Common use of Communication for Behavior Change Clause in Contracts

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: 1. Conducting formative research and undertaking a dialogue with the community to identify facilitating factors and barriers to child survival and effective channels for communication of messages; 2. Designing and producing an integrated package of communication material and activities to facilitate change; 3. Developing skills of the program staff and partners; and 4. Using multiple channels of communications to disseminate the behavior change messages in the community. A doer and non-doer survey was also undertaken to identify key behaviors and factors that influence them. decisions, responses, and indicators has been developed. The program staff has identified the target groups, the right behavior to promote, key factors to be addressed, channel or media for communication, activities to promote such behaviors, and indictors to measure change. To date CLICS has addressed 15 behaviors (outlined in Annex 5). For each behavior, messages have been developed. The messages are clear and simple, and appropriately address the targeted behavior. The messages were tested in the villages prior to development of the communication material. A variety of communication materials have been locally developed, including posters (printed and hand written), flip charts, and models. Some of the materials were procured from the District Health Office and the state health department. Mass media activities at the village level were the major strength of the behavior change efforts in the CLICS program. These included Bal Suraksha Diwas (Child Survival Days), ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ aani Balachi Mohim (Safe Mother and Child Campaign), ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ (Save the Female Child Movement) and Parenting Workshops. The first two activities were organized on a monthly basis in each village by the VCC with support of the COs, CLICS Doot, ANMs and AWWs of the respective areas/villages. The role of the VCC in organizing these activities was commendable. The members of the VCC commanded respect from the village women. Role plays and skits, performed by the VCCs, SHGs and KPs, were very popular and well attended. The following communication channels have been used in the program: • Interpersonal communication has been effectively used by the CLICS Doot and COs at individual and household levels to communicate key messages. The FE team observed that the members of VCCs, KPs, project ANMs, and AWWs are actively involved in IPC. However, the participation of ANMs belonging to the public health system was limited. • Group level communication activities were effectively organized for CBOs by COs and program coordinators through regular meetings. VCCs have played an effective role in the BCC activities by conducting group meetings with the women (SHGs and KPs) which were very effective in communicating messages on safe motherhood and child survival practices and interventions. KPs and VCCs have regularly organized orientation workshops for school teachers and upper class students for family life education to facilitate group interaction. • Mass media activities at the village level were the major strength of the behavior change efforts. These included Bal Suraksha Diwas (Child Survival Days), ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ aani Balachi Mohim (Safe Mother and Child Campaign), ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ (Save the Female Child Movement), and Parenting Workshops. The first two activities were organized on a monthly basis in each village by a VCC with support of COs, CLICS Doot, ANMs, and AWWs of respective areas/villages. The role of the VCC in organizing these activities was commendable. Members of VCCs commanded respect from the village women. Role plays and skits, performed by VCCs, SHGs, and KPs, were very popular and well attended.

Communication for Behavior Change. CLICS considered its BCC strategy crucial The project is using some methodologies that have a great potential for changing behavior. Use of support groups, dialoguing with mothers to achieving its objectives reach an agreement for behavior change and mass media have the potential to make sustainable changes in health behaviors. Most of creating awareness these activities are just beginning and should be the focus for increased emphasis during the second half of preventive the project. The project needs to continue to move away from the use of health 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 promote safe motherhood and child measure essential health behaviors and utilization 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 servicesthe final evaluation. It was critical for effective community mobilization to improve access, availability, and equity The use of information concerning changing health services. A well articulated BCC strategy behaviors has not been developed 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 Integrated Model the annual cycle of Communication seasonal employment and workload of project participants. Planning for Social Change (IMCFSC) that involves community dialogue and collective action to engineer a social change the work cycle, especially in the community through ownership urban area, will greatly enhance effectiveness of information the interventions, and decision making for action 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. It is unrealistic to expect that project activities will be able to continue at the community levelsame intensity during the months when the majority of people are working 15-16 hour days, than when they have less demanding work loads during other months. Take advantage of the months from July to September for group meetings and training. From October to June, focus on the use of indirect methods such as radio, popular education, printed materials, home visits, and activities with the schools. Take advantage of Sundays when people are at home. Another strategy to reach more people is to provide education where the people work, particularly taking advantage of the higher literacy rate of the urban population. There has been a significant impact of BCC on the critical behaviors in the households in the project villagessome attempt to do this, but there is so much potential that increased effort should be made. 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: 1. Conducting formative research and undertaking a dialogue with the community to identify facilitating factors and barriers to child survival and effective channels for communication of messages; 2. Designing and producing an integrated package of communication material and activities to facilitate change; 3. Developing skills of the program staff and partners; and 4. Using multiple channels of communications Increased efforts should be made to disseminate health information at work centers including the behavior change messages in the community. A doer and non-doer survey was also undertaken to identify key behaviors and factors that influence them. decisions, responses, and indicators has been developed. The program staff has identified the target groups, the right behavior to promote, key factors to be addressed, channel or media for communication, activities to promote such behaviors, and indictors to measure change. To date CLICS has addressed 15 behaviors coffee processing plants (outlined in Annex 5beneficios). For each behavior, messages have been developed. The messages are clear and simple, and appropriately address the targeted behavior. The messages were tested in the villages prior to development of the communication material. A variety of communication materials have been locally developed, including posters (printed and hand written), flip charts, and models. Some of the materials were procured from the District Health Office and the state health department. Mass media activities at the village level were the major strength of the behavior change efforts in the CLICS program. These included Bal Suraksha Diwas (Child Survival Days), ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ aani Balachi Mohim (Safe Mother and Child Campaign), ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ (Save the Female Child Movement) and Parenting Workshops. The first two activities were organized on a monthly basis in each village by the VCC with support of the COs, CLICS Doot, ANMs and AWWs of the respective areas/villages. The role of the VCC in organizing these activities was commendable. The members of the VCC commanded respect from the village women. Role plays and skits, performed by the VCCs, SHGs and KPs, were very popular and well attended. The following communication channels have been used in the program: • Interpersonal communication has been effectively used by the CLICS Doot and COs at individual and household levels to communicate key messages. The FE team observed that the members of VCCs, KPs, project ANMs, and AWWs are actively involved in IPC. However, the participation of ANMs belonging to the public health system was limited. • Group level communication activities were effectively organized for CBOs by COs and program coordinators through regular meetings. VCCs have played an effective role in the BCC activities by conducting group meetings with the women (SHGs and KPs) which were very effective in communicating messages on safe motherhood and child survival practices and interventions. KPs and VCCs have regularly organized orientation workshops for school teachers and upper class students for family life education to facilitate group interaction. • Mass media activities at the village level were the major strength of the behavior change efforts. These included Bal Suraksha Diwas (Child Survival Days), ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ aani Balachi Mohim (Safe Mother and Child Campaign), ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ (Save the Female Child Movement), and Parenting Workshops. The first two activities were organized on a monthly basis in each village by a VCC with support of COs, CLICS Doot, ANMs, and AWWs of respective areas/villages. The role of the VCC in organizing these activities was commendable. Members of VCCs commanded respect from the village women. Role plays and skits, performed by VCCs, SHGs, and KPs, were very popular and well attended.