C-Change Picks - Focus on Malaria and Family Planning/Maternal Health
C-Change Picks #6 - Focus on Malaria and Family Planning/Maternal Health
Information about Social and Behaviour Change Communication, sponsored by C-Change
May 12 2009
From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.
C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health, as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com
C-Change Picks #6 focuses on resources that may be useful for implementers, programme managers, policy personnel, and journalists who work on and write about malaria prevention activities. Also included in this issue are resources to support social and behaviour change communication activities for programmes focused on family planning and maternal health, particularly postpartum care.
C-Change is working in Ethiopia with the President's Malaria Initiative (PMI) at the community level to increase knowledge about malaria prevention and help communities put into practice malaria prevention actions. These efforts include encouraging the correct and consistent use of insecticide-treated nets (ITNs), increasing acceptance of indoor spraying, and promoting prompt care seeking for malaria symptoms and adherence to treatment. Additional information is available at the C-Change website.
You will find the current edition of C-Change Picks online - click here.
For the archived issues of C-Change Picks, please click here.
C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com
1. Malaria Supplies Useless Unless Combined with Appropriate Communication
2. Research on Use/Non-Use of Bednets
3. Malaria in Pregnancy Resource Package
4. Malaria: Integrated Campaigns Toolkit
5. Malaria: BCC/IEC Programming Q&A
6. PMI Communication and Social Mobilization Guidelines
7. Journalist Orientation Session: Effective Communication Is Vital for the Elimination of Malaria
8. African Media and Malaria Research Network (AMMREN)
FAMILY PLANNING/MATERNAL HEALTH
Social Change Communication (SCC):
9. Recommendations for Community-Based Postpartum Care Services
Behaviour Change Communication (BCC):
10. Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya
11. Strengthening Maternal and Newborn Care Services in Bangladesh
12. Comprehensive Postpartum Family Planning Care Training
13. XXVI IUSSP International Population Conference
14. International Conference on Family Planning: Research and Best Practices
MALARIA: PROGRAMMING RESOURCES
1. Malaria Supplies Useless Unless Combined with Appropriate Communication
This report, "Delivering Malaria Control to Those in Need: How to Succeed in a Time of Renewed Hope" from the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG), explores issues related to the proper delivery of existing tools for malaria control and treatment. According to this report, in many areas, malaria is as much of a problem as it ever was, and in areas associated with conflict, malaria can often increase, as control mechanisms break down. In these areas, "[t]he millions of deaths annually are largely due to failure of delivery of these tools to those who need them, particularly the poorest, and especially children." Thus, the argument here is that, although excellent tools like drugs and ITNs exist, they will be of limited effectiveness if they do not reach the right people, in the right ways.
To understand how to enhance delivery, APPMG looks at the multiple ways in which effectiveness can be reduced, proposing strategies to resolve these challenges. Some of the approaches explored in the report are communication-centred. For example, when it comes to ensuring coverage with anti-vector methods, APPMG observes that children and their parents may not have information about how to maximise the effectiveness, and therefore use ITNs at the wrong time of day (e.g., to ward off flies, not mosquitoes), or do not use them in the peak malaria season because they feel too hot.
The report extends 3 behaviour change-related key recommendations:
- Link methods of delivering ITNs through the public and private sector to interventions to promote use and retention.
- Base decisions on evidence of what works, not on ideology, when deciding how the public sector, civil society, and the private sector can help improve delivery of treatment.
- Combine interventions as packages tailored to particular settings, since the reasons for failure of delivery of existing tools are complex and context-specific.
2. Research on Use/Non-Use of Bednets
This August 2008 report, "Ethiopia Bednet Utilization Study: Why Some Nets Owned Are Not Used" describes a study carried out to determine levels of ownership and use of insecticide-treated nets (ITNs) in households in the Oromia and Amhara Regions of Ethiopia. Although nightly use is optimal, sometimes people use their nets sporadically or do not use them at all. To understand why, and to develop effective communication for optimal net use and public health impact, this research was carried out by NetMark, a project at the Academy for Educational Development (AED) funded by the United States Agency for International Development (USAID).
The study used both quantitative and qualitative methods. The survey instrument included close ended pre-coded questions as well as 4 open-ended questions. The study also included observation of nets in homes, in addition to market visits in three towns in order to assess commercial availability of nets, current prices, and leakage. The data were collected during October 2007, at the end of the rainy season when mosquito density and malaria transmission is high. In February 2008, rapid follow-up qualitative visits were made in selected kebeles (urban dwellers' associations) in the same three areas, enabling a seasonal comparison of net use.
After obtaining information on nets owned and usage patterns (all reported in the study), interviewers explored reasons for inconsistent or non-use of nets.
Responses pointed to the following:
- Perception that malaria is not a problem
- Perception - and possibly reality - that ITNs have lost their effectiveness
- Difficulty hanging nets in Ethiopian dwellings
- Nets in poor condition
- Misinformation and lack of information
- Saving nets for the future
- Nets being used for other purposes.
"It is imperative that a standard set of straightforward priority messages be developed to be delivered along with the nets...[N]ow that all free nets are LLINs, standard information can be given during distribution. Messages regarding [insecticide] treatment, specifically how long the treatment lasts, are key, along with a statement about maximum washing frequency. Accurate information about potential danger of ITNs should be conveyed in a way that does not cause alarm and rejection of ITNs for vulnerable groups. Community members also need to know how to hang the net properly....In addition to verbal communication during distribution, tested flyers or posters with key messages should be available as back-up reference. It is also important to communicate that as many family members as possible should sleep under a net and that the net should be used year-round. Along with factual information, families need motivation to go to the trouble of using nets, especially in areas where there are few mosquitoes. Our objective is to get people to use nets for malaria protection, but communication strategies should use messages that resonate and are likely to change behavior by drawing on other benefits people like, such as being able to sleep peacefully, nets killing other insects besides mosquitoes, or families saving money by having to buy fewer medicines or make fewer trips to the health center. It is also essential that information be received from a variety of channels..."
3. Malaria in Pregnancy Resource Package
This online resource package is designed for policy makers, public health professionals, and managers who are implementing, scaling up, or updating programmes designed to reduce malaria in pregnancy and provide effective treatment for pregnant women with malaria. The resource package includes training resources, programming resources, and reference materials, all free to download and intended to be easily adapted to a specific country's public health context.
The package contains the following sections.
- Training Resources - materials and guides for a two-day workshop to train health care workers to prevent, recognise, and treat malaria in pregnancy. Includes a multimedia tutorial that discusses the impact of malaria on pregnant women and newborns and other important issues concerning the prevention and control of malaria in pregnancy, as well as an orientation package that aims to rapidly disseminate new information in a technical area, such as national policy guidelines, to front-line providers through concise, user-friendly materials.
- Programme Resources - a programme implementation guide intended to help African countries implement and scale up programmes to prevent and treat malaria in pregnancy, communication strategy and information materials, and job aids that serve to improve communication between healthcare providers and clients about malaria in pregnancy.
- Reference Materials - information about the Malaria In Pregnancy (MIP) Strategic Framework, MIP monitoring and evaluation guidelines, information sheets, the WHO Technical Consultation Report on intermittent preventative treatment, and a collection of abstracts from key articles on MIP.
4. Malaria: Integrated Campaigns Toolkit
Published in September 2008 by the Alliance for Malaria Prevention (AMP) based on experience integrating LLIN campaigns with vaccination/nutrition campaigns for children under age five as primary platforms, this toolkit provides numerous lessons that can be applied across the goals of universal ITN coverage. With 7 key chapters, "A Toolkit for Developing Integrated Campaigns to Encourage the Distribution and Use of Long Lasting Insecticide-treated Nets (LLINs)" takes organisations through the process of planning and implementing campaigns around ITNs. It covers planning; coordination; budgets and fundraising; logistics; communication; the technical aspects of campaigning; and sustaining campaign results. It also includes examples of chronograms and a sample timeline, as well as a list of resources. The toolkit comes with a CD-ROM containing the documents referenced in the resource list.
5. Malaria: BCC/IEC Programming Q&A
"Q&A for Managers of President's Malaria Initiative (PMI) BCC/IEC Programs" explains the difference between managing a procurement programme and managing to change opinion, attitudes, and behaviour on use of recommended malaria preventions, such as: insecticide-treated nets (ITNs); artemisinin-containing combination therapies (ACTs); or intermittent preventive treatment (IPTp) for all pregnant women. The sheet was created by the PMI in March 2009 to give support to those managing behaviour change communication (BCC) and information, education, and communication (IEC) programmes.
Topics include:
i. What should I require BCC/IEC programmes to achieve at start up, expansion, and full-scale implementation? (This answer includes a "Checklist for One Year")
ii. Technical questions
iii. Programme implementation questions
iv. Monitoring and evaluation questions
v. Costs and budgeting questions
6. PMI Communication and Social Mobilization Guidelines
From the President's Malaria Initiative (PMI), the purpose of the "PMI Communication and Social Mobilization Guidelines" is to assist in the development, implementation, and monitoring and evaluation of programmes to influence behaviours around malaria interventions including the following: correct and consistent use of insecticide-treated nets (ITNs); acceptance of indoor residual spraying (IRS); and adherence to treatment and prevention therapies, including intermittent preventive treatment in pregnancy (IPTp) during pregnancy and treatment with artemisinin-combined therapy (ACT) for children under five within 24 hours of onset of symptoms. Published in January 2008, the guidelines intend to increase demand for malaria services and products, as well as community involvement in malaria control.
These guidelines are structured as a planning framework. They explain how to establish goals and objectives, review existing data and conduct a rapid assessment, develop a strategy with a budgeted plan of activities, and monitor and evaluate the process." The cycle diagrammed in the document begins with planning and strategy development, continues with selecting interventions, the programme implementation; and, finally, a rapid monitoring and evaluation process.
MALARIA: RESOURCES FOR JOURNALISTS
7. Journalist Orientation Session: Effective Communication Is Vital for the Elimination of Malaria
Because of the lack of information among the Cameroonian general public, the Global Malaria Action Plan (GMAP) indicated the necessity of an effective communication programme for the eradication of malaria. In response, the Cameroon Coalition Against Malaria (CCAM), in collaboration with the National Malaria Control Programme (NMCP) and the United Nations Information Centre (UNIC), organised an orientation session for journalists at the CCAM Courtyard in the Bastos neighbourhood in Yaounde, Cameroon, December 17 2008. "Effective Communication Is Vital For the Elimination of Malaria" reports on that event.
CCAM brought journalists together with manager of CCAM, Dr. Esther Talla, and the Drive Against Malaria members, David Robertson and Julia Samuel. Robertson and Small explained that many people are not informed about the disease, making it difficult for it to be stamped out, and expressed regret that, although malaria is the highest killer in Cameroon, the prices of malaria medicines are relatively high, making it difficult for the economically poor to purchase these drugs for treatment. According to this report, these presenters contributed to the power of their message by describing their work within Drive Against Malaria, which is bringing attention to malaria as a preventable and treatable disease and is raising money to fight malaria in Africa. Robertson began driving across Europe in 1998 as a one-man mission and now, with Julia Samuel, drives to remote villages in Africa to distribute mosquito nets and information to fight malaria.
8. African Media and Malaria Research Network (AMMREN)
Launched in 2006, the African Media and Malaria Research Network (AMMREN) promotes malaria research communication in Africa by strengthening the capacity of African journalists through training. The network also focuses on disseminating information on malaria control initiatives and monitors and advocates for the implementation of malaria policies in Africa. It also advocates and engages policy makers to implement international agreements on malaria control.
To support their key activities of information sharing, networking, advocacy, and training and capacity building, AMMREN produces the "Eyes on Malaria" news magazine. This is a 32-page magazine, available in English, French, and Portuguese, which is published bi-annually in hard copy and on the Internet. The magazine seeks to bring to the fore issues related to malaria, including research findings, policy directions, and general issues around prevention and treatment. The magazine also captures events and happenings in the international arena related to the disease.
FAMILY PLANNING/MATERNAL HEALTH
FP/MH: SOCIAL CHANGE COMMUNICATION
9. Recommendations for Community-Based Postpartum Care Services
From October 2008, this report, entitled "Community-Based Postpartum Care Services in MotherNewBorNet Member Programs" compiles results from a survey conducted to identify, document, and share information on the status of community-based (CB) postpartum care (PPC) and postpartum family planning (PPFP) services implemented by MotherNewBorNet (MNBN) member organisations in the Asia Near East (ANE) region. MNBN is a network established in 2005 to improve maternal and neonatal health at the community level.
In the summer of 2007, USAID's Extending Service Delivery (ESD) Project sent a structured questionnaire electronically to 50 individuals representing member projects and organisations within MNBN, of which 28 responded. The questionnaire covered the following topics: project background, provision of PPC services, newborn care, best and promising practices, challenges faced, monitoring and evaluation (M&E), recommendations for improvement, and lessons learned.
Selected findings include:
- In areas where participating projects are working, 70% of births took place in the home. Only 10% were reported to be assisted by skilled birth attendants, and 37% were assisted by traditional birth attendants (TBAs).
- The majority of projects are actively mobilising different categories of community-based health workers (CHWs) to identify women in the community for PPC services.
- According to ESD, 3 common models of CB PPC exist in the field: 1) home visits by professional health care providers; 2) home visits by CHWs with little or no referral provided (primarily used for newborn care home visit programmes rather than maternal health programmes); and 3) home visits by CHWs with referral or health facility support. When asked about the model that best described their PPC services, the majority (18/19) cited model 3.
- The majority of respondents reported that their service providers have been trained in delivery of PPC. Among those whose providers received such training, the majority reported that PPFP was included as part of that training. According to ESD, "[i]t is important that all service providers are trained in provision of postpartum care, i.e., all elements of PPC similar to training service providers in essential components of focused [antenatal care, or] ANC and newborn care...PPFP counseling should be an essential element of PPC training."
- As reported by survey participants, effective practices include: presence of referral mechanisms, home visits, community care starting from ANC, establishing community support systems, and focusing on activities valued by the family.
- The top 3 reasons for not providing FP counselling were: FP is not considered a priority by the woman/family; focus is on the newborn in the postpartum period; and CHWs have not been trained in FP counselling.
Based on survey findings, select prioritised strategic recommendations are as follows:
- Increase service providers' knowledge and skills related to essential PPC services that must be provided at a minimum, including timing and frequency of postpartum visits and PPFP. To that end, a consensus needs to be reached among international organisations and postpartum advocates for a prototype "essential integrated PPC minimum package" (similar to the essential newborn care package and focused ANC package).
- Improve community support for PPC by strengthening social mobilisation and community involvement activities to increase community/families' awareness, demand, and use of PPC - particularly in areas where PPC is "not considered a priority by the family," and PPC is "not considered a community norm."
FP/MH: BEHAVIOUR CHANGE COMMUNICATION
10. Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya
This June 2008 report describes and assesses an initiative to develop and introduce a strengthened postnatal care (PNC) package into one hospital and 4 health centres in Embu district, Eastern Province, Kenya. Two United States Agency for International Development (USAID)-funded projects - the Population Council's FRONTIERS project and Jhpiego's ACCESS–FP project - formed a partnership to support Kenya's Department of Reproductive Health (DRH) in its efforts to document the feasibility, acceptability, and quality of care of the endeavour to increase both the recommended timing and content of postnatal services a women and her infant should receive to at least 3 assessments within the first 6 weeks after childbirth. This orientation package, which was introduced and evaluated between 2006 and 2008, also provided opportunities to deliver appropriate family planning (FP) advice and methods at several points in time.
As detailed within the report, the PNC-FP package incorporated relevant maternal and newborn health care services in the postnatal period with a specific focus on postpartum FP. Job aids were also produced. The 3-day orientation training included staff from the participating health facilities, as well as provincial and district reproductive health (RH) trainers/supervisors.
The study used a pre-post intervention design. For the quality of care assessment, data were collected through interviews with health care providers, structured observations of client–provider interactions during the postnatal consultations and a facility inventory. Postpartum women were recruited and interviewed following childbirth on the postnatal ward in Embu Provincial General Hospital and interviewed again in their community after 6 months.
Selected key findings included:
- Comparisons of the quality of care provided at 6 weeks between the pre- and post-intervention groups found that, overall, the total score tripled.
- Comparisons of the quality of fertility and FP counselling during the 6-week consultations found that the intervention "led to dramatic improvements in all of the indicators, with over two thirds of women being advised about return to fertility and at least two methods, and over 80 percent of women being asked about and receiving their preferred method."
- Most women interviewed on the postnatal ward within 48 hours said that they intended to use FP during the subsequent 12 months; significantly more women made this statement after than before the intervention (84% vs. 68%). Also, significantly more women were observed accepting an FP method during the 6-week consultation after the intervention (specifically, the intrauterine device (IUD) and the lactational amenorrhoea method, or LAM).
- Although there was no difference in overall use of FP between the 2 groups at 6 months, there were significant differences in the timing of starting to use an FP method: Before the intervention, only 6% of women had started using FP by 2 months, whereas this had increased to 62% of women in the post-intervention group.
11. Strengthening Maternal and Newborn Care Services in Bangladesh
Through the Strengthening Maternal and Newborn Care Services project, the ACCESS programme is working to increase the practice of healthy maternal and neonatal behaviours at the household level in 7 upazillas (sub-districts) in Bangladesh. Community mobilisation and policy and advocacy activities to strengthen maternal and newborn health care services are designed to support this BCC effort.
This project draws on one of the key lessons learned from the community-based newborn care study project called "Projahnmo": interpersonal communication (IPC) in or near the household is considered the most effective means for behaviour change. Supported by USAID and the Saving Newborn Lives (SNL) initiative, Projahnmo was originally carried out in 3 upazilas; here, ACCESS has scaled up the project by extending it into additional areas within the district.
As with the Projahnmo initiative, ACCESS is carrying out IPC with the specific goal of involving the entire range of important decision-makers in the lives of pregnant women. To this end, community-based interventions are tailored to reach people at multiple levels - community, family, and individual. At the community level, resident community mobilisers (CMs) conduct group meetings with both men (husbands of pregnant women and heads of households) and women (pregnant and senior family members). These meetings are held at clusters of households or at locations in the community (shops, mosques, etc.). During the group meetings, CMs share information about maternal and newborn health; they also facilitate role-plays around improved practices.
Another key focus is negotiation at the home level to identify specific household barriers to maternal and neonatal health, and to arrive at viable solutions. Group-based meetings are supplemented by one-on-one counselling with pregnant women and their families. Resident literate women were trained as community health workers (CHWs). During the visits in pregnancy, CHWs emphasise BCC messages, encourage women to seek antenatal care at the health centre or satellite clinic, and negotiate maternal and newborn care practices with the family. During the postpartum visits, the CHWs assess the health of mother and baby and encourage use of postpartum care. During inclement weather such as floods, the counsellors travel to homes by boat.
For lessons learned from the original project on which this current ACCESS project was built, please see "Projahnmo I Sub-study: Maternal Behaviors and Morbidity during Pregnancy, Delivery, and the Early Postpartum Period in Rural Bangladesh - Final Report".
12. Comprehensive Postpartum Family Planning Care Training
These resources, available online, are part of a four-volume workshop package from ACCESS-FP on "Comprehensive Postpartum Family Planning Care." The training package addresses the need for family planning during the extended postpartum period and provides information for a three-day training designed with components for participants and trainers, as well as a set of presentations and presentation notes.
The package contains counselling checklists, role plays, and case studies for interactive training sessions. These sessions give providers the necessary information to provide clients with an understanding of the lactational amenorrhea method (LAM), transition to other family planning/control of conception methods, counselling for the period of the woman's return to fertility, and the health benefits of waiting at least two years after the birth of their last baby before trying to conceive again.
13. XXVI IUSSP International Population Conference
Marrakech, Morocco
September 27 - October 2 2009
This will be the first IUSSP International Population Conference to be held on the African continent and in an Arab country. The Conference will include over 180 regular scientific sessions, poster sessions, and training sessions, as well as plenary and debate sessions, side meetings and exhibitions. Simultaneous translation in French and English will be provided for all plenary, debate, regular and training sessions. In addition, simultaneous translation in Arabic will be provided for all plenary and debate sessions and all sessions organised by the Moroccan NOC on population issues in the Arab world.
14. International Conference on Family Planning: Research and Best Practices
Kampala, Uganda
November 15-18 2009
While an extensive base of research on and experience with family planning programmes has accumulated over the past forty years, its recent volume is much lower. The economic impact of reproductive change, such as on poverty or national savings with shifting dependency burdens, needs updating with emerging data. Likewise, full potential of contraceptive practice in preventing unsafe and unnecessary abortions, maternal and neonatal deaths, or the transmission of HIV to newborns warrants more complete study. This international forum for scientific and programmatic exchange will enable the sharing of available findings and identification of knowledge gaps, as well as using new knowledge to transform development policy. The individual abstract submission deadline is June 1 2009, and the preformed panel submission deadline is June 15 2009. Participant registration will be available June 15 2009. More information is available on the conference website.
Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org
The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.
This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.
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