Communication for Behavior Change. CLICS considered its BCC strategy crucial to achieving its objectives of creating awareness of preventive health practices to promote safe motherhood and child health behaviors and utilization of services. It was critical for effective community mobilization to improve access, availability, and equity of health services. A well articulated BCC strategy has been developed in the project, based on Integrated Model of Communication for Social Change (IMCFSC) that involves community dialogue and collective action to engineer a social change in the community through ownership of information and decision making for action at the community level. There has been a significant impact of BCC on the critical behaviors in the households in the project villages. The most important visible change is in the environment of villages. There was an increased commitment and enthusiasm among the community members with a positive attitude towards child survival and safe motherhood issues and project activities. More importantly, the CBOs and VCCs have consistently sustained active interest in the program. There was a significant change in the key indicators in the Endline Survey (ES) conducted in June- July 2008 (Table 4, pg 17). A few examples of improved behaviors include: breastfeeding of newborns within the first hour after delivery, fully immunized children, institutional deliveries, hand washing practices, and birth intervals. The process of BCC strategy development and implementation was completed in-house in four steps:
Communication for Behavior Change. One of the major activities of the project was awareness raising on child health issues. This was intended to provide mothers and caretakers of children pertinent information on the six top killer diseases of under fives. It was expected that this increased awareness would result in a positive change in attitudes and practices in the individuals and subsequently in the communities in favor of behaviors that promote child and maternal health and enhance their survival. Building on existing IEC materials of the MOH and the 16 key household/community practices that promote child health and survival developed by WHO/UNICEF, the project, the MOH and AAPPEC developed a set of IEC materials in the six domains of the project (flyers, posters, audio messages) and used them to facilitate behavior change communication between service providers and the caretakers of children. The project trained frontline health staff, CBO and health committee members, TBAs, the health promoters and project field staff on how to use these materials. The audio messages were broadcast by two rural radio stations in the project zone. The methods used to disseminate the messages included group health education talks, interpersonal communication, sketches, songs, and radio broadcasts. The FGD and KPC results demonstrate that there has been a tremendous increase in the knowledge level on child health issues among caretakers, and a significant change in behavior. Some behavior change objectives were attained while others were not. The overall trend was in favor of positive behavior change. However, there is still much to be done to sustain the trend. ITN use by under fives and mothers increased from 0.4 % at baseline to 33.6 % at the final evaluation, which exceeded the objective of 20%. The proportion of mothers who wash their hands with soap before feeding the child increased from 35.4 % at baseline to 62.5 % at the final evaluation. Those who wash hands with soap on return from defecating increased from 2.6 % to 20.6
Communication for Behavior Change. During preparation of the DIP, CSP staff took the first steps in building a BEHAVE framework. During a two-day workshop participants helped identify Priority Behaviors, Motivators, Barriers and Channels for communication. Due to time limitations at that point, the Doer/Non-doer exercise was not completed. After project start-up activities were established, the MTI HQ CS Advisor visited the project to collaborate with the team in defining a Social and Behavioral Change Communication plan, refining the BEHAVE framework and completing the Doer/Non-doer exercise. This further refined plans and a revised BCC Plan was developed. A follow up workshop was held with representatives of the MOHSW, the GCM County Health Team, the national Breastfeeding Advisory Group (BAG) and CHAL to review the revised plan (along with C-IMCI materials, below). The MTI HQ Capacity Building Advisor visited Liberia to conduct a workshop to develop C-IMCI curricula that also would include adult training methodologies. The HQ CS Advisor assisted the team to develop flip charts to complement the C-IMCI curriculum. Examples of materials used for C-IMCI were gathered from the MOHSW, BAG, CHAL, Africare and the Ghana MOH and discussed and adapted. These were then field-tested by project staff with input, revision and review by MTI HQ Capacity Building Advisor and CS advisor. MTI’s CSP uses the following Channels of Communication within its BCC strategy: Interpersonal communication: Regular home visits are provided by each Household Health Promoter to 15 homes with children U5 in every community, prioritizing those with children 0-23 months of age. LQAS results at midterm show this strategy to be effective in changing behaviors. Refresher training will be provided in Year 3 to further strengthen HHP skills in one-to-one dialogue and negotiation for behavior change. Traditional ways of Learning: CHAL Community Health Promoters train HHPs during Care Group activities within communities, and mentor HHPs during health outreach activities within their communities, which (besides home visits) include occasional group sessions with mothers and/or community gatherings called by the Town Chief. In group activities, traditional adult learning techniques are used employing drama, stories and songs to disseminate messages. Print education materials: MTI CSP and CHAL staff, with support and review by MTI HQ CS Advisor and Capacity Building Advisor, have produced a laminated set of flipcharts with pictures...
Communication for Behavior Change. Communication for behavior change is at the pillar of the six project interventions that have been carried out under the Strength Project in Nacala-a-Velha and Memba Districts. Hence, communication objectives were closely linked to the program interventions. Some of the BCC- related specific objectives under the project interventions include: • Immunization: Mothers/care takers will get their children fully immunized before their 12 month birthday; • Malaria Control: Mothers/care takers with children < 24 months old with fever in previous two weeks will seek care within 48 hours of noticing symptoms; • Maternal and Newborn Care: 85% of women have at least two antenatal visits with trained health personnel during their last pregnancy; and
Communication for Behavior Change. The project is using some methodologies that have a great potential for changing behavior. Use of support groups, dialoguing with mothers to reach an agreement for behavior change and mass media have the potential to make sustainable changes in health behaviors. Most of these activities are just beginning and should be the focus for increased emphasis during the second half of the project. The project needs to continue to move away from the use of health "talks" to give information towards the use of other more interactive and innovative methods of adult education. All of the messages being promoted by the project are in accordance with official MINSA policy and all essential elements are included. The project works in excellent coordination with ministry staff and uses whenever possible MINSA educational materials. During the MTE, anecdotal reporting of changes in practices was wide spread. In interviews with volunteers, community members and health personnel all reported that they observed changes in practices, primarily in increased breastfeeding, better hygiene, increased use of ORS and decreased use of baby bottles. A KPC survey was used at baseline to measure essential health behaviors in mothers with children under 2. This KPC was not repeated at mid term, but will be used to measure project impact as part of the final evaluation. The use of information concerning changing health behaviors has not been formalized in the project. CHWs report using home visits as an informal method for measuring changes at the household level, especially in hygiene and use of water filters. In some communities, CHWs report discussing health issues with the CHW network or committee, but the practice was not widely reported. In about half of the health facilities there are monthly meetings between health personnel and community volunteers for the purpose of sharing experiences. One of the most exciting recommendations to come out of the MTE is the planning for differences in activities based on the annual cycle of seasonal employment and workload of project participants. Planning for the work cycle, especially in the urban area, will greatly enhance effectiveness of the interventions, and take a more realistic view of what activities can be accomplished. A large percentage of the rural and urban population migrate temporarily to pick coffee and another segment to work in coffee processing. Work conditions are terrible-with long hours, few breaks, low pay and no benefits...
Communication for Behavior Change. The BCC approach employed by Healthy Babies is quite strong. All messages and materials have been very carefully developed by the project staff and validated with the target population. Illustrations created by a local illustrator, depicting people and situations that people identify with. As a result, the project has produced BCC materials and messages that truly resonate with the target audience and, most importantly, are completely understandable. However, only a minority of the planned materials have been published and distributed, and the radio spots are also still under development. The materials that are in use (birth plan poster, laminated picture cards on various topics) have been very well-received by health personnel, CHWs, and beneficiary mothers, and quite effective in conveying the behavior change messages. They report that the designs and colors are very understandable and draw attention. In the case of the laminated picture cards, the CHWs and health staff find them very effective in the community because they do not intimidate the audience with text. These also work well with low literacy populations, and native groups who do not speak Spanish. The supply of sufficient picture cards to all CHWs is essential to their work in their communities. In general, all participants in the project (both trainers and trainees) would like to have more BCC materials to use as education tools and to distribute to the community: their request is a compliment to the project’s materials, but these need to be made available for more effective interventions. For the BCC materials still under development, it will be important to ensure that the company making the materials fully takes into account the suggestions given during the validation tests for the illustrations and messages, as has been done thus far with other materials.
Communication for Behavior Change
