Mekong RBM IEC Initiative

This regional initiative draws on face-to-face interactions (e.g., meetings and training workshops), as well as various types of media (designed to be entertaining as well as informative) to raise awareness about malaria and instigate action to prevent and treat it.

Community participation has been a key theme in developing the project's communication strategy. Following a workshop on field research in June 2003, country teams began developing research tools, which were then translated into ethnic languages and pre-tested for accuracy and appropriateness using methodologies such as group discussion, semi-structured interview, participatory learning, and action or participatory rural appraisal. People who can speak the ethnic language of the intended populations were selected and trained on how to use questionnaires and interview techniques to collect information. They asked questions meant to decipher how much people know about malaria transmission and prevention, what kinds of prevention behaviours (e.g., insecticide-treated nets, or ITNs) are being exhibited, which populations are most vulnerable to infection, how malaria education is being conducted, and so on.

Based on this process, the Mekong RBM IEC Initiative has undertaken training workshops and other activities in an effort to strengthen country teams’ capacity to identify main messages for IEC and appropriate IEC channels and materials, and to carry out a participatory approach for IEC materials development. Each country team developed its own protocols for malaria IEC communication implementation plans. Community participation is, again, a key theme here. For instance, the Thailand team organised a workshop with villagers, village volunteers, local health staff, school teachers, and school children to produce IEC materials that suit the needs of the communities. The participants produced drafts in both Karen and Thai languages for posters, calendars, and leaflets. The Cambodia team has also organised a few small workshops with different groups to plan and further develop a video script focusing on seeking prompt and appropriate treatment. In an effort to produce appropriate materials to suit the needs of a particular population, they invited Kreung villagers to do the acting, using their own language.

A wide variety of other printed, audio, and visual materials have been designed in communities across the region to suit the local context. Entertaining strategies, such as a malaria-themed cartoon, are combined with purely informational modes of communication. For example, the Myanmar IEC team organised a few different workshops to advocate and mobilise different partners on malaria prevention and control in May 2004; school-based malaria education was identified as a suitable channel to use to encourage schoolchildren to pass on their knowledge and encourage the community on malaria prevention. During the workshop, teachers and basic health workers drafted malaria-related activities that children can do over a weekend; they also developed short songs and poems that can be used in classrooms and in communities.

Other programme endeavours include:

• providing technical support and coordination for anti-malaria drug resistance monitoring, and the development and harmonisation of rational treatment policies
• offering technical support and coordination for monitoring of drug quality and drug use both in public and private sectors
• facilitating cross-border communication at national, provincial, and district levels
• stimulating and provide technical support for malaria prevention and control interventions, including ITNs for marginalised populations at risk of malaria
• instigating assessment of risks of malaria associated with migration and labour
• advocating malaria prevention and control among the migrant population
• exchanging information from the Mekong RBM project within and outside the region, in part through a monthly newsletter that is designed to share project experience among 6 member countries and with various malaria partners in the region
• providing a forum for fund raising for malaria control in Greater Mekong Sub-region (GMS) countries.

Health.

As part of the research focus of this initiative, an evaluation of existing educational materials was conducted in two remote villages; selected findings were as follows:

• People could not easily follow a poster on malaria transmission and prevention. Villagers did not have a clear understanding of its contents, perhaps because there were many messages within one poster. However, organisers concluded that posters nonetheless have a place in providing and reinforcing malaria information. The IEC team is in the process of redesigning the posters to reinforce malaria messages with a focus on promoting the use of ITN and early diagnosis and treatment.
• Results from a trial of the pictorial card set in 3 southern provinces and remote villages in Vientiane province were very positive. Villagers and local health staff participated in learning and discussion by using the card set. According to organisers, "they have gained more knowledge and increased awareness of malaria prevention and control."
• Audio educational material has shown good results. People were interested in, and paid attention to, malaria prevention and control messages delivered through this medium. Many people, including people in remote villages, have access to radios and tape cassette players. The IEC team is working with the national radio station to adapt the existing audio educational material to suit the present control strategies. According to the plan of action, the IEC team will need to develop this audio material in three languages (Lao, Khamu and Hmong). This material will be produced in tape cassette and compact disc formats for distribution to all villages in the areas being addressed.
• Video is an up-and-coming material that local health staff and villagers would like to see developed. People said video could provide malaria information with visuals and sound. It could help illiterate people to understand the messages more easily than other educational materials. The IEC team decided to develop a video to promote the use of longer lasting insecticide treated bednets (LLITNs), artemisinin combination therapy (ACT), and rapid diagnostic tests (RDTs).
• The flipchart is also an effective educational material. The flipcharts were initially developed in Lao through an interactive mechanism, which was found to be expensive, increasing the price 4-fold. This interactive production method could not be reproduced due to budget limitations. In Myanmar, Cambodia, Yunnan-China and Vietnam, flipcharts were developed based on the Laos experience, but without the interactive mechanism.

Based on this type of research, organisers have concluded that many malaria control programmes do not put an emphasis on planning and budgeting for the communication component of malaria education. When local health staff are not involved in the process from the get-go, malaria institutes may not anticipate the great potential of such IEC materials as the interactive flipchart, which was quite popular. Involving these personnel in the entire process, organisers stress, would help ensure that there was enough within the budget to produce the printed materials and radio and TV spots that local organisations need and want.

In another research study conducted as part of the project, focus group discussion was carried out with the Kreung Ethnic Minority in in 3 villages in Rattanakiri, Cambodia. The study revealed that - when it comes to malaria IEC materials - many community members "would like to see real photos that show the full human body. If only one arm or leg is shown, it has no meaning for us and we do not understand drawings. We want to see photos to educate us on malaria, that present the reality of a sick person and the treatment s/he received ." Another finding about communication patterns, which guided subsequent IEC materials development, was that villagers in the selected Kreung villages prefer colour pictures to black and white pictures: " We cannot even recognize people in our own village with a black and white photo...but a color photo we can remember well...", said one woman who was interviewed.