of ways to encourage and support Bhandari's population work. He could be a major new asset for the ICOMP network. First, we think it would be useful to help him get as much exposure as possible for his work. HE is interested in working with anyone interested in trying out the methodology in other settings. Second, it is important to help him get whatever support may be required to keep him fully active in the population field. He will be returning to IIM Ahmedabad in mid-1976. We are not sure whether arrangements have been made for him to join Satia's team, but Dave has written Satia a letter recommending Bhandari as a member of his team. We should be looking for other ways to involve him in ICOMP. One thought that comes to mind beyond development of the cases would be to include him in an editorial role on the casebook we are considering which would focus primarily on the marketing aspects of family planning. We suspect he would be very useful in working up the conceptual parts of the book and in making input to the analysis sections. We could work out an appropriate mix of responsibility between him and us once we get some actual samples of his work.

Labdhi has an immediate problem of funding. His field work in India was funded by the Population Council. His work at Columbia has been covered by a fellowship which runs out the end of this month. He needs funding for another two or three months in New York for completing his thesis. He then apparently has another two or three months before he is due to return to Ahmedabad. During that time he is anxious to find some means of support so that he can get some further experience outside of India, particularly experience that would give him more exposure to population efforts in some other countries. He could be a real asset to Allen Rosenfield in planning the evaluation-management seminar and Dave has suggested to Al that he contact him. Perhaps there might be some role for him in preparation for the ICOMP conference. We could also see trying to link him up with the Population Services International for purposes of developing cases on some of their commercial distribution projects.

In additional to talking to Rosenfield we have suggested to Hank Elkins and Joel Montague that they get acquainted with him. Dave has talked to Pathfinder which has a potential interest in his work. Dave has discussed his situation with Wickham and he will be discussing his work with Farley.

*Over the years, LRB would continue to collaborate with David and Fran Korten, through ICOMP and then the Management Institutes Working Group. When we contacted them recently, David wrote "I remember his name so fondly and so well as a valued friend and colleague over many years in relation to my work with ICOMP and the Management Institutes Working Group. His article on the Poor as Consumers in "Bureaucracy and the Poor" so well reflects his keen intellect and readiness to challenge the flawed conventional wisdom that was all too common in development work.".

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