C-Change Picks - Focus on Family Planning in Eurasia, HIV/AIDS, Malaria
C-Change Picks #4 - Focus on Family Planning in Eurasia, HIV/AIDS, Malaria
Information about Social and Behaviour Change Communication, sponsored by C-Change
March 2 2009
From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme
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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 communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com
Issue 4 of C-Change Picks provides a window into the status of family planning in the Eastern Europe and Eurasia (E&E) region, where C-Change has opened an office in Albania. Research shows that prior to the early 1990s, there was not a high value placed on health education, care seeking behaviours, or consumer demand. Under the Soviet system, each person was registered with a local clinic and received services free of charge. According to an assessment led by C-Change and commissioned by USAID, with health reforms currently emerging in many E&E countries, consumers are now able to participate in selecting providers and products. This active participation is working to empower consumers to make their own decisions about their health care and places the responsibility for health care with the individual and the family rather than the state. The C-Change final report, "Empowering Health Care Consumers in Europe and Eurasia" is a highlight of this issue.
C-Change Picks issue 4 also addresses developments in social and behaviour change communication in the areas of HIV prevention and malaria.
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C-Change Picks continues to seek new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com
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A Focus on Family Planning in Eurasia
1. Empowering Health Care Consumers in Europe and Eurasia
2. Introducing a Natural Family Planning Method in Albania
3. Maximizing Private Sector Contribution to Family Planning in the Europe and Eurasia Region
4. Eastern European and Eurasian Regional Family Planning Progress
5. Normalising Sexual and Reproductive Health Education in Uzbekistan
6. Supporting the Right to Family Planning and Safe Motherhood Information in Eurasia
7. Strategies for Addressing Cross-Generational Sex
8. HIV Prevention Among India's Long-Distance Truckers
9. Male Circumcision for HIV Prevention
10. UNAIDS Combination Prevention Briefs
11. HIV/AIDS Prevention Outreach Guides
12. Improving Community Health Worker Use of Malaria Rapid Diagnostic Tests in Zambia
13. Community Factors for Participatory Malaria Control
14. Improving Access to Malaria Treatment and Care in Rural Tanzania
15. XXVI IUSSP International Population Conference
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FAMILY PLANNING – Focus on Eurasia
1. Empowering Health Care Consumers in Europe and Eurasia
The C-Change final report, "Empowering Health Care Consumers in Europe and Eurasia" explores experiences in Europe and Eurasia (E&E) with motivating health care consumers to take more responsibility for their health. In this region, it is not infectious diseases that are of growing concern but, rather, chronic (non-communicable) illnesses such as diabetes, cancer, and heart disease. These illnesses are frequently related to lifestyle choices such as alcohol, smoking, physical activity, and diet - choices that may be impacted by social norms, social networks, and social systems. The assessment focused on Kyrgyzstan, Albania, and Armenia, and consisted of 4 components: a literature review of the state of health promotion and primary health care; pre-assessment surveys and conference calls with USAID missions; country visits to conduct in-depth interviews and to visit active USAID-funded projects and health facilities in rural sites; and focus groups with health consumers in each country.
C-Change recommends working with governments to develop an overarching health promotion strategy that is based on behavioural research and the epidemiology of each country. Affecting behaviours related to chronic disease requires a long-term commitment to interventions that address the individual, the community, and decision-makers, as well as laws and policies related to high-risk behaviours. This strategy centres on a commitment to supporting individual behaviour change related to healthy lifestyles by creating an environment that reinforces the change through structures, programmes, and policies. Thus, multidimensional interventions are needed to initiate and sustain empowered health care consumers and more effectively address chronic diseases.
To facilitate this process, the document provides specific recommendations for each of the following areas: governments, health care providers and pharmacists, communities, the private sector, the media, civil society, and research.
2. Introducing a Natural Family Planning Method in Albania
Family planning was an essential element of the five-year Albania Child Survival Project (ACSP), which the American Red Cross (ARC) and the Albania Red Cross together implemented in mostly rural Diber Prefecture in eastern Albania. Following its conclusion in September 2008, ARC published this 8-page case study. “Introducing a Natural Family Planning Method in Albania," to explore the extent to which ACSP succeeded in its goal of improving the health of women of reproductive age and children 0 to 59 months old.
The project organised a network of village nurse-midwives and Red Cross volunteers that worked to facilitate women's family planning support groups, offer household-level counselling, and refer women for Ministry of Health (MOH)-approved contraceptives, either at the nearest commune-level health centre or in a woman's own village if it contained a pilot delivery point. The project promoted all MOH-approved methods: oral contraceptives, condoms, injectables, the intrauterine device (IUD), and natural contraception, including the lactational amenorrhoea method (LAM). Included in this category of natural contraception - and the topic of the case study - was the Standard Days Method (SDM), which the ACSP introduced to Albania in 2006.
SDM has been determined to be especially attractive to couples who fear the side effects of other modern methods and/or in cultures where barrier and hormonal methods are viewed negatively. One tool used as part of this method is CycleBeads, a colour-coded string of beads that comes with a flexible rubber ring. On the first day of her period, the user moves the ring to the red bead. She then moves the ring one bead every morning until the start of her next period. She (and her partner) can clearly see white beads (which mark the days that the user is likely to get pregnant) and brown beads (which mark the days that she is not likely to get pregnant).
ACSP and MOH staff trained 89 providers (family doctors, maternity health staff, counsellors, and village nurse-midwives) from the 25 health centres in 3 districts of Diber on the use of SDM. SDM was found to be the second-most popular method (after the pill) among 254 women who chose a modern method to fulfill their stated interest in both spacing births and limiting their family size.
The Albanian MOH has since incorporated SDM training for health providers into its family planning curriculum Even though individual counseling sessions for SDM users require somewhat more time than for user of other methods, it is notable that SDM discontinuation was not a direct result of client dissatisfaction or fear of side effects. It is also recommended that couples receive more than one counseling session and providers counsel clients while demonstrating how to use the method with Cyclebeads.
3. Maximizing Private Sector Contribution to Family Planning in the Europe and Eurasia Region
Based on review of private sector contribution to reproductive health (RH) and family planning (FP) in the Europe and Eurasia (E&E) region, "Maximizing Private Sector Contribution to Family Planning in the Europe & Eurasia Region: Context Analysis and Review of Strategies," by the PSP-One Project, analyzed information and conducted assessment visits in Albania, Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russia, Tajikistan, Ukraine, and Uzbekistan during 2005-2006. Of these, four countries were firmly classified as having advanced FP private sector markets - Kazakhstan, Russia, Romania, and Ukraine – but clearly needed help with mechanisms for sustained communication between public and private sector entities, such as joint promotional and training programmes. In Russia, for example, they found that communication between public sector programmes and commercial suppliers was often minimal, and that contraceptive manufacturers needed help identifying "champions" in the provider community that could help overcome resistance to hormonal contraception in addition to increasing training and educational opportunities.
In Romania, on the other hand, the Ministry of Public Health helped to stimulate demand among the rural population and used a three-pronged approach: information, education, and communication (IEC)/behavior change communication activities, service promotion, and community outreach. Private sector firms worked closely with the Ministry to time the demand-creation activities to correspond with the scale-up of quality services and availability of products to meet demand, thereby avoiding loss of confidence in the programme and the disappointment of the client.
Among the countries with less-developed markets, Kyrgyzstan, Armenia, and Georgia were found to have "a sufficient number of positive private sector conditions to be classified in the intermediate category” but require focused interventions to make them more “private sector friendly." In the emerging category, Azerbaijan had room for limited private sector development, while Uzbekistan and Tajikistan had "almost no private sector potential in FP at this time." For many of the Central Asian countries, it was recommended that private providers and pharmacists should be included in public and/or non-governmental organisation (NGO) training on RH/FP clinical skills, interpersonal communication (IPC)/counseling and contraceptive technologies.
More information on the status of the private sector can be found in C-Picks 3 in a summary about the report, "Ten Best Public and Private Sector Practices in Reproductive Health and Family Planning in the Europe and Eurasia Region."
4. Eastern European and Eurasian Regional Family Planning Progress
"Family Planning Situation Analysis 2007: Executive Summary - The Europe and Eurasia Regional Family Planning Activity" is a summary of a series of country desk reviews conducted by John Snow International (JSI) in 2007 to assess the environment for improving family planning programming in the Eastern European and Eurasian region. This USAID-funded activity explores general issues affecting family planning programming in Albania, Azerbaijan, Georgia, Kyrgyzstan, and Tajikistan and making recommendations for potential action to increase utilisation of modern contraception and reduce reliance on induced abortion. JSI identified 10 family planning policy and programme best practices based on the 2005 report, "An Assessment of USAID Reproductive Health and Family Planning Activities in the Eastern European and Eurasian Region", as well as a current literature review and field interviews in selected countries participating in USAID's Europe and Eurasia Regional Family Planning Activity programme.
The following is list of the best practices, against which progress in each country was reviewed:
1. National health regulations require that family planning counselling and services are readily available through a range of health professionals.
2. Family planning counselling, services, and contraceptives are part of the Basic Health Benefit Package. At the primary health care level contraceptives are provided to all women, regardless of ability to pay.
3. Up-to-date and evidence-based policies, regulations, guidelines, standards, and supportive supervision systems are in place to ensure the quality of family planning services at all levels of health care.
4. A broad range of family planning methods are available, accessible, affordable, and acceptable in both rural and urban areas.
5. Programmes are in place that are designed to meet the needs of vulnerable groups such as adolescents, internally displaced persons (IDPs), new urban migrants, prostitutes, and the very economically poor.
6. Family planning is part of pre- and in-service training programmes for health care providers.
7. Planning within the government is guided by a well-functioning Logistics Management Information System (LMIS) that enables targeting of subsidised contraceptives and efficient supply chain management of all contraceptive commodities throughout the country.
8. Adoption of a "culture" in which providers and clients engage in frank, regular conversation about sensitive RH issues, and in which family planning and appropriate services are offered.
9. Family planning is actively promoted through social marketing and behaviour change/social mobilisation efforts, including wide distribution of quality informational materials for clients and "job aids" for providers.
10. A well-functioning national health management information system collects, analyses, and uses family planning data to monitor progress and evaluate and improve programme effectiveness.
Based on an assessment of the above, this overview ends with a summary of recommendations for each country for achieving best practices in family planning. Links are provided to specific-country analyses from the URL above.
5. Normalising Sexual and Reproductive Health Education in Uzbekistan
"Reaching Out to Youth: Youth-Friendly Sexual and Reproductive Health Services Through Schools, Clinics, and Communities" describes the implementation and impact of an initiative to increase young people's access to accurate information about their sexual health and reproductive lives in the Navoi oblast of Uzbekistan. By creating a triangular support structure composed of clinics, schools, and communities, the international organisation Project HOPE worked to integrate family planning into its child survival project (2003-2007). With funding from USAID, Project HOPE provided training, materials and guidance; helped the health system develop service protocols; and helped the education system create curricula.
As detailed here, a core tenet of the initiative was that sexual and reproductive health (SRH) should be understood and approached as a normal, necessary topic for young people. Project Hope worked to sensitise and train health workers and education workers, and through them, to reach local community leaders, parents, and youth. These trained leaders offered information and advice in official settings (health centres, schools) and in casual settings (homes, coffee shops, sporting events, discos). Posters, informational brochures, and short films were developed and distributed to support the interpersonal conversations.
Through these strategies, Project HOPE reached out to more than 25,000 teens via 129 schools, 126 neighbourhoods, 2 new youth-friendly clinics, and 3 youth-friendly rooms within clinics in 5 pilot sub districts. At baseline (February 2004), only 1.3% of youth surveyed knew when during her menstrual cycle a woman was most likely to become pregnant; the June 2007 evaluation showed that this percentage had increased to 35.3%. At baseline, 30% could name 3 or more contraceptive methods, whereas 83% could do so at the end of the project. Over 90% of youth could name 2 or more mechanisms of HIV transmission by the conclusion of the project, in contrast to 44% of those at baseline. The percentage of youth who could name 2 or more ways to protect themselves from STIs increased from 16.7% to 80.3%.
The Ministry of Health used the materials and methods piloted in the pilot clinics, schools, and with the community leaders of Navoi to replicate the activities of Project HOPE in non-pilot subdistricts of Navoi oblast and in Surhandarya oblast.
6. Supporting the Right to Family Planning and Safe Motherhood Information in Eurasia
The "Services to the People" project in Kazakhstan, Kyrgyzstan, and Tajikistan aims to support the right of mothers-to-be to health information and health care. The key aim is to properly train obstetricians for home deliveries and emergency management; rural reproductive health services are also being equipped and service personnel trained in preventive medicine, family planning, counselling, and community health promotion. An information and health education campaign is being developed in an effort to reach not only the women concerned but also others in the family environment (husbands and mothers-in-law) and community decision-makers.
This project uses interpersonal communication approaches in an effort to enhance the access of vulnerable people (women in rural areas, and their children) to quality health services. The project's name reflects the rationale that, if women cannot go to quality services (because these services are non-existent, or due to problems of transport and finances), trained providers will bring these services to them.
Core components of this strategy include:
i. Developing the capacity of community members to stay healthy, make healthy decisions, and respond to obstetric and neonatal emergencies.
ii. Increasing awareness within communities of the rights, needs, and potential problems related to maternal and newborn health.
iii. Strengthening linkages for social support between women, men, families, and communities and with the health care system.
iv. Improving quality of care of providers and of health services and of their interactions with women, men, families, and communities.
7. Strategies for Addressing Cross-Generational Sex
This brief, "Cross-Generational Sex: Risks and Opportunities" published in July 2008, is based a larger review entitled, "Addressing Cross-Generational Sex: A Desk Review of Research and Programs," as well as discussions with experts about the findings of the larger review. The brief is designed to broaden the understanding of cross-generational sex, look at how many young girls it affects, describe frameworks that guide current thinking about the behaviour, and propose lessons for improving future interventions. The brief proposes that looking beyond surface portrayals of cross-generational sex to understanding the motivations behind this behaviour and the increased risks it engenders, there are important lessons learned for addressing programmes for women, who are shouldering the burdens of HIV, sexually transmitted infections, and unintended pregnancies.
The brief begins with a definition of cross-generational sex, explaining that such a relationship is one in which girls receive money or goods in exchange for sex. It goes on to talk about how widespread the practice really is, comparing the results of various studies conducted in several sub-Saharan African countries. It then looks at the approaches used in existing programmes that deal with cross-generational sex. These include youth mobilisation and empowerment and creating livelihood opportunities for youth; social marketing campaigns; awareness raising and health education campaigns; and addressing power imbalances and social and gender norms.
The authors of the brief mention two methodologies they feel are particularly promising: "Stepping Stones" and "Community Conversations". The "Stepping Stones" methodology encourages community participation in facilitated discussions, and often uses drama and role-plays to help people talk about sensitive subjects. It also engages men and women to work together. "Community Conversations" fosters dialogue within communities to stimulate local responses, and according to the report, has had promising results in dealing with various issues including HIV, female genital cutting and other customary practices, and multiple sexual partners.
8. HIV Prevention Among India's Long-Distance Truckers
This publication explores the thinking behind the behaviour change communication (BCC) activities comprising one component of Avahan, an HIV prevention programme launched in Foundation in 6 states in India. Avahan sought to provide HIV prevention services along 8,000 kilometres of national highways to "free agent" long-distance truckers, who are three times more likely than men in the general population to have sex with someone who is not a regular partner.
As detailed within this report, "Off the Beaten Track: Avahan's Experience in the Business of HIV Prevention Among India's Long-Distance Truckers," each Avahan intervention site offers high-visibility multimedia communication activities set up in and around broker and transporter offices. These natural traffic areas also provide the space for satellite clinic services that are allied with a large static clinic at each location. The project also conducts monthly health camps at the intervention sites on a fixed day to provide truckers with quality specialist health services, building visibility through corporate sponsorship of these events.
In order to address the challenge of fragmented engagement with a mobile population, the programme focused on building a uniform look and feel (ie: brand) of services across intervention sites. In an effort to counter messaging fatigue and cynicism among truckers, organisers have made truckers the face of the programme by engaging them as peer outreach workers. Interpersonal communication is complemented by events including street plays, supplemented with kiosks where truckers can play games that reinforce select themes. Films are also used to deliver HIV messages and tell truckers about available services. Audio cassettes which contain popular local songs interspersed with spoofs on Hindi film actors delivering HIV prevention messages and endorsing Khushi services are distributed. The programme also builds recall of services through billboards at popular roadside cafes and along the highway.
Key strategies for engaging customers have included:
a. Consumer research to develop the programme's overarching positioning theme included focus group discussions and in-depth interviews with truckers across multiple ethnicities, age groups, and route categories. Based on this research, the project is attempting to move beyond the utilitarian "health benefit" positioning of safe sex practices towards making such behaviour aspirational for truckers. This involves using positive cues (enhanced self-esteem, being responsible, being in control and, hence, masculine) to promote behaviour change.
b. All interpersonal communication and a large portion of the events are facilitated by peer workers using language, anecdotes, and themes with which the population can identify.
c. Peer discussions form the basis of themes presented in all project activities. These insights inform efforts to dispel myths and fears, and help identify psychological barriers to condom usage, such as the belief that condom usage is not the mark of a "real" man.
9. Male Circumcision for HIV Prevention
Published by the Bulletin of the World Health Organization (WHO) in September 2008, the paper "Male Circumcision for HIV Prevention: A Prospective Study of Complications in Clinical and Traditional Settings in Bungoma, Kenya" suggests that, based on over 35 observational studies and three randomised controlled trials from sub-Saharan Africa, male circumcision interventions in high HIV prevalence areas would be at least as cost-effective as any of the other evidence-based HIV prevention tools. It points to the need for more awareness-raising and training on male circumcision, as well as increased advocacy and information to place it in the context of HIV prevention.
According to this article, male circumcision should not be considered a stand-alone medical procedure for HIV prevention, but rather should be incorporated into a full complement of HIV prevention and reproductive health services, including, but not limited to, counselling about safe sex, diagnosis and treatment of sexually transmitted infections, HIV testing, and referral to HIV treatment and care. Therefore, training for practitioners should include education about all of these HIV prevention methods.
10. UNAIDS Combination Prevention Briefs
This series of Combination Prevention Briefs, published by Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2008, is designed to offer an overview of the key interventions needed as part of a combination prevention approach in the countries of Eastern and Southern Africa with high HIV prevalence. The briefs focus on the following 4 areas: modes of transmission, multiple concurrent partnerships, vulnerabilities of women and girls, and male circumcision. Each brief offers background information, outlines challenges to scaling-up within a combination prevention approach, and offers recommendations for action.
According to UNAIDS, combination prevention in Eastern and Southern Africa asserts the importance of combining a number of proven social and medical approaches to achieve maximum impact on HIV prevention. Coordinated evidence-informed strategies that work in concert towards shared prevention goals in the context of a well researched and understood local epidemic will have the best chance of success. Resources and efforts should prioritise these approaches rather than those for which evidence of impact is weak. The starting point is sound analysis of what is driving the epidemic in different contexts - modes of transmission modeling and other "know your epidemic", "know the evidence", and "know your responses" synthesis reviews.
The following briefs are available for download in PDF format:
i. Focus on modes of transmission.
ii. Focus on multiple concurrent partnerships.
iii. Focus on the vulnerabilities of women and girls.
iv. Focus on male circumcision.
11. HIV/AIDS Prevention Outreach Guides
Pact Botswana has developed a series of 10 Outreach Guides to assist HIV/AIDS programme implementers working in HIV prevention interventions. The Guides utilise participatory methodologies and intend to underline approaches that promote behaviour change, especially for the most-at-risk groups, taking co-factors such as alcohol abuse, sexual violence, and intergenerational sex into consideration. Each Guide focuses on a particular aspect of HIV prevention.
Six of these guides are particularly relevant to behaviour change communication:
• Abstinence Promotion: Developed for use with young people who have not yet had their first sexual experience, the goal of this guide is to encourage the delay of individual’s first sexual encounter, including helping to prepare young people for pressures to have sex.
• Values and Goal Setting: This guide deals with looking at the future and what can be achieved in life by setting goals, as well as deciding and living by moral values. The idea is that people make better behaviour choices today if they set their own standards and future goals. Choosing moral values and living by them is also covered.
• Sexual Behaviour Changes: Since HIV is very likely going to be transmitted sexually, this guide says that working on making good decisions about sexual behaviour is essential to avoiding becoming infected. Different kinds of sexual behaviour that put people at risk are examined.
• Better Couple Communication: Improving couple communication and avoiding infidelity is the focus of this guide. The author says that when couples, whether married or not, are not listening to and understanding each other, they can end up disrespecting and not trusting each other.
• Enhancing Parent-Child Communication: According to the guide, parents often have difficulty guiding their teenagers towards making good decisions about avoiding HIV. This guide focuses on building parents’ communication skills and ability to communicate with teenagers without alienating them.
• Partner Reduction and Protection: This guide is for conducting outreach with those who practice "risky sexual behaviour." It recommends reducing the number of partners and includes content on how to promote condom use, including how to overcome obstacles to use.
12. Improving Community Health Worker Use of Malaria Rapid Diagnostic Tests in Zambia
This Zambia-based study, published by the Malaria Journal, was designed to determine: (i) whether community health workers (CHWs) could prepare and interpret rapid diagnostic tests (RDTs) for malaria accurately and safely using manufacturer's instructions alone; (ii) whether simple, mostly pictorial instructions (a "job aid") could raise performance to adequate levels; and (iii) whether a brief training programme would produce further improvement. "Improving Community Health Worker Use of Malaria Rapid Diagnostic Tests in Zambia: Package Instructions, Job Aid and Job Aid-Plus-Training" describes the methodology used for the study and provides details about the job aid and half-day training programme.
Many countries in Africa where malaria is most widespread have been reluctant to allow CHWs to handle blood because of risks of HIV transmission and concerns about whether these minimally-trained providers could accurately use and interpret RDTs. However, this study found that CHWs were able to master the skills needed to administer and interpret RDTs correctly and safely.
This study measured two outcomes: 1) ability to conduct test procedures safely and correctly; and 2) ability to interpret the results correctly. Regarding outcome #1: On average, CHWs using the manufacturer's instructions performed 57% of test steps correctly. Those using the job aid alone improved significantly to 80%. Job aid-plus-training CHWs scored highest, at 90% correct. Regarding outcome #2: Accuracy of the RDT test interpretation improved significantly in the job aid-only and job aid-plus-training groups. Manufacturer's instructions CHWs read a mean 54% of test results correctly compared to 82% in the job aid-only group and 93% in the job aid-plus-training group. The study concludes that volunteer CHWs can use malaria RDTs safely and effectively.
13. Community Factors for Participatory Malaria Control
"An Exploratory Study of Community Factors Relevant for Participatory Malaria Control on Rusinga Island, Western Kenya", part of the ongoing Rusinga Malaria Project (RMP), evaluates community factors relevant for participatory malaria control on Rusinga Island, western Kenya. Project implementers and community members joined together here in a participatory initiative to study how much local people understood about the existing malaria problem on Rusinga, assess their socio-economic background, and create awareness for the ongoing project while sensitizing community members for active participation. In order to do this, focus group discussions and semi-structured individual interviews (knowledge, attitude and practice (KAP) surveys) were carried out to determine socio-economic and behavioural baselines to identify indicators for monitoring programme effectiveness, and to reveal the perceptions, misconceptions and practices of malaria control.
Results showed that, though malaria is considered one of the major threats to life, there is little effective knowledge of malaria prevention, including causal knowledge of the transmission cycle. "[D]espite the fact that there is a lot of knowledge in the community, this knowledge was distorted and causal connections were not understood, raising questions about the quality of past health education messages and whether they might be more confusing than helpful if not implemented in a cultural sensitive way."
Socio-economic factors impacted the use of known preventative measures. "Although many (88%) knew bednets prevent malaria, only 48% of households actually owned a net, with... 37% sleeping under one the previous night." The authors found little knowledge of insecticide treatment of nets and no knowledge of a causal understanding of insecticide treatment as killing mosquitoes. Based on the information that bednet use was linked to socio-economic status and education, the authors recommend increased training and increased availability of bednets.
The authors conclude that "[t]here is an urgent need to design culturally sensitive but evidence-based education interventions which take local beliefs into account and which help the community to understand the causal connections between mosquito habitats, malaria transmission, malaria symptoms, treatment and prevention." The authors hypothesize that this will be best achieved through participatory, hands-on experience.
14. Improving Access to Malaria Treatment and Care in Rural Tanzania
This document describes a research project on malaria interventions that was designed to evaluate the ACCESS programme, a programme intending to understand and improve access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy, as stated within "Understanding and Improving Access to Prompt and Effective Malaria Treatment and Care in Rural Tanzania: the ACCESS Programme", is based on a set of integrated interventions, including social marketing for improved care seeking at the community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores.
The research was designed to look at various intervention areas. The communication-related intervention area uses behaviour change campaigns, including:
1. Sensitising community leaders to gain their support and collaboration;
2. Social marketing of information to mothers and caregivers of children under 5 years old and pregnant women;
3. Efficient and cost-effective communication channels and materials to disseminate behaviour change messages include road shows on the platform of a truck used as a mobile stage for a show;
4. Special campaigns in Mother and Child Health (MCH) clinics; and
5. A study of the "shamba component" - the farming period when people live away from the village, a period being studied as a heightened risk period.
To date, a number of peer-reviewed articles and an independent document have been published based on this research. Links to these articles are provided at the URL above.
15. 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. Submissions of abstracts should be made on the programme website.
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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see 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.
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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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