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PRELIMINARY BENIN ARM3 BEHAVIOR CHANGE COMMUNICATION STRATEGY
(2012-2016) ACCELERATING THE REDUCTION OF MALARIA MORBIDITY AND MORTALITY (ARM3) IN BENIN
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 2
Table of Contents
Executive Summary: ................................................................................................................................... 4
1 BCC and community mobilization (CM) Strategy: Overview ............................................................... 8
2 Situation Analysis ................................................................................................................................ 9
2.1 Malaria in Benin .......................................................................................................................... 9
2.2 Overview of the National Malaria Control Plan and Strategy ................................................... 12
2.3 Organizations supporting malaria communication interventions in Benin ............................... 13
2.4 Communication gaps/Challenges .............................................................................................. 16
2.5 Accelerating the Reduction of Malaria Morbidity and Mortality (ARM3) ................................. 20
3 Communication Strategy .................................................................................................................. 23
3.1 Pathways for malaria prevention and control in Benin ............................................................. 23
3.2 ARM3 BCC Strategic Objectives:................................................................................................ 25
3.3 Audiences and priority behaviors targeted by the ARM3 Communication Strategy ................. 25
3.4 Key Messages ............................................................................................................................ 27
3.5 Communication Channel ........................................................................................................... 33
3.5.1 Mass Media ....................................................................................................................... 33
3.5.2 Interpersonal Communication .......................................................................................... 34
3.5.3 Counseling in Government and Private Health Facilities ................................................... 34
3.6 Communication Materials ......................................................................................................... 35
3.7 Capacity Building ....................................................................................................................... 37
3.8 Gender ...................................................................................................................................... 38
3.9 Monitoring and Evaluation ........................................................................................................ 39
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4 Implementation ................................................................................................................................ 53
4.1 Activities.................................................................................................................................... 54
4.1.1 Objective 1: Coordination ................................................................................................. 54
4.1.2 Objective 2: Community mobilization ............................................................................... 56
4.1.3 Objective 3: Social marketing of LLITNs............................................................................. 58
4.1.4 Objective 4: Capacity Building in BCC ................................................................................ 59
4.1.5 Objective 5: Advocacy for increased support for malaria control ..................................... 60
4.1.6 Objective 6: BCC and Community Mobilization materials ................................................. 61
4.1.7 Objective 7: Monitoring and Evaluating the BCC Strategy ................................................ 62
4.2 Scheduling for mass media and community mobilization interventions ................................... 64
4.3 Scheduling for mass media and community mobilization interventions for the remaining three
years (Oct 2013- Sep 2016) ................................................................................................................... 65
5 Annexes ............................................................................................................................................ 68
5.1 Annex A : Terms of Reference for GTTC .................................................................................... 68
5.2 Annex B : Key Messages for Targeted Audiences ...................................................................... 71
5.3 Annex C: Information about Benin ............................................................................................ 74
5.4 Annex D: ARM3 Results and Targets ........................................................................................ 75
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 4
Executive Summary:
To achieve the vision of a malaria-free Benin by 2030, the government, through the National Malaria
Control Program (NMCP) and other programs has formulated a National Strategic Plan for malaria to be
implemented by government agencies, international partners, and local civil society organizations. The
ARM3 Behavior Change Communication (BCC) strategy aims to support the National Strategic Plan by
contributing to the development, implementation, monitoring, and evaluation of NMCP initiatives to
influence behaviors and mobilize communities to create long-term normative shifts toward desired
behaviors and to sustain enabling behaviors around the President’s Malaria Initiative (PMI) interventions
in Benin with a focus on those related to ARM3 project objectives. The desired behaviors should result
in: improved adherence to treatment regimens, IPTp during pregnancy (as well as other MIP-related
behaviors); regular LLIN use by the general population, focusing on vulnerable groups to include
pregnant women and children under five; prompt, appropriate treatment with Artemisinin-based
combination therapy (ACTs) for children under five within 24 hours of onset of symptoms; and
community involvement in malaria control.
The strategy is designed to support ARM3 and NMCP malaria prevention and treatment objectives by
promoting improvement in prevention and treatment behaviors. It draws on guidance presented in the
BCC section of the GHI strategy document for Benin, PMI’s communication strategy guidelines, and the
Roll Back Malaria (RBM) Strategic Framework for Malaria Communications at the country level. The
strategy document has benefited from MCDI’s experience in developing national malaria
communication strategies elsewhere in West Africa and draws upon JHU-CCP’s work in developing the
Pathways model of malaria communication.
The ARM3 BCC Strategy has seven main objectives:
O.1. To support BCC interventions by the National Malaria Control Program and ARM3 through:
effective coordination of activities by the BCC Working Group; participation in activities by other
existing working groups [1] ; harmonization of BCC/IECC messages, materials and tools
developed in Benin[2].
O.2. To increase community engagement in /mobilization for malaria prevention and treatment.
O.3. Increase the supply and use of LLINs through social marketing with private sector partners.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 5
O.4. To upgrade BCC skills of health workers from private and public sectors at national and
community levels, and provide supervision in the use of BCC guidelines.
O.5. To advocate for increased support for malaria control, by government authorities and key
partners (reflected in support for coordination, availability of funds, allocation of human
resources and development of public policies that support malaria mortality and morbidity
reduction).
O.6. To develop and disseminate materials supporting BCC and Community Mobilization
O.7. To monitor and evaluate the ARM3 BCC and Community Mobilization Strategy.
BCC supports implementation of activities to ensure that commodities are used effectively and that
healthy practices become normative. IPTp activities will target pregnant women, their partners, and
health providers to encourage the uptake of IPTp at both the provider and the client level. Training
curricula on interpersonal communication (IPC) will be developed to train new cadres of health workers
and nurses in counseling techniques and proper administration of the drug. Pregnant women
frequenting ANC services will be encouraged to seek prompt care when experiencing a febrile episode
and to sleep under an LLIN, and the campaign will promote the role of responsible husbands in their
family's overall health.
LLIN activities will target caregivers and their partners to encourage the use of LLINs among children
under five as well as the general population, and workplace programs will be implemented to promote
malaria prevention in the private sector, including both distribution of LLINs and communication
activities to promote prevention practices.
A special umbrella campaign to support providers will focus on provider-client communication to
support the quality assurance and capacity strengthening strategies of the ARM3 under this project.
Diagnostics activities will target caregivers and their partners to stimulate demand for a malaria test and
at the same time, target health providers and their supervisors to ensure compliance with diagnostic
policies.
Treatment activities will target caregivers and their partners and immediate family members to
stimulate demand for ACTs and to ensure compliance. Improved case management of malaria at
frontline facilities will occur within the IMCI framework thereby also supporting the effective case
management of malaria.
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Communication channels to be employed in all intervention areas will include radio, to reach a
maximum number of persons in a cost-effective manner with radio spots, drama programs, and talk
shows. TV spots will also be produced on a limited basis to reinforce key messages and to provide
models of ideal behavior, particularly important for new practices such as net care and repair. Mass
media will be complemented by a strong community mobilization component wherein local leaders,
associations, women's groups, and community health workers will be mobilized to promote malaria
prevention and proper diagnosis and treatment at the grass roots level. By creating and building
stronger social norms via radio and television, and stimulating discussion among clients and providers,
caretakers of children and their families and friends, and boosting training and compliance among
health care workers to government policies, ARM3 intends to improve malaria preventive behaviors
among the population as a whole.
The campaign will be tied together with cohesive visual elements, logo and slogan that will identify
mutually reinforcing components of the strategy and lend credibility to individual activities and
products.
At the advocacy level, coordination with government entities including the PNLP, the TGGC and other
ministry officials will serve to bring partners together around the same goals, reduce bottlenecks and to
develop harmonized work plans for communication on malaria.
This current communication strategy document is intended to provide a framework within which ARM3
malaria communication can occur and remain aligned with the NMCP’s own program. The strategy will
undergo subsequent revisions as deemed appropriate by the BCC Working Group. It is hoped that the
document will serve as a foundation upon which the GFATM -supported initiative managed by Africare
Benin can formulate a National Malaria Communication Strategy.
Monitoring of the communication activities presented in the strategy will focus on program
implementation and input and output indicators. Outcome indicators with a behavioral component will
be employed. Tracking the progress outcome indicators in project intervention areas enables the
success of the communication strategy to be evaluated.
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List of Acronyms
ACT Artemisinin-based combination therapy ADB African Development Bank ANC Antenatal care ARM3 Accelerating Reduction of Malaria Morbidity and Mortality CAME Centrale d’Achat des Médicaments Essentiels (Central Medical Stores) CBO Community-based Organization CCM Country Coordinating Mechanism CEBAC-STP Coalition des Entreprises Béninoises contre le sida, la tuberculose et le paludisme CHW Community Health Worker CRS Catholic Relief Services DHS Demographic and Health Survey FY Fiscal Year GFATM The Global Fund to Fight AIDS, Tuberculosis, and Malaria GHI Global Health Initiative GOB Government of Benin GTTC Groupe Technique de Travail en Communication IEC/BCC Information, education, communication/Behavior change communication KAP Knowledge, attitude, practice IMCI Integrated Management of Childhood Illness IPC Interpersonal communication IPTp Intermittent preventive treatment of malaria in pregnancy IRS Indoor residual spraying ITN Insecticide-treated net LLIN Long-lasting insecticide-treated net M&E Monitoring and Evaluation MCH Maternal and child health MOH Ministry of Health NGO Non-governmental Organization NMCP Programme National de Lutte contre le Paludisme (National Malaria Control Program) PISAF Projet Intégré de Santé Familiale (Integrated Family Health Project) PITA Plan intégré de Travail Annuel PMI President’s Malaria Initiative PSI Population Services International URC University Research Co. LLC RBM Roll Back Malaria RDT Rapid diagnostic test SBCC Social and Behavior Change Communication SP Sulfadoxine-pyrimethamine UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 8
1 BCC and community mobilization (CM) Strategy: Overview The BCC and CM Strategy is designed to support ARM3 and NMCP malaria prevention and treatment
objectives by promoting improvement in prevention and treatment behaviors. It draws on guidance
presented in the BCC section of the GHI strategy document for Benin, PMI’s communication strategy
document, and the Roll Back M Strategic Framework for malaria communications at the country level.
The strategy document has benefited from MCDI’s experience in developing a national malaria
communication strategy in Equatorial Guinea; it also draws upon JHU/CCP’s work in developing the
Pathways model of malaria communication.
The Strategy is aligned with:
1.1. National Health Development Plan (Plan National de Development Sanitaire) 2009-2018, supporting
its priorities, particularly the ones oriented to the reduction in infant, child and maternal mortality due
malaria and strengthening the capacity of the health systems, the providers and the community,
through the malaria program with participation of the private sector.
1.2. National Malaria Strategic Plan. The National Malaria Strategic plan calls for intensive IEC/BCC,
including mass media activities, advocacy, and social/community mobilization as a core element. (Plan
Strategique de Lutte Contre le Paludisme au Benin 2011-2015)
1.3. Global Health Initiative Benin Country Strategy, oriented to increase inter-agency coordination and
program sustainability, and to harmonize health programs led by US Government under one country
strategy. The GHI is based on seven core principles: focusing on women, girls and gender equality; and
building sustainability through health systems strengthening. It is oriented to support the reduction of
the under-5 mortality rate, improve maternal health and reduce the burden of Malaria, contributing to
the achievement of the Millennium Development Goals in the country.
1.4. The PMI Communication Strategy highlights the role of communication and community
participation to attain sustainable changes in the behavior of individuals and communities, on malaria
treatment and prevention. It provides a path for ARM3 to increase the demand for malaria services and
products, improvement in the adherence to treatment regimens and IPTp during pregnancy, and use of
LLINs, especially among pregnant women and children under five, prompt care-seeking behavior by
caretakers of children under five, and community involvement in malaria control. It also focuses
communication interventions on each target audience, and includes a Monitoring and Evaluation
component, using PMI outcome indicators that allow measurement of changes in behavior.
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1.5. JHU- CCP Communication experience.
The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU•CCP)
envisions a world in which communication saves lives, improves health and enhances well-being.
JHU•CCP has extensive experience working in many African countries in malaria behavior change
communication, including the development of the National Strategy for Malaria BCC in Tanzania and the
six-year Communication Initiative for Malaria in Tanzania (COMMIT), the Ghana Behavior Change
Support project, the Stop Malaria Project in Uganda, and activities in Zambia, Senegal, Rwanda, Mali,
Malawi. JHU•CCP has also conducted training of NMCP staff in over 30 countries in malaria BCC through
Alliance for Malaria Prevention and Leadership in Strategic Health Communication workshops in
Bamako, Dakar, Cote d’Ivoire, Nairobi, Abuja and Dar es Salaam.
2 Situation Analysis
2.1 Malaria in Benin Malaria is highly prevalent in all regions of Benin, with virtually 100% of the population at risk. According to the Global Health Initiative’s Benin Country strategy, malaria’s contribution to Benin’s disease burden is significant, affecting both the health and finances of many households. It is the number one killer of children under-five and is a common condition afflicting many mothers and pregnancies each year. It constitutes 40 percent of all out-patient consultations in health facilities, and 22 percent of all hospital admissions. In 2010, The Lancet (375:9730, pp.1969 – 1987) estimated that 9,165 children under-five died of malaria in 2008, representing 23% of all under-five deaths. Malaria transmission is stable but influenced by several factors such as vector species, geography, climate, and hydrography. The primary malaria vector in Benin is Anopheles gambiae s.s.; however, secondary vectors may become important in certain circumstances. For example, the widespread distribution and continuous breeding of An. gambiae results in endemic transmission nationwide, with three distinct regions. In the coastal region of Benin, which has many lakes and lagoons, transmission is heterogeneous because of the presence of both An. melas and An. gambiae. Above the coastal region, malaria is holoendemic. Finally, in northern Benin, malaria is seasonal, with a dry season (November to June) and a rainy season (July to October) during which malaria rates are highest. Current Status of Key Indicators
1. Infant mortality: 73 per 1,000 live births (WHO Global Health Observatory Data Repository 2010) 2. Under five mortality rate: 115 per 1,000 live births (WHO Global Health Observatory Data
Repository 2010) 3. Maternal mortality: 397 per 100,000 births 4. Proportion of households with at least one ITN: 79% (DHS 2011-2012)
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5. Proportion of children under five years old who slept under ITN the previous night: 71% (DHS 2011-2012)
6. Proportion of pregnant women who slept under an ITN the previous night: 75.5% (DHS 2011-2012)
7. Proportion of women who received > 2 doses of IPTp during their last pregnancy in the last 2 years: 22.8% (DHS 2011-2012)
8. Proportion of children under five years old with fever in the last two weeks who received treatment with ACTs within 24 hours after onset of fever: 6.7% (DHS 2011-2012)
9. Houses targeted for IRS that have been sprayed: 89% (DHS 2011-2012)
Benin is divided into 12 Departments de Santé (DDS), which are subdivided into 34 Health Zones (HZ). In
addition to the literature review and the results of the workshops conducted jointly with the
Department of Littoral and Atlantic in July 24 to 26 2012, the ARM3 team reviewed other demographic
and epidemiological surveys and reports that shed light on current malarial problems and issues in
Benin. The situation analysis was conducted on the basis of an assessment of current Social and
Behavior Change Communication activities and materials in Benin that address malaria program areas.
The most recent data available to describe the current malaria indicators is the preliminary 2011-2012
DHS survey. Although estimates from the DHS survey are considered representative at national level and
accepted by PMI Benin, it is worth pointing out that these results are preliminary therefore, they should
be used with precaution.
Table 1 Malaria indicators
Malaria indicators 2006 DHS DHS 2011-2012
Proportion of households with at least one ITN 25% 79.8%
Proportion of children under five years old who
slept under an ITN the previous night
20% 71%
Proportion of pregnant women who slept under
an ITN the previous night
20% 75.5%
Proportion of women who have completed the
recommended 2 doses of IPTp during last
pregnancy in the last 2 years
>1% 23%
Proportion of children under five years old with
fever in the two weeks who received treatment
with ACTs within 24 hours of onset of fever
<1% 6.7%
Other sources:
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Government health facilities with ACTs available
for treatment of uncomplicated malaria
PMI Health Facility Survey/End Use Verification Survey 2010: artesunate-amodiaquine (3)
17.5% artemether-lumefantrine (6)
35.1% artemether-lumefantrine (12)
56.1% artemether-lumefantrine (18)
10.3% artemether-lumefantrine (24)
36.2%
Number of positive malaria cases among
pregnant women (reported to DDP in 2011)
27,185 (SGSI/DDP/MS, 2011
Annuaire des statistique
sanitaire 2011)
Percentage of uncomplicated malaria case
among children under the age of 5
49% among 0-11 months; and
28. 1 among 1-4 years old
(SGS1/DDP/MS, 2011-
Annuaire des statistiques
sanitaires 2011)
Percentage of ANC visit (in public, private and
religious health centers)
85% (Annuaire des statistiques
sanitaires 2011)
Houses targeted for IRS that have been sprayed 99.3 (2010 RTI
report)
85% (2011 RTI Report)
The sharp increase in ITN use can be attributed in large part to Benin’s free LLIN mass distribution
campaign in 2010, as well as the combined interventions of the President’s Malaria Initiative (PMI),
World Bank Booster Program for Malaria Control in Africa, the Government of Benin, and other
stakeholders. However, the DHS results also show that although antenatal care (ANC) visits are very
high (an estimated 86% of women received prenatal care from a trained health care professional during
their last pregnancy; 61% of women reported having 4 or more visits), only 23% of pregnant women
reported having completed the two doses of SP required during their last pregnancy in the last 2 years.
The reason for this significant gap between the first dose and second doses is one of questions that the
ARM3 formative research (that will be led by JHU-CCP) is planning to answer in year two.
Although malaria can be severe, early and appropriate treatment is very effective. However, in Benin,
care-seeking outside of the home is still limited; in the 2011-2012 DHS survey, only 39% of children who
had fever were taken to health center for treatment. Although home-based care can be effective, it is
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 12
essential that caregivers are knowledgeable about proper home treatment, as well as danger signs
requiring medical attention.
2.2 Overview of the National Malaria Control Plan and Strategy
With the support of PMI, WHO, and Roll Back Malaria, the NMCP has developed its new five-year
National Malaria Strategic Plan 2011-2015. The vision behind the new strategy is to continue to
promote universal access to malaria prevention and treatment interventions, implement activities
that encourage positive behavior change, achieve and sustain high coverage levels, thereby
reducing malaria’s burden and achieving near zero deaths by 2015.
The core interventions of the 2011-2015 strategy include:
Universal coverage with ITNs, with a special emphasis on distributing LLINs through mass
distribution campaigns in July 2011 and 2014
Donors and the GOB are continuing to support routine distribution to pregnant women during
ANC visits and to children under five years during routine immunization clinics
Further expanding IRS, which covers all nine communes of the department of Atacora
Universal access to ACTs, as well as improved diagnosis and management of severe malaria
Emphasis on the prevention and treatment of malaria in pregnancy, particularly with IPTp
Intensive IEC/BCC efforts and social mobilization at all levels, especially at the community level
Integration of malaria control activities within the health system with an emphasis on human
resource development
Strong monitoring, evaluation, and operations research to monitor progress, evaluate impact,
and continuously improve interventions
In its 2011-2015 Strategic Plan, the NMCP is seeking to enhance coordination capacity within the
decentralized structures at the departmental level. Under this approach, 12 departmental coordinating
structures will continue to be supported to improve health outcomes through implementation of
policies and strategies defined by the national coordination structures and the GOB such as.
Waiver of user fees for children under five attending health facilities
Increasing capacity of community health cowrkers (CHWs)
Free malaria treatment for children under five and pregnant women
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National Malaria BCC Strategy:
The Behavior Change Communication Strategy for NNCP Benin was developed in 2006 as part of
the National Malaria Control Plan and Strategy (2006-2011). This document was desined to be
an integrated communication plan that would standardize messages and tools for all partners
working on malaria in Benin. The NMCP is now planning to develop and implement a new
integrated communication plan that accompanies the new National Malaria Control Plan and
Strategy (2011-2015). The new integrated communication plan will include strategies for
advocacy, BCC and social mobilization.
As part of the National Malaria Control Plan and Strategy, the NMCP has identified the following
target indicators for BCC:
100% of heads of households in urban and rural areas know that LLINs are an effective means of
prevention against malaria
100% of mothers an/or caregivers of children know the treatment for uncomplicated malaria
100% of mothers and/or caregivers of children know that treatment with ACTs requires positive
confirmation with RDTs
100% of mothers and/or caregivers know the signs of malaria
100% of pregnant women in urban and rural areas are aware of IPTp and its advantage
2.3 Organizations supporting malaria communication interventions in Benin
Over the past five years, the Global Fund Round 3 grant to Africare has also supported malaria
messaging at the community level through organized social mobilization campaigns, support to women’s
groups, and training of CHWs in IEC/BCC. The RCC for Round 3 includes a significant communication
component, which will encourage CHWs and women’s groups to promote prompt treatment for febrile
children at the community level, timely referral of severe malaria cases, and use of ANC to increase IPTp
uptake among pregnant women.
UNICEF is the lead for Benin’s health sector partners. They support IMCI, maternal mortality reduction,
and the management of severe child malnutrition in several departments in both the northern and
southern parts of Benin. They are piloting performance-based financing of CHWs through health zones
and communes. UNICEF’s Communication for Development (C4D) approach is referenced in the National
Malaria Strategic Plan’s section on IEC/BCC.
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PMI has supported BCC for all malaria interventions, with a particular focus on net hang up and use,
including CHW visits and community mobilization in support of the mass campaign in 2011. PMI also
funds a National Malaria Communications Working Group (Groupe Technique de Travail en
Communication), which receives routine technical assistance from a number of PMI implementing
partners. The group is responsible for reviewing the technical content of all IEC/BCC messages
pertaining to malaria. The NMCP included key IEC/BCC priorities in its 2011 integrated plan, which has
been used to prepare monthly and quarterly plans for all activities. PMI supports BCC related to IRS
activities through RTI in nine communes in the north. PMI also funded a TRAC survey to measure
communication interventions and changes in behaviors and attitudes in 2010.
Roll Back Malaria:
The RBM network is also very active in coordinating and enlisting broad-based participation in scaling up malaria efforts in Benin. This local RBM network is closely linked to the West Africa RBM Network (WARN) and the global RBM Network based in Geneva. In Benin, the NMCP acts as the convener of the RBM network. The NMCP coordinator is the chair and the WHO malaria advisor is the co-chair. Meetings are held monthly and are well attended. All stakeholders present are given the opportunity to report on their malaria activities during the previous month including on behavior change communication and community mobilization.
World Bank
Between 2006 and 2011, the World Bank implemented a $22 million performance-based financing
project to improve maternal and neonatal health in eight health zones in Benin. The World Bank’s
project, Projet d’Appui à la Lutte contre le Paludisme, ends in 2011. USAID and the World Bank’s Project
are collaborating on the universal distribution campaign for bed nets. Although this project’s scope of
work was not directly linked to any malaria communication activities, the impact of their activities had
somehow benefited the national malaria programs.
World Health Organization (WHO)
WHO supports the Government of Benin (GOB) in the development of technical norms, protocols and
service standards in the health sector. For instance, in 2006, the development of the National Malaria Control Plan and Strategy was funded by the WHO. Also, USAID and WHO collaborate on various health topics such as Maternal and Child Health (MCH), or the development of a national policy on the use of RDTs, malaria treatment protocols, routine malaria information system, and most recently on the evaluation of the five-year National Malaria Control Strategy and the development of the next road map for malaria control in Benin. African Development Bank: The ADB was another contributor to the malaria program through its
support to local health committees and Communicty Health Workers and the distribution of bed nets to
pregnant mothers and infants in Zou, Borgou and Donga departments.
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Malaria Communications Working Group members (GTTC): In year 2012 ARM3 helped to resume the
GTTC quarterly meetings. Members of the group include the NMCP, USAID/PMI, Research Triangle
Institute, University Research Corporation/PISAF, Africare, CRS, PSI, the World Bank, WHO, UNICEF, and
the Peace Corps. The group met in April and September 2012, to review the existing communication
tools and materials assess their quality and usefulness vis-à-vis the current malaria situation in Benin.
The National Malaria Communications Working Group came to the conclusion that almost all malaria
partners working in Benin have either produced audio, visual or printed materials. Many of them have
also developed messages for their community based-activities.
Along the same lines, the Malaria Communications Working Group members pointed out the need to
update materials and messages during the first meeting on April 24, 2012. They also recognized that
current materials do not include new elements such as net use by all members of the family and malaria
diagnostic. ARM3 has started to develop a new document containing all key information about malaria
prevention and management to replace the old version “Mieux connaitre le paludisme pour l’eviter”,
edited in 2008. However, this document needs to be validated by the NMCP.
During the last working group meeting in September 2012, the National Malaria Communication
Working Group urged the NCMP coordinator to rush for the designing of a new integrated
communication plan in replacement of the previous version, which expired in 2010. This activity will be
funded by Global Fund under a subcontract with Africare.
Several bilateral and multilateral donors, as well as civil society, have also played an important role in
supporting the NMCP malaria communication efforts in Benin. Although some of the donor support
ended in recent years, their impact is still felt on the malaria communication activities, directly or
indirectly. These donors include:
Bilateral: (1) Belgian Cooperation; (2) Chinese Government; (3) the Coopération Française; (4) Japanese
International Cooperation Agency
Multilareral: (1) UNFPA
USG Agencies: Peace Corps
Civil Society and Private Sector: (1) Benin Business Coalition; (2) Gates Foundation;
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2.4 Communication gaps/Challenges In Benin, the NMCP is responsible for coordinating the national communication strategy through policy
formation, setting standards and monitoring quality assurance, resource mobilization, capacity
development and technical support, coordination of research, and monitoring and evaluation.
Coordination among communication partners has improved, but challenges remain in providing
integrated communication, harmonizing messages and engaging the community. Several key documents
such MOP 2013, the National Malaria Strategic Plan 2011-2015 identified that obstacles to the success
of communication interventions are socio-cultural, economic and political in nature. They include poort
perception of the magnitur of the malaria burden, poor treatment seeking behaviors of the individuals
and communities, lack of political will and commitment and lack of qualified BCC personnel and all level.
For instance, the National Malaria Strategic Plan for 2011- 2015 identifies five weaknesses to the
implementation of BCC and community mobilization in Benin. These focus on national-level and
management gaps:
o Lack of follow up of community based- outreach activities by the field staff;
o Weak dissemination system of partnership and strategic communication documents
o Lack of qualified personnel in charge of communication and community based-services at
the central and departmental levels
o Under use of the PNLP website
o Lack of audio-visual tools for training
A literature review, site visits, meetings with local partners during a workshop and the access to official
documents helped us to identify additional gaps. In May 2012 ARM3 hired a consultant to conduct an in-
depth literature review to gain an understanding of barriers to IPTp uptake and LLIN use in the country.
Key findings emerging from this literature review include the following:
Table 2 Barriers to Behavior Change
Topic Lit Review Findings Other Sources
Vector control-LLINs
Household level
Persistence of negative
perceptions around mosquito
nets (discomfort, lack of air,
sensation of heat)
Negligence from the care
providers (mothers and fathers)
2010 TRAC/PILP
Self efficacy and motivation
were found to be significant
determinants for LLIN use in
Benin. Many heads of household
and family members do not
sleep in mosquito nets
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The perceived burden associated
with hanging the net and taking
it down every morning
Perception that mosquito nets
are not important
Perception that mosquito nets
cause sleep disruption
Doubts about the efficacy of
LLINs
Difficulty associated with
replacement and repair of
damaged mosquito nets
Lack of awareness about the
importance and benefit of LLIN
use among the population
Configuration of the room where
the LLIN will be hung.
Perceived poor quality of care at
health facilities leading to
infrequent attendance.
Confusion about whether ITNs
need to be retreated or not
consistently every night.
Service delivery level: Providers at understaffed
facilities had little time for
counseling on benefits and
appropriate use of ITNs as part
of comprehensive strategy to
prevent malaria
Although many providers
generally spent some time
counseling on the benefits and
appropriate use of ITN as part of
a comprehensive strategy to
prevent malaria, these
conversations were usually
dominated by the providers,
leaving no room for clients to ask
questions or address their
concerns (Source: ARM3 BCC
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team site visits)
Malaria and pregnancy
Household level Late ANC attendance of
pregnant women
Lack of awareness about the
importance of its use
Some people think that SP is
harmful to pregnant women
Family (men’s involvement) and
economic factors influence
timing of antenatal care
Negative social norms around
IPTp (rumors from friends and
family members)
Taste and size of the SP pills
2010 Africare Report
Pregnant women are not
necessarily aware of what
medications they are given nor
what they are for
Lack of awareness about the
benefit of the ANC among users
(pregnant women)
Lack of awareness of the need
for two doses of SP-IPT
Many pregnant women start
ANC attendance late or attend
ANC irregularly
Service delivery level Stock outs of Sulfadoxine-
Pyrimethamine in certain health
centers
Some health service providers do
not follow national directives for
IPTp use
Lack of training for providers on
how to administer SP
Poor quality of client services
Although many providers
generally spent some time on
counseling on the benefits and
appropriate use of SP, these
conversations are usually
dominated by the providers,
leaving no room for clients to ask
questions or address their
concerns (Source: ARM3 BCC
team site visits)
Providers may be reluctant to
give SP on an empty stomach
Providers at understaffed
facilities had little time for
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 19
counseling on the benefits and
appropriate use of SP (Source:
ARM3 BCC team site visits)
Perceived poor quality of
healthcare facilities leading to
infrequent attendance
Malaria Case Management
Household level: Mistrust in results of RDT by
clients
Delays in seeking care from
qualified source
Preference for seeking care from
private and street drug vendors
Malaria not perceived as serious
health problem
Service delivery level: Mistrust in results of RDT by
providers
DDP/Health Zones (Littoral and
Atlantic) reports
Many health providers prefer to
rely on their own judgment
when diagnosing suspect malaria
case
Weak health information system
A more recent study found that net care and repair practices are not widespread in Benin and that nets
are wearing out faster than expected. Following the NMCP 2011 mass LLIN distribution campaign, the
Centre de Recherche Entomologique de Cotonou (CRE-Cotonou) with the support of NMCP, USAID, PMI
and CDC found that deterioration of net fibers was visibly showing after six months of use. The same
study also revealed that almost half the nets had holes and /or tears. In addition the net attrition was
followed by a drastic decrease in the amount of insecticide available at the surface of the nets, possibly
due to excessive washing. The same study revealed that some people used the nets for fishing rather
than protecting against mosquitoes.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 20
Site visits were another source of information. Health centers were visited by the ARM3 BCC team to see
firsthand how clients were being received and what kind of services were provided to them. The team
also met with local community leaders to understand how they use their influence. These site visits
gave some insight into the client-provider relationship within health centers, the provider-community
relationship, as well as how to address some of the communication issues they encounter.
Other barriers to proper diagnosis and treatment of malaria were discussed and addressed during a
three-day workshop in Grand Popo (July 24-26, 2012) with the Atlantic and Littoral Health Department
to develop the two regions’ health zone action plans for year 1 (2012-2013) and for 3 years (2012-2015).
Among the identified barriers were providers’ trust in the accuracy of the RDT results and their
perception of RDTs as a threat to provider’s own ability to make clinical diagnoses based on symptoms,
their training, and medical experience. From the community side, it was believed that the main barrier
to proper diagnosis and treatment is that many households think that malaria is a very common disease
therefore not perceived as a serious health problem.
These findings, along with other existing research and reports, provide the basis for ARM3’s strategic vision and communication strategy. Identified gaps reflect the need for a comprehensive strategy that allows stakeholders to create synergy across programs and use multiple channels of communication to maximize reach and depth. ARM3 proposes a comprehensive, results-oriented communication strategy to address the issues from the central level to the community. Throughout, a BCC capacity building process that engages all malaria partners, including NMCP, is crucial.
2.5 Accelerating the Reduction of Malaria Morbidity and Mortality (ARM3) With funding from the United States Agency for International Development (USAID), a consortium led by
Medical Care Development International (MCDI) as the prime recipient, and Africare, John Hopkins
University - Center for Communications Project (JHU-CCP) and Management Sciences for Health (MSH)
as sub-grantees, in partnership with the National Malaria Control Program (NMCP), is implementing the
Accelerating the Reduction of Malaria Related Morbidity and Mortality (ARM3) Project in Benin. It is a
five year project (October 1, 2011 to September 30, 2016) with a budget of $30 million.
In collaboration with USAID/Benin’s President’s Malaria Initiative (PMI), ARM3 seeks to assist the
Government of Benin (GOB) in improving malaria health outcomes in accordance with the NMCP’s
guidelines and standards. The primary objective of ARM3 is to help the Government of Benin achieve
the PMI target of reducing malaria-associated mortality by 70%, compared to pre-initiative levels in
Benin. In support of this PMI objective, the ARM3 program’s specific goal is to increase coverage and use
of key life-saving malaria interventions in support of Benin’s NMCP Strategy by scaling up malaria
control, accelerating the reduction of morbidity and mortality, and building local capacity for sustained
control. ARM3 will also complement and expand the efforts of other donors (for example the Global
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 21
Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), and private sector organizations) to reach the
NMCP’s goal of eliminating malaria as a public health problem in Benin by 2030.
For years 1 and 2, the ARM3 project will cover 12 health zones within the Atlantic and Littoral Health
Department and the Oueme and Plateau Health Department, as well as five former MSH/Basics health
zones in Alibori, Bogou and Donga. As described in the process used in the development of the ARM3
communication strategy section, part of the data used in developing this communication strategy are
from the Littoral and Atlantic Health Department.
The ARM3 BCC strategy aims to support the overall national strategic plan by contributing to the
effective implementation of LLIN distribution in the private sector, promoting use of nets, creating
demand for IPTp and diagnostics, and facilitating positive client-provider interactions to improve malaria
case management and IPTp uptake. The expected results of the ARM3 BCC Strategy are: to empower
individuals to prevent and treat malaria through increasing desired behaviors in target populations
benefited by the project including pregnant women and caretakers of children under five; and improve
desired behaviors in health providers and caretakers at the community level.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 22
ARM3 Results and Sub-Results are as follows:
Table 3 ARM3 Results and Sub-Results Activity
Objective: Assist the Government of Benin to achieve the PMI target of reducing malaria-associated mortality by 70%,
compared to pre-initiative levels
Result 1: Implementation of
malaria prevention programs in
support of the National Malaria
Strategy improved.
Result 2: Malaria diagnosis and
treatment activities in support of the
National Malaria Strategy improved.
Result 3: The national health system’s
capacity to deliver and manage quality
malaria treatment and control interventions
strengthened.
1.1 IPTp uptake increased 2.1 Diagnostic capacity and use of
diagnostic testing improved
3.1 National Malaria Control Program’s
technical capacity to plan, design, manage, and
coordinate a comprehensive malaria control
program enhanced
1.2 Supply and use of LLINs
increased
2.2 Case management of uncomplicated
and severe malaria improved
3.2 MOH capacity to collect, manage and use
malaria health information for monitoring,
evaluation and surveillance improved
3.3 MOH capacity in commodities and supply
chain management improved
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3 Communication Strategy
3.1 Pathways for malaria prevention and control in Benin
The communication strategy is informed by the Pathways for Malaria Prevention and Control in Benin, a
framework developed by JHU•CCP that illustrates the ways in which different communication
methodologies can impact outcomes at different levels of society. The model supports the concept that
social and individual behavior change will not happen as a results of one intervention alone or by
focusing on one level or segment of society, but rather through social, individual, and structural change
coming together to produce a supportive society.
ARM3’s strategy describes the way in which media communication is used to influence decision making
of communities and individuals. Advocacy communication is used to promote the support and
adherence to program objectives as well as improve public and private sector partnerships. Community
mobilization communication targets groups and associations to address needs in relation to
malaria prevention and treatment efforts. Interpersonal communication (IPC) will address each behavior
problem individually.
This is based on the analysis of underlying conditions (situational analysis, including partner analysis),
domains of communication (roles, providers, beneficiaries and framework including NMCP), initial
outcomes from the MOP, GHI, PMI and ARM3 proposal; and expected behavioral outcomes based on
the beliefs, actions required, expected behaviors and barrier analysis, towards achieving sustainable
health outcomes targeted by ARM3.
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Table 4 ARM3 Pathways for malaria prevention and control
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 25
3.2 ARM3 BCC Strategic Objectives:
The strategic objectives of the ARM3 BCC strategy are:
O.1. To support BCC interventions by the National Malaria Control Program and ARM3 through: effective
coordination of activities by the BCC Working Group; participation in activities by other existing working
groups[1] ; harmonization of BCC/IECC messages, materials and tools developed in Benin[2].
O.2. To increase community engagement in /mobilization for malaria prevention and treatment.
O.3. Increase the supply and use of LLINs through social marketing with private sector partners.
O.4. To upgrade BCC skills of health workers from private and public sectors at national and community
levels, and provide supervision in the use of BCC guidelines.
O.5. To advocate for increased support for malaria control, by government authorities and key partners
(reflected in support for coordination, availability of funds, allocation of human resources and
development of public policies that support malaria mortality and morbidity reduction).
O.6. To develop and disseminate materials supporting BCC and Community Mobilization
O.7. To monitor and evaluate the ARM3 BCC and Community Mobilization Strategy.
3.3 Audiences and priority behaviors targeted by the ARM3 Communication Strategy
In addition to the primary target populations, BCC interventions will seek to achieve behavior change in
secondary audiences. Husbands (or other heads of household) often play a key role in the decision by a
pregnant woman or a caretaker of a young child to use an LLIN, seek ANC/IPT, or seek treatment. The
study entitled “Enquête exploratoire sur les perceptions des beneficiaries du future pole d’excellence”1
in Benin stated that all the husbands interviewed think that they can support their wives to attend ANC.
Community leaders (chiefs, kings, religious leaders), relais communautaires and mothers-in-law can also
influence decisions related to preventive measures and care-seeking.
[1] i.e.: (i) Clinical case management, (ii) Supply chain management, (iii) Monitoring &evaluation [2] Includes the alignment of ARM3 Communication Strategy with MOH’s priorities, existing evidence; and to
provide strategic guidance for the articulation of the ICP supported by GFATM (being developed by Africare)
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 26
Section 0 provides presents these target populations and desired behaviors, together with key message
content and communication channels and approaches.
Table 5 Summary Target Audiences and Key Behaviors by Sub-Result
ARM3 Result Target Audiences Key Behaviors
Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved.
Sub-Result 1.1- IPTp
Uptake Increased
Primary audience: Pregnant Women
Secondary audience: Husbands, “heads of
households in Beninese context), in laws, health
providers, and community.
Tertiary audience: Health policy makers and
Government authorities from other ministries will be
targeted for advocacy.
Receiving and taking 2 or more doses of
SP/Fansidar during their last pregnancy
Encouraging other pregnant women to
receive IPTp at least twice during pregnancy
Support their partners/relatives/friends to
attend ANC
Use their influence to remove or reduce
implementation bottlenecks
Encourage health providers to provide
information and services for malaria control
Promote BCC/IEC activities at community
level to support malaria and pregnancy
Sub-Result 1.2 Supply
and use of LLINs
increased
Primary audience: Caretakers of children under 5
(Fathers and mothers)
Secondary audience: Heads of households, relais
communautaires, community and religious leaders as
well as owners and managers of private companies.
Tertiary audience: Health policy makers and
Ensure that all children under the age of 5 in
their care sleep under an LLIN every night of
the year
Sleeping under an LLIN every night
throughout pregnancy and continuing to do
so with the newborn
Support their
partners/relatives/friends/employees to
sleep under LLIN every night
Use their influence to remove or reduce
implementation bottlenecks
Encourage health providers to provide
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 27
Government authorities from other ministries will be
targeted for advocacy.
information and services for malaria control
Promote BCC/IEC activities at community
level to support LLINs
Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy
improved.
Sub-Result 1.3. 2.1 Diagnostic capacity and
use of diagnostic
testing improved
From the service supply side:
Primary audience: Health service providers (both
public and private)
Secondary audience: Health service supervisors are in
the position of ensuring compliance with Benin
policies on diagnostics and treatment, providing
supportive supervision and evaluating performance.
Tertiary audience: Health policy makers and
Government authorities from other ministries will be
targeted for advocacy.
Care-seeking at the nearest health facility or
trained provider within 24 hours of the
onset of symptoms
Properly diagnose malaria before
administering treatment, using an RDT or
microscopy.
All individuals diagnosed with malaria are
treated in accordance with the NMCP
treatment protocol.
Encourage health providers to provide
information and services for malaria control
Promote BCC/IEC activities at community
level to support care seeking practices
2.2 Case management
of uncomplicated and
severe malaria
improved
From the demand side:
Primary audience: As they bear most of the costs and
burden of malaria at home, caregivers (mothers and
fathers) are considered as the other primary audience
for this behavior change communication strategy.
Provide information (especially to mothers
and caretakers of small children) on the
importance of prompt care-seeking when
malaria is suspected
Use their influence to remove or reduce
implementation bottlenecks
3.4 Key Messages Messages will be engaging, and contain information that is readily understood and actionable. They will
be fully compatible with existing NMCP and USAID guidelines for malaria prevention and control. The
content and format may be adapted to reflect local customs and language. IPT uptake will be promoted
through messages highlighting that SP is free, that all pregnant women should attend ANC and seek IPTp
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 28
(highlighting that they should do so even if they feel fine; this is not to treat a sickness, but to prevent it
from happening). Pregnant women will also be advised to sleep under an LLIN every night of the year,
and that they should continue to do so with their baby. Messages directed at health service providers
(primarily through training) will center on the differences between malaria and other febrile illnesses,
how malaria is transmitted, the dangers malaria poses to everyone, especially pregnant women and
small children, provider-patient relations, and the NMCP protocol for malaria diagnosis and treatment.
Although no specific messages were developed during the Grand Popo workshop, the BCC team from
the workshop was able to formulate ideas and key message content that will guide the development of
clear messages for each behavior that needs to be addressed. For treatment, messages will promote
generic ACTs, and for IPTp, generic SP. Since message development is one of the key pillars of an
effective SBCC strategy, ARM3 BCC team will refine each of the messages and propose them to the
NMCP for approval before using them in the field. An activity complementing this activity is already
under way as the ARM3 team has started updating the NMCP “Mieux connaitre le paludisme pour
l’eviter” which included all the important information and key new messages for malaria prevention and
treatment for health providers and partners working in the malaria field.
We have attached in Annex B : Key Messagesa list of existing key messages that the NMCP has approved
from the message inventory collected during the documentary review carried by ARM3. The list is not
exhaustive and additional message development activities are needed and should be adapted to the
cultural context of the program’s main intervention sites. Section 0 also includes the complete behavior
analysis and strategic responses, with key audiences, messages and activities.
Messages are oriented to encourage target audiences to take actions supporting certain key behaviors
in the identified audiences. The table below presents illustrative key messages by target audience.
Table 6: Illustrative Key Messages by Target Audience and Sub-Result
Result ARM3 Target Audiences Illustrative Messages (to be finalized with NMCP and
partners)
Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy
improved.
Sub-Result 1.1-
IPTp Uptake
Increased
Primary audience:
Pregnant Women
Pregnant women, attend ANC and take SP at your visit;
you and your baby will be protected from malaria.
Pregnant women, SP is free for you at health centers
during your ANC visit. Go to ANC to find out more about
the benefits for you and your baby.
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Pregnant women, SP tablets are effective and safe for you
and your baby. Attend ANC and take the tablets.
SP is used for intermittent preventive treatment of malaria
and protects you and your baby. Take your SP and get your
recommended two doses.
Secondary audience:
Heads of households,
relais
communautaires, or
community health
workers
Men, malaria is dangerous for pregnant women and their
babies. Encourage your spouse to attend ANC to prevent
complications from malaria.
Men, support your spouse when she goes for ANC, since
when men take care of their wives, you will have a healthy
baby and healthy mother.
Men, malaria in pregnant women can lead to anemia,
premature birth, low birth weight. Encourage your spouse
to get two doses of SP during ANC; this will protect them
both from the dangers of malaria.
Secondary audience:
Leaders/managers
Malaria in pregnancy can lead to anemia, premature birth,
low birth weight. Encourage female employees to get their
two doses of SP, this will protect them and their baby from
the dangers of malaria.
Fever during pregnancy is not normal. Your support is
important for women to seek treatment from a qualified
health provider as soon as they get a fever.
Tertiary audience:
Health policy makers
and Government
authorities from other
ministries
Encourage health providers to provide information and
services for malaria prevention
Promote BCC/IEC activities at community level to support
malaria and pregnancy
Sub-Result 1.2
Supply and use of
LLINs increased
Primary audience:
Caretakers of children
under 5 (Fathers and
mothers)
Pregnant women
Pregnant women: LLINs are free at our first ANC visit; be
sure to get one
Once you have your LLIN, hang it up
Use your LLIN every night (women and children)
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 30
Take care of your LLIN; repair it if needed and follow
instructions for washing it
Secondary audience:
Heads of households,
relais
communautaires,
Malaria is a serious disease transmitted by mosquitoes
that bite during the night. As head of household, you can
change this situation by encouraging your whole family to
sleep under LLINs every night, all year round.
LLINs are offered free to each child under five in Benin.
Encourage your spouse to go to a health center to get
one.
Secondary audience:
Opinion leaders:
Community and
religious leaders as
well as owners and
managers of private
companies.
For Business leaders: malaria reduces productivity and
increases absenteeism among your employees. You can
change this situation by encouraging staff to sleep under
LLINs every night and all year round.
For community and religious leaders: Malaria harms the
well-being and the quality of life of your communities; tell
community members, especially women and children, to
sleep under LLIN
Tertiary audience:
Health policy makers
and Government
authorities from other
ministries
Encourage health providers to provide information and
services for malaria prevention
Promote BCC/IEC activities at community level to support
LLINs
Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy
improved.
Sub-Result 2.1
Diagnostic
capacity and use
of diagnostic
testing improved
From the service
supply side:
Primary
audience: Health
service providers
(both public and
private)
Consider all cases of malaria in pregnant women to be
severe, and treat them with appropriate drugs to save
lives.
Use new recommended medicine “ACT” to treat malaria
and earn patient confidence
Not all fevers are malaria; RDTs are very useful in making
effective use of antimalarials.
RDTs are very useful in preventing development of drug-
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 31
resistance.
RDTs are effective and reliable. You must use an RDT to
each patient with suspected malaria before beginning
treatment in order to save lives.
All fevers should be treated within 24 hours. A child can
die from malaria if he is not treated in time and with the
appropriate drugs.
As soon as danger signs appear, both in children and
adults, go immediately to a health center for appropriate
treatment.
Secondary audience:
Health service
supervisors
Poorly managed malaria in children, adults and pregnant
women can lead to complications and even death. Ensure
compliance with the malaria treatment protocols to save
lives.
All fevers should be treated within 24 hours. A child can
die from malaria if he is not treated in time and with the
appropriate drugs.
Do not provide any treatment without malaria
confirmatory diagnosis
Provide treatment as soon as possible during the first 24
hours and refer severe malaria cases to a level appropriate
for treatment
You must use an RDT to each patient with suspected
malaria before treating them to avoid treatment failure
due to ACT resistance.
.
As model service providers we follow the Ministry of
Health treatment protocols to save lives.
From the demand
side:
Primary audience:
Pregnant women, malaria is dangerous for you and your
baby. Go immediately to a health center for treatment if
you develop symptoms of malaria.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 32
Caregivers (mothers
and fathers), mothers
and in laws
Mothers and caretakers of young children, heads of
household, take your child under five to the CHW if he has
fever for treatment with ACTs, and he will get better
quickly.
Mothers and caretakers of young children take your child
under five to the clinic if he has fever for treatment with
ACTs, and he will get better quickly.
Mothers and caretakers of young children, treat your child
with ACT according to the directions of CHW or health
agents. ACTs are available from CHW or in health centers.
Mothers and caretakers of young children, heads of
household, all fevers should be treated within 24 hours. A
child can die from malaria if he is not treated in time and
with the appropriate drugs.
Mothers and caretakers of young children, heads of
household, not all fevers are malaria, so it is important to
quickly to a health center when you suspect malaria.
Mothers and caretakers of young children, heads of
household, as soon as your child has one of these
symptoms, take them to a health center for a quick
recovery:
· Vomits everything he eats
· Does not nurse or eat
· Doesn’t react or seems asleep
· Has convulsions
· Is more pale than usual; palms and bottoms of the
feet; nails and lips are pale
· is breathing rapidly or with difficulty
Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and
control interventions strengthened.
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3.1 National
Malaria Control
Program’s
technical capacity
to plan, design,
manage, and
coordinate a
comprehensive
malaria control
program
enhanced
Primary audience:
Health policy makers
and Government
authorities from other
ministries
Encourage health providers to provide information and
services for malaria control
Promote BCC/IEC activities at community level to support
care seeking practices
3.5 Communication Channel This document is an important step towards the implementation of a comprehensive and integrated
communications strategy. One of the means for achieving impact through BCC is to combine a number
of approaches to reach the maximum number of beneficiaries. The Consortium’s multi-channeled BCC
program will coordinate with the BCC component of Africare’s Global Fund program so that the reach of
the NMCP’s BCC program is maximized.
3.5.1 Mass Media
Mass media channels have the possibility of reaching large numbers of beneficiaries at a low to moderate cost, and are an excellent means of increasing awareness about the gravity of malaria in Benin, of improving knowledge about transmission, prevention, and treatment, and of modeling positive behaviors. Mass communication channels to be used by the program include radio and television, print media such as billboards, posters, and banners, and special events. In Benin, TV and radio remain the most used and trusted media to date (MIS 2010). Benin has four television stations and more than one hundred radio stations. Radio stations in Benin currently engaged by the World Bank’s Malaria Booster Program have already started broadcasting messages developed by the Consortium and the NMCP. Radio programming may include (based on the results of the consumer research) short programs of music jingles, interviews with opinion leaders (political, religious, social), and skits. Dividing the geographical responsibilities for radio broadcasting between the Consortium and Africare’s Global Fund program will reach a wider audience with more frequency. Women are less likely than men to be regularly exposed to any media in Benin. According to the 2006
DHS survey, only 57% of women listen to radio at least once every week compared to 85% of men.
Television viewership is not widespread, with 35.6% of men reporting that they regularly watch
television vs 25.3% of women. The DHS survey also reported that in Benin, the proportion of people
without any exposure to media is quite high at 38% for women and 13% among men. The proportion of
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 34
exposure to newspapers or magazines is almost negligible among Beninese men and women (12.8%
among men and 3.8% among women). The exposure level in urban areas is much higher than in rural
areas. According to the same DHS survey, more than 13% of men in urban areas are exposed to either
TV, radio or print media at least once per week (compared to 4.6% in rural areas). The figure is much
lower among women, only 5.4% of whom are exposed to the three media at least once per week in
urban areas and 0.7% among rural women.
The 2010 final evaluation of PALP project documenti reported that 68% of households possess a radio.
More than 32% of the population also owns a television and 59% possess cellular phones. Knowing
audiences’ exposure to media and preferences is key in designing strategic health communication.
3.5.2 Interpersonal Communication
Effective interpersonal communication is key to achieving positive behavior change. In comparison with
mass media communications, interpersonal activities have the advantage of allowing heads of
household and caregivers to discuss their concerns and doubts about the program’s different
interventions. They also provide an opportunity for communication agents to better understand values
and obstacles to behavior change, so that individual solutions can be devised.
About 39% of Beninese women have no access to any form of media and will require alternative
communication channels. The interpersonal communication component will incorporate community
engagement approaches through games, songs and theater performed at social, cultural, sports, and
market-related events, and through school-based competitions (song, theater). To build social norms
supportive of malaria prevention and prompt treatment, Mobile Video Units and local opinion leaders
and “champions” will be used to promote the Consortium’s messages. The strategy will include home
visits by CHWs to identify pregnant women and motivate them to keep their ANC appointments, to
remind families about the proper use and maintenance of LLINs, and to promote environmental control
of malaria and prompt care-seeking for febrile disease. This component will also provide a voice
whereby the community can influence the quality of care provided, particularly in public facilities. The
Consortium will provide financial and technical assistance to local NGOs/CBOs to implement the
community engagement activities of the BCC program. The NGOs that implemented similar BCC
activities for the World Bank Booster Program will be invited to compete to be selected for this
initiative. Funding for these NGOs will be split between the Consortium and the Global Fund.
3.5.3 Counseling in Government and Private Health Facilities
The Consortium will design and implement a training of trainers program for providers in government
and private health facilities on improved counseling and patient interaction skills to enhance the
patients’ understanding and adherence to treatment regimes. It will be applied during the
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implementation of the performance improvement (through quality assurance) approach at hospitals and
health zones. In addition, communications staff in Hospitals, Health Zones and Health Directorates will
be trained to serve as effective spokespersons in conveying the Consortium’s key messages to local
media outlets.
3.6 Communication Materials The communication materials to be developed under the strategy are.
Table 7: List of existing communication materials
ARM3 Result Type of material
(printed/audiovisual)
Name of Material
Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved.
Sub-result 1.1: IPTp
uptake increased
Printed IPT flyer for the general public and pregnant women
T-shirt and hats
Audiovisual IPT radio spots and programs for general public and
pregnant women
IPT radio spots and programs for men
IPT radio spots and programs for community leaders
IPT TV spots for men
IPT TV spots for general public and pregnant women
Sub-Result 1.2
Supply and use of
LLINs increased
Printed LLIN flyers for general public
T-shirts and hats
Audiovisual LLIN radio spots and programs for caregivers and
pregnant women
LLIN radio spots and programs for men
LLIN radio spots and programs for community leaders
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LLIN TV spots for men
LLIN TV spots for general public and pregnant women
LLIN TV spots for community leaders
Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy
improved.
Sub-Result 2.1
Diagnostic and
treatment improved
Printed Provider-patient IPC job aid
Job aid (aide memoire) on the national new case
management for providers
Flyers on “ACT efficacy”
Audiovisual Diagnostic and treatment radio spots and programs for
caregivers and pregnant women
Diagnostic and treatment radio spots and programs for
men
Diagnostic and treatment radio spots and programs for
community leaders
Integrated materials
Printed LLIN use and repair pamphlet for general public
Malaria key messages booklet for health providers
Booklet on new case management policy for providers
Malaria advocacy pamphlet for community leaders and
managers/supervisors
Malaria advocacy pamphlet for decision makers (local
leaders and other ministries)
Malaria jobaid for health providers/community health
workers and “relais communautaires”
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 37
Banners with LLIN and IPTp messages
Audiovisual TV songs with malaria prevention and case
management messages
3.7 Capacity Building
According to MOP 12, the factors impeding the PMI implantation include: the NMCP staff lack of
requisite knowledge and skills to fulfill their job description, weak health information system and health
commodities supply. Within the BCC unit, there are only three staff, each with different background.
One is in charge of social mobilization, and he is seconded by a BCC chief and a program officer. The
unit maintains contacts with implementing partners and provides them with guidance on the
development of strategies in Benin. The unit also has an inventory of produced materials and in some
cases can distribute some materials to partners who express an interest. To allow the unit to be
effective in BCC strategy conception, delivery, implementation and monitoring, it needs to be
strengthened. At the department level, there is a medical doctor focal point and a social assistant who
are in charge of BCC and social mobilization. While they are tasked to develop the BCC interventions in
the department, they face a shortage of skills, which hampers their effectiveness developing strategies
and implementing them. At the zone level, there is no single person in charge of BCC. Within the health
centers, the BCC activities are carried out by different people including birth attendants and nurse
assistants. Mothers are educated during preschool and prenatal care consultation. Unfortunately, it has
been discovered during the site visits that the interpersonal communication between provider and
patient is dominated by the medical model of teaching, where providers talk and patients listen.
Patients are not treated as adults with whom the educator needs to negotiate to obtain an agreement
on what should be done at home. Parents are not given enough time to ask questions and raise their
concerns regarding managing child health or their own health.
Under the supervision of health centers, community health workers do outreach activities to bring ANC
and EPI visits to hard-to-reach areas. Home visits, one-on-one contact or group discussions are the
strategies used to reach the beneficiaries. However, to be effective, CHW need to be well selected,
trained, supervised and motivated.
Capacity building will be a key component to achieve the communication objectives laid out in this
communication strategy. Capacity building activities conducted under the ARM3 will be multi-
dimensional as they focus on building skills, nurturing existing and local values as well as promoting
closer and more effective coordination among all partners implementing SBCC malaria activities. Three
main approaches will be used to ensure capacity building: formal training, learning by doing or on the
job training, and coaching. There are several audience segments at different levels (central,
departmental, zonal, community) for capacity-building activities. These include: (1) at central level:
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 38
National Malaria Communications Working Group and local health institutions;(2) at department level:
Departmental BCC Teams that are comprised of people in the department, health zones and health
centers ; and (3) at community level: NGO, CBO, media professionals and community. For the team
from the central and departmental levels, it is important to strengthen their capacity in SBCC skills as
they are the ones who supervise the quality of health providers’ services in health facilities, as well as
the quality of NGOs and associations at the community level. These stakeholders will take part in all
ARM3 planned trainings (from designing the modules to implementing and evaluating them). They will
also take part in strategy and materials design workshops, as well as the Leadership in Strategic Health
Communication course with media professionals, NGOs and CBOs. Through an established cascade
training system, and with support and coaching from the ARM3 team, the core group of master trainers
will then provide training to BCC teams at the department level to ensure that all health providers are
trained on patient-provider counseling and community participation. Through the ARM3 training activity
with the Medical School and Department of Nursing, stakeholders including representatives from the
NMCP and the Medical school will take part in the design and validation of the pre-service training
provider-patient interaction modules and materials. At the community level, Africare will lead training,
supervision and motivating community health workers in ARM3 catchment areas.
Supervisory capacity related to SBCC of the Departmental Malaria teams will also be reinforced. By
conducting regular supervisory visits with the ARM3 BCC team, local partners will benefit from their
experience in coaching as the ARM3 will emphasize the BCC component of the supervisory forms.
Coordination of all BCC activities is also important to achieve the project and NMCP objectives.
Activities such as media production and release of information are the responsibility of the NMCP and
its partners at the central level. All SBCC strategies and materials for Benin will be built upon the
materials and activities produced at the central level. By using existing structures and coordination
mechanisms including those of partners such as PMI, ARM3 will work closely with the NMCP and other
implementing partners to make sure that all communication malaria activities will be coordinated,
messages will be harmonized and disseminated, and capacities within partner institutions are optimally
used to assist others in a “One team” perspective. Other mechanisms such as the Roll Back Malaria
Network, the quarterly program review from the USAID team, will also be used to ensure open sharing
of information and transfer of lessons learned. ARM3 has conducted an inventory of existing SBCC tools
and messages. These tools and messages will then be communicated to Departmental Malaria teams,
which in turn will communicate and disseminate to other implementing partners at zonal and
community levels.
3.8 Gender Effective BCC requires that program managers and media practitioners observe the ways people may be
marginalized because of their gender. This could be their defined social role in society, race, ethnicity or
class. These and other factors might determine how the target audiences respond to BCC intervention.
Research has consistently shown that men play key roles in changing their families’, especially their
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 39
wives and children’s behaviors (Cabinet Afrique Conseil’s study, March 2009). In each of the
communication activities we propose, the role of men is a significant part of the strategy because they
have the power to change the current trend of behavior around malaria in Benin. In this strategy gender
will be mainstreamed into the design of interventions at all levels to ensure minority ethnic groups,
women and girls have access to information and services, and are supported by their family members of
both genders.
Effective BCC requires a communications approach that not only responds to the biological and cultural
dynamics of malaria as they relate to men and women; the communication response should also be
underpinned by the principle of equity. In Benin BCC should address the fact that women are
biologically more susceptible, particularly during pregnancy, to malaria infection. At the same time
women are the principle care providers of their families, most importantly of children when they are
most vulnerable to the disease. As such BCC will target women for intermittent preventive treatment of
malaria in pregnancy as well as for desired preventive and curative behaviors. On the other hand,
research shows that men are an underexploited audience for BCC messaging in health. As key decision-
makers in household financial decisions, they play a critical role in the several desired health behaviors
of household members, including use of LLIN and compliance with treatment regimens. BCC activities
will target both men and women to ensure optimal behaviors and equitable access to treatment.
Simultaneously, ARM3 will regularly assess the message efficacy, especially during community events
aimed to educate both males and females in an entertaining way. Doing so will help ARM3 determine
how the conveyed messages are responsive to the needs of women, girls and males in acquiring LLINs
and using them consistently, receiving early diagnostic and care in cases of suspected malaria, in
attending antenatal care and in receiving IPTp and supporting wives. ARM3 will ensure also that all
message content spread through media emphasizes the role of gender in maintaining good health
among family members.
3.9 Monitoring and Evaluation The monitoring and evaluation plan for the communication strategy will complement the overall ARM3
M&E plans. Indicators are divided into two groups: inputs and outputs. Inputs pertain to media
materials produced and disseminated. Outputs pertain to reactions generated by audiences (which
include exposure, recall, and recognition of mass media channels and messages. Under ARM3 M&E plan
the following cross-cutting BCC indicators will be used to measure expected results of the BCC
intervention:
Number and type of BCC materials developed
Number of radio broadcasts performed
Percent of population reached with radio messages
Number of NGOs/CBOs implementing community-based BCC activities
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 40
Number of people reached with community based activities
Number of government and private health workers trained on patient counseling
The BCC M&E plan under the ARM3 project will be implemented in partnership with NMCP’s BCC staff
and the National Malaria Communications Working Group. NNCP’s operational plan will be used as a
reference in monitoring and evaluating all BCC activities related to this project. The following logframe
will provide an overall overview of ARM3’s plan to evaluate its BCC activities:
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 41
Table 8: Input Indicators:
ARM3 Activity Name of indicator(s) to
measure results
Data source Frequency Expected Results
Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy
improved.
Sub-Result 1.1- IPTp Uptake Increased
Mass media activities on IPTp
Production of
radio
spots/programs
on IPTp
Number of radio
spots/programs on IPTp
produced
Script Quarterly CDs are available
at the radio
stations/partners
Production of
Tv
spots/programs
on IPTp
Number of TV
spots/programs on IPTp
produced
Script Quarterly DVD/VCDs are
available at the TV
stations/partners
Reproduction
of leaflets (, s,
on IPTp
Number of leaflets
reprinted
Receipts for products
delivery
Quarterly Leaflets are
available and
visible in
interventions
areas
Diffusion of
radio
spots/programs
on IPTp and
advocacy
Number of radio
spots/programs aired
Reports, diffusion
plans
Monthly Radio spots and
programs are aired
through national
and community
radio stations
Diffusion of TV
spots/
programs on
IPTp
Number of TV
spots/programs aired
Reports, diffusion
plans
Monthly TV spots and
programs are aired
through the three
main TV stations
Community-based activities on IPTp
Distribution of Number of visual aids: Activity reports Quarterly Visual aids
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 42
leaflets on IPTp
and advocacy
leaflets and advocacy
tool on IPTp distributed
(leaflets on IPTp
and advocacy) are
available and
visible in
interventions
areas
Interpersonal
communication
for BCC on IPTp
Number of house-to
house visits, IPC
conducted by Africare’s
community health
agents/ Peer educators
Activity reports Quarterly Target groups
informed
Sub-Result 1.2 Supply and use of LLINs increased
Production of
radio
spots/programs
on LLIN use
Number of radio
spots/programs on LLIN
use produced
Script Quarterly CDs are available
at the radio
stations/partners
Production of
TV
spots/programs
on LLIN use
Number of TV
spots/programs on LLIN
use produced
Script Quarterly DVD/VCDs are
available at the TV
stations/partners
Reproduction
of leaflets on
LLIN and
produce
another for
advocacy
targeting
private sectors
Number of leaflets
reproduced and
produced
Receipts for products
delivery
Quarterly Visual aids (,
leaflets) are
available and
visible in
interventions
areas
Diffusion of
radio
spots/programs
on LLIN use
Number of radio
spots/programs aired
Reports, diffusion
plans
Monthly Radio spots and
programs are aired
through national
and community
radio stations
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 43
Community-based activities on LLIN use
Distribution of
visual aids
(leaflets) on
LLIN use
Number of visual aids
(leaflets) on LLIN use
distributed
Activity reports Quarterly Visual aids
(leaflets) are
available and
visible in
interventions
areas
Interpersonal
communication
for BCC on LLIN
use
Number of house-to
house visits, IPC
conducted by Africare’s
community health
agents/ Peer educators
Activity reports Quarterly Target groups
informed
Interpersonal
communication
for BCC on LLIN
use
Number IPC
sessions/group
discussion sessions
conducted by private
sectors health agents/
Peer educators
Activity reports Quarterly Target groups
informed
Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy
improved.
Sub-Result 2.1 Diagnostic and treatment improved
Activities with health care providers
Training and
refresher
training of
health
providers on
new national
case
management
policy
Number of training
conducted
Training reports Quarterly Health provider
trained and apply
new national case
management
policy
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 44
Production of
Job aid (aide
memoire) for
health
providers
Number of job aids (aide
memoire) printed
Receipts for products
delivery
Quarterly Job aids (aide
memoire) are
available and
visible in
interventions
areas
Training
Leadership
course
Number of training
conducted
Training report Once Health provider
trained in
Leadership
Advocacy
and/or
supervision
sessions for
health
providers
Number of advocacy
and/or supervision
conducted
Advocacy/supervision
sessions
Quarterly Health provider
convinced on the
importance of
applying the new
national case
management
policy
Community-based activities
Production of
radio
spots/programs
on diagnostic
and treatment
Number of radio
spots/programs on
diagnostic and
treatment produced
Script Quarterly CDs are available
at the radio
stations/partners
Diffusion of
radio
spots/programs
on diagnostic
and treatment
Number of radio
spots/programs aired
Reports, diffusion
plans
Monthly Radio spots and
programs are aired
through national
and community
radio stations
Reproduction
of visual aids
(leaflets) on
diagnostic and
treatment
Number of visual aids
(leaflets) printed
Receipts for products
delivery
Quarterly Visual aids
(leaflets) are
available and
visible in
interventions
areas
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 45
Distribution of
visual aids
(leaflets) on
diagnostic and
treatment
Number of visual aids
(flipchart, brochures,
leaflets) on LLIN use
distributed
Activity reports Quarterly Visual aids
(flipchart,
brochures,
leaflets) are
available and
visible in
interventions
areas
Interpersonal
communication
for BCC on
diagnostic and
treatment
Number of house-to
house visits, IPC
conducted by Africare’s
community health
agents/ Peer educators
Activity reports Quarterly Target groups
informed
Interpersonal
communication
for BCC on
diagnostic and
treatment
Number IPC
sessions/group
discussion sessions
conducted by private
sectors health agents/
Peer educators
Activity reports Quarterly Target groups
informed
Organization of
community
events on
malaria control
Number of community
activities conducted by
type, topic, place and
date
Activity reports Quarterly Target groups
informed
Output indicators:
If survey questions are able to be added to the large household surveys on exposure to malaria
messaging, ARM3 will compare exposure to malaria messaging with the outcome indicators to
assess effectiveness and reach of messages. The 2013 Malaria Indicator Survey will include two
new standard questions on exposure to messages and channels.
Table 9 Output indicators:
Key behavior Indicators Sources , Reporting
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 46
Frequency
Result 1: Implementation of malaria prevention programs in support of the National Malaria
Strategy improved.
Sub-Result 1.1 IPTp uptake increased
Percent of women who have received 2 + does of a
recommended antimalarial drug treatment during ANC visits for
their last pregnancy in the last 2 years
Source
DHS/MIS 2013/MICS
Frequency
2011,2013,2016
Percent of women who recall hearing messages about IPTp, by
channel
MIS 2013
Sub-result 1.2 : Supply and use of LLINs increased
Percent of households with at least one insecticide-treated net
(ITN)
Percent of population that slept under an ITN the previous night
Percent of children under 5 years old who slept under an ITN the
previous night
Percent of children under 5 years old who slept under an ITN the
previous night or in a house sprayed with IRS in the last 12
months
Percent of pregnant women 15-49 who slept under an ITN the
previous night
Percent of pregnant women 15-49 who slept under an ITN the
previous night or in a house sprayed with IRS in the last 12
months
Source
DHS/MIS 2013/MICS
Frequency
2011,2013,2016
Percent of population who recall hearing messages about
diagnosis or treatment, by channel
MIS 2013
Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 47
improved.
Sub-Result 2.1 Diagnostic and treatment improved
Among children under 5 years old with fever in the 2 weeks
preceding the survey, percent who received any antimalarial drug
Among children under 5 years old with fever in the 2 weeks
preceding the survey, percent who received any antimalarial drug
the same or next day
Source
DHS/MIS 2013/MICS
Frequency
2011,2013,2016
Percent of population who recall hearing messages about
diagnosis or treatment, by channel
MIS 2013
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 48
Table 10: Behavior Analysis and Strategic Responses
Audiences Communication Objectives
Barriers to Behavior changes
Desired Behavior
Key Promise Key Message Content Communication Channels and Approaches
Sub-Result 1.1- IPTp Uptake Increased
Primary audience: Pregnant Women NB:
principally those who do not attend ANC at all and those who attend but not completing the 2 doses of IPT required People who can influence primary audiences’ behavior Husbands, “heads of
- Increase the proportion of pregnant women that:
- Know that IPT is free for pregnant woman in public health centers
- Know the dangers of malaria in pregnancy
- Feel that it is important to attend ANC
- Know how to prevent malaria in pregnancy
- Feel that malaria in pregnancy is dangerous
- Lack of awareness about the importance of the IPTp -- Many do not know that IPT is free in public health centers Do not feel that malaria is a serious problem
-Understand the importance of taking drugs and completing the two does of SP/Fansidar during ANC visits - Receive and complete the 2 doses of SP/Fansidar during ANC visits - Know that IPT is free in public health centers Encourage other pregnant women to come for ANC and to go for IPTp at
IPT for malaria during pregnancy is the gateway of having a healthy child SP/Fansidar is free for pregnant women in public health centers
- SP/Fansidar is free for pregnant women in public health centers
- Pregnant women are more likely to get malaria than women who are not.
- -Any pregnant woman that experiences signs or symptoms of malaria should see a health workers immediately.
- When a pregnant woman has malaria it is very dangerous for both the woman and her baby
- Malaria during pregnancy can cause: - Abortion - Stillbirth - Premature delivery - Low birth weight babies - Maternal and perinatal anemia
- Fortunately, it is very easy to prevent malaria in pregnancy! All pregnant women should: - Go for antenatal visits, starting early in pregnancy; - Get at least two doses of IPT (SP/Fasidar) at ANC; - Many people do not understand why pregnant women have to take drugs when they are not sick. This is because many pregnant women who have malaria will not show any signs,
Advocacy: -Capacity building -Harmonization -Supervision -Coordination Service Quality: -Training of providers Training of providers supervisors -Production of jobaids/tools -Supervision Mass media and community mobilization RADIO: - 45 second radio spots (broadcasted in both national and community radios) - drama (addressed though couple of episodes) -TV - 45 second TV spots addressing the importance of IPT during pregnancy. Broadcasted through the 3 most popular TV channels Community Community Outreach Activities - Community posters on IPTp (designed with those who are illiterate in mind) - Community flyers (to be used by community health workers and “relais communautaires” as part of
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 49
Audiences Communication Objectives
Barriers to Behavior changes
Desired Behavior
Key Promise Key Message Content Communication Channels and Approaches
households in Beninese context), in laws, health providers, and community leaders
least twice during pregnancy
and not know that they have malaria. Therefore, it is very important to prevent malaria before it is too late. - The 1st dose of three tablets of SP/Fansidar should be swallowed during the second trimester, between 4th and 6th month of pregnancy. The 2nd dose of three tablets should be taken during the third trimester, between the 7th and 8th month of pregnancy. This is done at a health facility and is observed by a health professional.
Africare community outreach activities (ie. home visits) - Use immunization outreach sessions opportunities to educate women
Sub-Result 1.2 Supply and use of LLINs increased
Primary audience: Pregnant women, Caretakers of children under 5 (Fathers and mothers)
Increase the proportion of pregnant women and caretakers of children under 5 that: - feel that malaria is a serious problem -state that they can convince their family to sleep under mosquito net (LLIN) every night and all year long - feel that encouraging their family to sleep under nets every night and all year long is their responsibility
Do not feel that malaria is a serious problem Feeling of discomfort (hot, lack of air ) Do not encourage the systematic use of LLIN (every night and all year long)
- Ensure that all children in their care under the age of 5 years and everybody in the households sleep under a net every night and all year long - Talk about family, friends and community members
If you protect your children from malaria, you will be seen as a responsible parents/caregivers, you will increase your family’s productivity If you encourage your family to use mosquito net every night and all year long, you will be seen as a good/parents (father/mother) and good citizen
Prevention: use of LLIN -Sleep under a mosquito net every night, all year long. All nets are safe for the mother and the unborn baby. -The best way to prevent malaria is to sleep under a net every night, every all year long -By encouraging your children and family to sleep under a net every night, all year long, you will not only protect your entire family, but also protect your neighbors and the entire neighborhood and you’ll be seen as a good fathers and good citizen -The long lasting nets are not
Prevention: use of LLIN Mass media and community mobilization - RADIO - 45 second radio spots (promotion of LLIN use broadcasted in both national and community radios) -TV - 45 second TV spots promoting LLIN use (every night, all year long) through 3 most popular TV channels - 45 second TV spots for Malaria Day (final subject/topic will be discussed with NMCP prior to Malaria Day)
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 50
Audiences Communication Objectives
Barriers to Behavior changes
Desired Behavior
Key Promise Key Message Content Communication Channels and Approaches
- think that sleeping under net is comfortable and can save lives
about the advantages of using nets every night and all year long
by your community (building social norm around mosquito net use)
dangerous for people, including babies or children. Some nets contain small amounts of chemicals that kills mosquito, but the amount are not enough to harm humans. The chemicals have been specially tested and approved by the Ministry of Health and the World Health Organization
-
People who can influence primary audiences’ behavior “Heads of households ” (in Beninese context), community leaders Employers/supervisors for the private sectors
Same as above Same as above
Same as above
Same as above Promote nets sales and use through social marketing
Outreach activity - Outreach activities with private sector health committee members - Outreach activities with community health workers and “relais communautaires” as part of Africare community outreach activities (ie. home visits) - Advocacy activity toward employers and community leaders who have influence on primary audience - Advocacy support materials (flyers with LLIN messages) - Social Marketing - Sport events with private sector’s participation (with UAM)
Sub-Result 2.1 Diagnostic and treatment improved
Primary audience: Health providers
- Increase the proportion of health
Despite training
- Properly diagnose
- If you first determine
- Not every fever is malaria - It is important that you first carry
Advocacy: -Capacity building
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Audiences Communication Objectives
Barriers to Behavior changes
Desired Behavior
Key Promise Key Message Content Communication Channels and Approaches
People who can influence primary audiences’ behavior Supervisors
providers who: - Believe that it is
important to properly diagnose fevers as malaria before administering treatment
- State that they are confident and capable of providing proper diagnose to all fevers before administering treatment
many still treat all fevers as malaria
fevers as malaria before administering treatment
whether or not a fever is malaria before treating someone with ACTs, you will be a highly respected health provider in your community
- By providing proper diagnose and treatment to your patients ,you will be saving lives and receive the respected of your community
out the appropriate tests to determine whether or not a patient has malaria before administering treatment
- Treating non-malaria fevers as malaria may lead to resistance to ACTs
-Harmonization -Supervision -Coordination Service Quality: - Training of health providers - Refresher training for HP - Support supervision of HP - Job aids (aide memoire) on the
new National Case Management Policy
- Update existing prevention and case management booklet that reflect the new National case management policy
Information provided should follow the new National case management policy and guidelines
Secondary audience: Caregivers (fathers and mothers) People who can influence primary audiences’ behavior “Heads of households” (in Beninese context) , community and religious leaders
Increase the proportion of caretakers of children under 5 that: - feel that malaria is a serious problem -recognize the signs and symptoms of malaria - Feel that they are able to prevent, seek diagnosis and appropriately treat malaria in their children under 5 - Feel that the
Do not feel that malaria is a serious problem
- Seek appropriate diagnosis and treatment for malaria for children under 5 in their care within 24 hours of onset of malaria symptoms - Talk about family,
If you protect your children from malaria, you will be seen as a responsible parents/caregivers, you will increase your family’s productivity
The burden of Malaria: - Many people do not feel that malaria is a serious problem, but it is the number one cause of death in children and illness in households in Bénin - If you protect your children from malaria, you protect will save resources and have more time to earn money, -If you protect your family from malaria, you will save resources (money) and have more time to earn money, -Although there are mosquitoes around during rainy season, you can
- The burden of Malaria: Advocacy: -Capacity building -Harmonization -Supervision -Coordination Mass media and community mobilization RADIO: - 45 second radio spots (broadcasted in both national and community radios) - drama (addressed though couple
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Audiences Communication Objectives
Barriers to Behavior changes
Desired Behavior
Key Promise Key Message Content Communication Channels and Approaches
prevention, diagnosis and treatment of malaria in children under five is their responsibility
friends and community members about the importance of malaria prevention, diagnosis and treatment
get malaria any time of the year, Diagnosis and Treatment - Malaria is caused only by the bite of female mosquito called anopheles -Not every fever is malaria. Make sure you visit the health center/clinic before you are treated - A child can die of malaria if not treated early and with the proper drug Mothers or caregivers, if your child has any of the following symptoms: - Vomiting everything -Cannot nurse -Cannot eat - No longer reacts and seems to be asleep -Has convulsions - Seems lighter than usual (more pale) - Have trouble breathing or breathing fast Take him/her to the health care immediately; this will allow him/her to receive fast care and to recover quickly
of episodes) Community Outreach Activities - Community posters (designed with those who are illiterate in mind) - Community flyers (to be used by community health workers and “relais communautaires” as part of Africare community outreach activities (ie. home visites) - Advocacy activity regarding the burden of Malaria toward employers and community leaders who have influence on primary audience (UAM campaign) - Diagnosis and treatment advocacy activity toward employers and community leaders who have influence on primary audience (in collaboration with Africare)
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 53
4 Implementation
The ARM3 BCC Strategy (2012-2016) aligns to national priorities as articulated in current governmental
malaria strategies and plans. It is a multi-year strategy implemented within Benin’s MOH/NMCP
structure, as well as the Communications Unit, local and regional health systems, and international
partners such as RBM, USAID, Africare, Global Fund, UNICEF, and others. Alignment is ensured through
coordination of annual workplans. Implementation of activities and message dissemination will be
monitored and evaluated under specific frameworks for target audiences.
ARM3 engages with stakeholders to ensure that the support provided on the demand creation side is
matched with strengthening service quality and supply to ensure that malaria quality services and
products such as LLINs IPTs and ACTs are available to meet the demand being generated.
The BCC Strategy supports ARM3’s program activities that will focus on motivating pregnant women to
seek ANC and IPTp, and on training health service providers to consistently provide IPTp during ANC
visits, and to treat their clients with respect. This “Caring Provider” campaign will recognize the
importance of the providers, motivate them to be responsive to the real problems of their clients (i.e. do
not treat all fever as malaria), provide quality services according to the new national case management
policy and guidelines, and model and reinforce provider behaviors. This provider campaign focusing
mostly on provider-client communication will specifically build on and logically follow the
implementation of the quality assurance and capacity strengthening strategies of the ARM3 under this
project.
The campaign will also include messages on the promotion of mosquito net use and repair for pregnant
women and for the households. The concept of the campaign will be built around a social norm for net
use, with an emphasis on the role of a good father figure who can model or encourage others to protect
themselves by starting with himself and his family. By protecting his family, he is protecting his
neighbors and by protecting his neighbors he is protecting the entire community.
A focus on secondary audiences will also be layered in the campaign, especially regarding all activities
related to social marketing. In this component we will emphasize the role of employers, supervisors and
peers who can model and/or encourage others to become champions in using and/or encouraging net
use every day and all year long.
In order to achieve the anticipated results, the key messages and do-able actions must be
communicated to the intended audiences and the audiences need to be supported to implement their
do-able actions.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 54
As they will be playing an important role in supporting the primary target for this project, decision
makers and other government institutions will be targeted with advocacy messages as well. Below is a
list of activities that will facilitate the implementation of the do-able actions to bring about the desired
behaviors and actions.
4.1 Activities
4.1.1 Objective 1: Coordination
Objective 1: To support BCC interventions by the National Malaria Control Program and ARM3
through: effective coordination of activities by the BCC Working Group; participation in activities by
other existing working groups; harmonization of BCC/IEC messages, materials and tools developed in
Benin.
Benin, like other donor-friendly countries, suffers from uncoordinated and overlapping initiatives. What
is needed is a coordinated, strategic advocacy strategy and initiative to be implemented by all malaria
partners. The Leadership for Strategic Health Communication Course (LSHC) will be a key element in
improving the leadership and coordination of the NMCP and its partners. The LSHC workshop integrates
communication theory and experiential learning. The workshop features an easy-to-learn, computer
software program called SCOPE-WEB that guides participants through the steps of designing effective
health communication and strategies. The learning process emphasizes the whole individual and
“learning by doing.” Building institutional capacity at different levels is also critical to effective BCC.
Under ARM3 capacity building activities will be organized for entities at the national, departmental, and
local levels. On the national level particular attention will be given to strengthening coordination
between all parties engaged in BCC as well as in harmonizing messages. This will be achieved by
strengthening the capacity of the National Malaria Communication Working Group, whose members
include the National Malaria Control Program BCC team, UNICEF, WHO, Catholic Relief Service, ARM3,
Africare, Peace Corps, CEBAC, Population Services International (PSI) and representative of health
departments. The Working Group will serve as a forum to coordinate activities in the field, building on
BCC experiences to date, to both harness and share best practices. Appropriate training will also be
used as a tool to build skills and craft messages around local values and norms. Messages will be
informed by quantitative and qualitative research studies under ARM3 on barriers of desired behaviors.
All BCC strategies and materials for Benin will be built upon the materials and activities produced at the
central level. The BCC working group will assist in harmonizing the messages of all implementing
partners and assist in obtaining a “one team” perspective. ARM3 will also collaborate with the Medical
School and Department of Nursing to design and validate pre-service training in provider-patient
interpersonal BCC.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 55
At the departmental level efforts to build capacity will involve Departmental Malaria Teams by use of
the vehicles of formal training, on-the-job-training, and coaching. Special attention will be given to
strengthening the supervisory capacity of these teams to assess the quality of health providers’
interpersonal communication skills with patients in health facilities and community participation. Their
capacity to assess the quality of BCC of NGOs and associations at the community level will also be
reinforced. Some of the mechanisms used will be the design of training in designing BCC modules,
strategy and materials design, workshops on strategy and materials design, and strategic health
communication. Through an established cascade training system, and with the support and coaching
from the ARM3 team, the core group of master trainers will then ensure the training of BCC teams at
the departmental level. Supervisory capacity will also be reinforced by regular supervisory visits with
the ARM3 BCC team that will provide coaching.
Capacity building at the community level will focus on NGOs, community based organizations (CBOs),
media professionals and community groups. ARM3 will provide BCC guidance through an international
NGO under the project that will engage local NGOs, groups and individuals to undertake community
engagement and mobilization.
Activity 1.1: Support the coordination meetings of the National Malaria Communication Working
Group and coordination with other working groups under ARM3, including: (i) Clinical case
management, (ii) Supply chain management, (iii) Monitoring &evaluation.
Activity 1.2: Promote MOH coordination with other ministries, promoting a cross-sectoral
approach.
Activity 1.3: Harmonize tools, materials, messages and broadcast among the working group
members (avoiding conflicting messages, avoiding duplication and saturation, and providing
message reinforcement).
Activity 1.4: Develop guidelines and tools for ARM3, on: BCC, community mobilization, and
capacity building.
Activity 1.5: Hold a workshop to review/update existing community mobilization tools in use by
contracted NGOs (2013)
Activity 1.6: Organize a strategic meeting with Africare to align all community-based activities
with the preliminary ARM3 BCC strategy
Activity 1.7: Support Africare’s community activities for BCC and community mobilization.
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 56
Activity 1.8: Develop an integrated toolkit that includes community mobilization tools and
materials developed in Benin, as a result of the harmonization
Activity 1.9: Conduct research to identify barriers to IPTp use (2013)
4.1.2 Objective 2: Community mobilization
Objective 2: to increase community engagement in /mobilization for malaria prevention and
treatment.
Community mobilization activities will greatly complement the advocacy activities and training of
providers under this strategy. These activities are important ensuring that messages reach those who do
not have access to or listen to TV or radio, as well as to complement the messages broadcast through
mass media. As more than a third of Beninese women have no access to any form of media, alternative
channels that target women’s associations’ meetings or dialogues in the local language are needed.
Community mobilization activities spark discussions that continue long after the activity itself has ended.
Community mobilization activities will focus on malaria interventions at health facility level. Following
the recommendation made by participants during the Grand Popo workshop, ARM3 will support social
mobilization events. To do so, it will facilitate the development of social mobilization teams made up of
staff within the health zones and community assets such as the chefs d’arrondissement, neighborhood
chiefs, traditional leaders, women leaders and community health workers. All these opinion leaders will
have the responsibility to mobilize people and continually remind them about ways to prevent malaria.
ARM3 BCC team will work closely with Africare to make sure that Africare and its NGO partners’
community mobilization strategy is in line with ARM3. Community mobilization activities will take into
account traditional and popular channels such as songs, games, sports, caravans and market-related
events.
Home visits are an important BCC strategy that can be operationalized within the short term plan.
Africare is one of the key partners implementing home visit activities in collaboration with a network of
local NGOs supporting a large number of community health workers. ARM3 activities will reorient
Africare’s current activities so that they are aligned with the key behaviors and strategy for malaria
control. ARM3 will review with Africare its communication strategy and materials for health for its
home visit sessions.
As soccer is one of the Beninese’s favorite sports, the ARM3 program will capitalize on this opportunity
to mobilize audiences, especially men, and to promote key malaria preventative behavior including
appropriate use of LLINs, increased participation in IPTp, prompt care, and adherence to treatment in
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 57
malaria campaign. This activity will be reinforced with messages through mass media and interpersonal
communication.
To implement this strategy, the following key activities will be carried out:
Activity 2.1: Organize and support local leaders (private sector, community teams).
Activity 2.2: Organize strategic meeting with Africare to align all community-based activities with
the ARM3 preliminary BCC strategy
Activity 2.3: Facilitate community advocacy/outreach activities, including: (i) advocacy activities
in workplaces, communities to improve LLIN use and good care seeking behavior, (ii) partners
sensitization meetings for opinion leaders that address at community level issues related to
LLIN, IPT use and good care seeking behavior (woman leaders campaign Abomey-
2013), (iii) mass community outreach or health education sessions at village/community events
to provide information and messages on LLINs, case management, malaria in pregnancy (5 CCM
events in 5 BASIC HZs-2013)( Prompt care seeking mass media campaign -2013), (iv) household
visits by CHW to counsel families on ITN use, IPTp and good care seeking behavior in
partnership with Africare, (v) programmed IPC activities by CHW to counsel families on IPTp ,
ITN use and good care seeking behavior in partnership with Africare, (vii) public-private-
community sector dialogues(including Under Mango-Tree radio programs) to facilitate private
sector support and subsidies for relevant malaria control interventions.
Activity 2.4: Organize strategic activities supporting prevention and treatment, as: (i) Organize
“special events” for World Malaria Day, (ii) Promote key malaria preventive behavior at soccer
games and other sports events[3],[4] (This activity will be reinforced with messages through mass
media and interpersonal communication), (iii) Implement campaigns, (iv) caravans, (v) market-
related events..
Activity 2.5: Develop and provide print materials on LLINs, case management, malaria in
pregnancy and vector control for household distribution
Activity 2.7: Organize “special event” for World Malaria Day and other community events
Activity 2.6: Carry out an NGO/Community Facilitator training on community engagement and
advocacy strategies
[3]
Promotion of malaria in soccer games incudes: appropriate use of LLINs, increased participation in IPTp, prompt care-seeking, and adherence to treatment [4]
Soccer is one of the Beninese’s favorite sports. The ARM3 program will seize this opportunity to mobilize audiences, especially men
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 58
4.1.3 Objective 3: Social marketing of LLITNs
Objective 3: Increase the supply and use of LLITNs through social marketing with private sector
partners.
ARM3 will conduct social marketing with the private sector to ensure LLIN coverage and continued
distribution through sales of subsidized LLINs via employee programs based on the Malaria-Safe model.
The approach has two advantages, first, to educate the target audience to buy their own LLINs and to
inform them where to get quality LLINs when they need them. To achieve the objective 3 of ARM3
program the following activities will be implemented:
Activity 3.1: Review and coordinate the implementation of the Strategy and Plan for social
marketing of LLITNs with CEBAC-STP (meetings, 2 day workshop), including the creation of a
logo for the social marketing distribution of LLIN and a tagline to increase action and product
visibility. As the social marketing of LLINs will primarily be handled by CEBAC-STP, the BCC team
proposes to hold an initial meeting with its members involved in the distribution campaign. This
is essentially a single coordinated meeting to bring CEBAC-STP management personnel on board
and in line with ARM project’s strategy to implement LLIN distribution campaign. At the same
time, the project will take the opportunity to meet with the CEBAC-STP Health Committee
members to orient them on their anticipated responsibilities during the LLIN social marketing
and distribution campaign. Part of the social marketing strategy will be implemented at the
workplace. The ARM3 team proposes a 2-day workshop to lay out the groundwork for the
CEBAC-STP campaign.
Activity 3.2: Launch the social marketing campaign (event, key participants, media coverage).
After this initial coordination and orientation meetings have successfully been completed the
ARM3 BCC team will officially launch the LLIN distribution campaign through the engagement of
a promotion agency identified through a call for proposals. To further work toward achieving
the ARM3 target of increasing the use of LLINs, the BCC team will create a project specific LLIN
logo and tagline to increase action and product visibility.
Activity 3.3: Facilitate public-private-community sectors dialogues to make possible private
sector support and subsidy for relevant malaria control interventions: LLIN promotion activities.
By following the biding process, ARM3 will work with the best advertisement agency in Benin to
create state of the art materials for the LLIN promotion. These materials will range from
promotional video/radio spots to gadgets such as flyers, T-Shirts, flyers and banners.
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4.1.4 Objective 4: Capacity Building in BCC
Objective 4: to upgrade BCC skills of health workers from private and public sectors at national and
community levels, and provide supervision in the use of BCC guidelines.
Building the capacity of health providers to provide quality counseling to patients is important.
Communication strategies designed for providers will emphasize the idea that “Caring Providers” are
those who:
Believe that it is important to properly diagnose fevers as malaria before administering
treatment
Feel confident and capable of providing proper diagnosis to all fevers before
administering treatment
This strategy should motivate providers to be responsive to the real problems of their clients (not to
treat all fevers as malaria) and feel good about their actions. For this program, training of health
providers on client-patient communication will be crucial in improving service quality. ARM3 will design
and implement a training of trainers program for health providers in government and private health
facilities on improved counseling and patient interaction skills to enhance the patient’s understanding
and adherence to treatment regimes. Two curriculums will be designed and used during training with
health providers.
Interpersonal Communication (IPC):
Linking health providers with communities through interactive IPC sessions will increase the likelihood of
quality IPC and trust between providers and clients. Entertainment education programs that support
providers and recognize them for their good work will provide motivation for them to do their job well.
ARM3’s other focus will also be in providing effective patient-provider communication tools, including
production of training materials and job aids. The provision of these tools to health providers will help
them to guide their clients during field visits or visits to the health center for IPTp, LLIN and RDT. The
following activities will be performed by partners to support audiences to achieve do-able actions.
Activity 4.1: Develop and validate an assessment instrument
Activity 4.2: Supervise compliance with guidelines under the M&E component of this strategy
Activity 4.3: Develop/adapt and produce BCC materials/Job aids for health workers on Malaria
Control
Activity 4.4: Develop curriculum, training modules-materials, and identify trainers. As a sub
activity , include the development and validation of an in-service training module on patient-
provider communications
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Activity 5: Conduct the following courses and trainings: (i) Client-provider training in
communication skills for service providers, (ii) Patient counseling training and supervision for
public/private health professionals-2013), (iii) Interpersonal Communication training for
providers and MOH personnel, (iv) Training of trainers training (ToT) on patient-provider
communication (create a Center of Excellence) (2013), (v) Strategic Communication course for
the NMCP, MOH and extended staff (2013), (vi) Pre-service training scheme for health
professionals in malaria prevention, diagnosis, and case management (2013), and (vii) In-service
Malaria in Pregnancy training for health professionals (to include IPC) (2013),
Activity 4.5: Develop indicators for the capacity building plan, under the M&E section
Activity 4.6: Periodic monitoring and supervision of the CB Plan, including the following key sub-
activities: (i) Supervision of midwives on promotion and use of IPTp (2013), and (ii) Supervision
to enhance patients’ understanding of, and adherence to, treatment regimes.
4.1.5 Objective 5: Advocacy for increased support for malaria control
Objective 5: To advocate for increased support for malaria control, by government authorities and key
partners (reflected in support for coordination, availability of funds, allocation of human resources
and development of public policies that support malaria mortality and morbidity reduction).
Advocacy can be carried out at national and subnational level, but always focuses on motivating
decision-makers to use their influence to improve implementation of interventions and eliminate
bottlenecks that impede progress towards healthy behaviors. Advocacy includes capacity building and
coordination, media advocacy, and supervisory activities. These will be carried out at the appropriate
level among government personnel in charge of supervising health providers (from the Ministry Health
structure2) at department zone and community level, community and business leaders. The Malaria-Safe
advocacy package ( in annex E) will be used when engaging in dialogue with community leaders,
business leaders, and service providers to foster desirable commitment and support for increased
resources and effective management of resources for malaria control. To reach the above objective, the
following activities will be carried out:
Activity 5.1: Identify target audiences for the advocacy component at the governmental level to
support the implementation of the BCC and Community Mobilization Strategy, including key
behaviors and desired behavior changes for these audiences, as a result of the advocacy
efforts.
2 At national level (NMCP BCC team), at departmental level (BCC focal points: doctors and social assistant in charge of BCC and
social mobilization and zone level (currently lacking personnel n charge of the BCC)
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Activity 5.2: In collaboration with the NMCWG, develop advocacy guidelines and tools to guide
the NMCP’s advocacy activities for Malaria control
Activity 5.3: Collect and harmonize advocacy tools and materials being used to for Malaria
Control
Activity 5.4: Conduct advocacy activities directed at high-level government authorities,
managers and workers at workplaces, and communities to obtain the desired behavior change.
Activity 5.5: Promote advocacy activity through media and facilitate public-community-private
sector’s dialogue to enhance private sector participation and engagement
Activity 5.6: Monitor the results of advocacy under the M&E section, based on assumption of
the expected behavior.
4.1.6 Objective 6: BCC and Community Mobilization materials
Objective 6: To develop and disseminate materials supporting BCC and Community Mobilization
Like the IPC approach, mass media communication interventions will cut across all the program areas.
As reflected in the audience preference analysis, radio and TV remain the most used media
communication in Benin although exposure is not as high as in other countries. Since 1 in 3 households
has a TV or radio, this program will focus on radio and TV to get messages across our audiences. In
addition Benin has witnessed rapid growth in information communication technology (ICT). Although
cellular phones have reached the rural areas of Benin, coverage is not high enough to rely upon this
channel exclusively. A partnership with the mobile phone company will be explored through the “United
Against Malaria Campaign.” ARM3 will pilot a program that uses SMS to get malaria messages to
audiences (MTN users) for year 2. Strategy and contents will be discussed with MTN. ARM3 will
therefore use these channels to get messages across and to maximize reach and frequency of exposure
through a cost-effective selection of media channels. Spots, magazines and reality programming will be
the main programs to be produced and broadcast through community radio stations. ARM3 has
identified the main local radio stations covering the following departments: Littoral, Atlantique, Oueme
Plateau and Parakou. In addition, to avoid conflicting programs and saturation of messages to target
audiences, ARM3 is currently working closely with Africare and other partners to identify existing radio
spots and programs that can be still be used, to coordinate radio broadcast in intervention zones and
dividing geographical responsibilities for radio broadcasting. The use of three radio programs came
from JHU-CCP’s many years of experience in designing and implementing radio programs. The radio
spots and magazines will be specifically designed to improve malaria knowledge. The reality radio
program will be designed with the direct participation of target audiences. One of these radio
programs, for example, will be designed to break the provider-client barrier by gathering community
members and recording their interactions regarding malaria issues for later broadcast. This platform will
Draft Benin ARM3 BCC and Community Mobilization Strategy Page 62
allow providers and the community direct interaction, but most importantly it will allow radio listeners
to learn what can be expected at the health facilities or clinics, and what can expected from health
providers.
All activities related to all BCC and community mobilization materials development and dissemination
will be planned, coordinated and implemented in collaboration with the National Malaria
Communications Working Group.
Activity 6.1: Develop and integrate messages and materials on LLINs, case management, malaria
in pregnancy (IPTp) and treatment, and vector control, for household distribution
Activity 6.2: Develop/adapt and air TV and radio spots, TV and radio programs related to LLIN,
IPT use and care- seeking behavior
Activity 6.3: Make a cost-effective selection of media channels and program types (e.g., spots,
magazines and reality programming) in the departments of Littoral, Atlantique, Oueme Plateau
and Parakou).
Activity 6.4: Coordinate radio and TV dissemination with all program implementers, to maximize
reach and frequency of exposure to messages.
Activity 6.5: Provide mass media communication support to program components, including
advocacy, community mobilization, bed net distribution and others through radio and TV
(dialogues between patients and health providers through community dialogue or radio
program i.e.: “Under the Mango Tree” radio show)
Activity 6.6: Conduct a malaria in pregnancy mass media campaign (2013)
4.1.7 Objective 7: Monitoring and Evaluating the BCC Strategy
Objective 7: To monitor and evaluate the ARM3 BCC and Community Mobilization Strategy.
Monitoring and evaluation of the ARM3 BCC and community mobilization strategy are based on the
indicators presented in the project logframe and will be carried out through regular reporting, site visits,
and research results. Monitoring of ARM3 activities will focus on program implementation and process
and output indicators. It will help to assess whether program activities are on track, how close they are
to meeting the projected timeline and budget, and whether staff members perform their roles correctly.
The evaluation component on the other hand will measure the success of communication activities by
tracking progress toward outcome indicators in program areas. Among key activities to be carried out
during the project life cycle are:
Activity 7.1: Conduct monthly/quarterly monitoring of the indicators under this strategy
Activity 7.2: Develop monthly/quarterly reports
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Activity 7.3: Develop BCC and community mobilization material inventory
Activity 7.4: Develop television and radio logs that show when programs are aired
Activity 7.5: Conduct periodic supervision visits with the NMCP to assess ARM3 BCC and
community mobilization activities
Activity 7.6: Conduct regular spot checks of BCC and community mobilization materials
distribution at representative points in the field
Activity 7.7: Hold focus group discussion between rounds or after campaign, including questions
on community mobilization and communication messages
Activity 7.8: Disseminate reports and other pertinent information.
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4.2 Scheduling for mass media and community mobilization interventions Table 11: Year 2 mass media and community interventions Plan
Scheduling for mass media and community mobilization interventions: (Oct 2012-Sep 2013)
Quarter I (Oct-Dec 2012)
Quarter II (Jan-Mar 2013)
Quarter III (Apr-Jun 2013)
Quarter IV (July-Sep 2013)
Scheduling for IPTp uptake Campaign
Encourage women to attend ANC and complete two doses of IPT
Television (national level)
Radio (national and community level)
IPC (client-provider and community)
Home visit (community level)
Posters and Prints (community level)
Other community events
Scheduling for LLIN use and supply Campaign
Television (national level)
Radio (national and community level)
IPC (client-provider and community)
Home visit (community)
Posters and Prints (community)
Other community events
Scheduling for diagnostic and treatment improvement Campaign
Television (national level)
Radio (national and community level)
IPC (client-provider and community)
Home visit (community level)
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Posters and Prints (community level)
Other community events
4.3 Scheduling for mass media and community mobilization interventions for the remaining three years (Oct 2013-
Sep 2016) Bellow’s implementation chart is a tabular expression of the mass media and community mobilization interventions (development, pre-test,
diffusion and/or implementation) to be carried out by ARM3 from October 2013 until the end of the project to support audiences to achieve do-
able actions, as listed above under the detailed strategic framework.
Table 12: Year 3-5 mass media and community mobilization interventions Plan
Scheduling for mass media and community mobilization interventions: (Oct 2013-Sep 2016)
Year 3 (Oct- 2013 –Sep 2014)
Year 4 (Oct- 2014 –Sep 2015)
Year 5 (Oct- 2015 –Sep 2016)
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Scheduling for IPTp uptake Campaign
Encourage women to attend ANC and complete two doses of IPT
Television (national level)
Radio (national and community level)
IPC (client-provider and community)
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Home visit (community level)
Posters and Prints (community level)
Other community events
Scheduling for LLIN use and supply Campaign
Television (national level)
Radio (national and community level)
IPC (client-provider and community)
Home visit (community)
Posters and Prints (community)
Other community events
Scheduling for diagnostic and treatment improvement Campaign
Television (national level)
Radio (national and community level)
IPC (client-provider and community)
Home visit (community)
Posters and Prints (community)
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Other community events
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5 Annexes
5.1 Annex A : Terms of Reference for GTTC
TERMES DE REFERENCE DU GROUPE DE TRAVAIL TECHNIQUE EN COMMUNICATION
TERMES DE REFERENCE DU GROUPE DE TRAVAIL TECHNIQUE EN COMMUNICATION
-----&&&---
Dans le cadre de la lutte contre le paludisme, plusieurs interventions ont été mises en œuvre. En
matière de communication pour un changement de comportement, certains supports ont été réalisés
par le Programme National de Lutte contre le Paludisme(PNLP), les partenaires sociaux et les
Organisations non gouvernementales.
Dans son rôle de coordonnateur, le PNLP a mis en place une organisation ou tout le monde de
la communication et de la mobilisation sociale se retrouve. Ce creuset dénommé le Groupe Technique
de Travail en Communication (GTTC) bénéficie de l’appui financier et technique du PMI à travers PSI. Il
permet d’échanger et d’assurer la mise en œuvre du volet communication dans le cadre de la lutte
contre le paludisme.
Ce groupe une fois mis en place, a pour rôle de coordonner, organiser les échanges, partager
toutes les interventions de mettre en commun leur capacité et les moyens de lutter efficacement
contre le paludisme.
Ce système d’organisation au Bénin a fait l’objet d’une admiration à l’étranger notamment par
l’Alliance pour la Prévention du Paludisme (APP) à BAMAKO en 2010 qui a demandé aux autres pays de
prendre l’exemple. Il s’agit la d’une expérience à ne pas laisser tomber car elle se vent déjà.
Par ailleurs le lancement de la prise en charge gratuite du paludisme chez les enfants de moins
de cinq ans et chez les femmes enceintes depuis le 04/10/2011 par le gouvernement du Bénin est une
occasion pour planifier un certain nombre d’actions prévues dans ce cadre.
OBJECTIF GENERAL
Créer un cadre de concertation pour la mise en commun des expériences et des moyens
d’IEC/CCC et la mobilisation sociale dans le cadre de la lutte contre le paludisme ;
OBJECTIFS SPECIFIQUES
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Revoir et approuver le matériel conçu par les partenaires y compris les documents écrits,
les messages á diffuser á la radio ou á la TV.
Partager les meilleures pratiques en communication sur le changement des
comportements et mobilisation sociale tirées des expériences sur le terrain.
Conseiller sur l’appui pouvant être apporté á tout événement communautaire visant la
promotion des comportements sur la prévention et la prise en charge du paludisme
Faire le point du matériel mis à la disposition de la communication et de la mobilisation
sociale au Bénin
Faire le répertoire des supports disponibles qu’on peut utiliser dans le cadre de la mise en
application de la prise en charge gratuite du paludisme chez les enfants de moins de cinq
ans et chez les femmes enceintes.
Faire le rapport et planifier les activités trimestrielles.
CIBLES
Partenaires techniques intervenant dans la lutte contre le paludisme au Bénin en matière de
CCC et de la mobilisation sociale.
RESULTATS ATTENDUS
Les réunions du GTTC ont repris ;
Tous les Partenaires ont été atteints ;
Tous les supports et éléments intervenant dans la CCC et la mobilisation sociale ont été
mis en commun afin de réussir la mise en application de la prise en charge gratuite des
soins du paludisme chez les enfants de moins de cinq ans et chez les femmes
enceintes.
Les supports complémentaires ont été identifiés.
Chaque Partenaire a fait le point de ses activités sur le terrain sur la CCC et sur la
mobilisation sociale.
METHODOLOGIE
La méthodologie est essentiellement faite de présentations suivies de débats.
MATERIELS
Un tableau flip-chart
Un ordinateur portable
Un projecteur Power Point
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Vingt cinq kits de participants
LISTE DES INSTITUTIONS DONT LES CHARGES DE COMMUNICATION
ET/ OU DE MOBILISATION SOCIALE SONT CONCERNES
RTI-INTERNATIONAL
OMS
CRS/BENIN
UNICEF
PSI/BENIN
URC/PISAF
AFRICARE
CARITAS/BENIN
ARM3
USAID
Corps de la Paix
Plan/Bénin
CEBAC
Directions Départementales de la Santé
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5.2 Annex B : Key Messages for Targeted Audiences Les messages clé tirés de la boite à image éditée par le programme National de Lutte contre le
paludisme (2010)
1. Paludisme chez les femmes enceintes
Audience Comportements clés Messages clés
Femme enceinte
Les femmes enceintes dorment sous
moustiquaire imprégnées
d’insecticide chaque nuit
La plupart des femmes enceintes
reçoivent leurs doses complètes de
SP au cours de CPN
Femme enceinte, dors sous moustiquaire imprégnée à longue durée d’action toutes les fois ; ainsi tu seras protégée et tu protégeras aussi l’enfant que tu portes contre le paludisme. Femme enceinte, va en consultation prénatale, et prends les comprimés de SP devant l’agent de santé ; ainsi l’enfant que tu portes et toi-même serez protégés contre le paludisme. Femme enceinte, le paludisme est dangereux pour toi et l’enfant que tu portes. Va immédiatement au centre de santé dès que tu sens les signes du paludisme pour ta prise en charge.
2. Prise en charge
Audience Comportements clés Messages clés
Les
personnes
en charge
des enfants,
mères,
personnel
de santé,
chefs de
ménage
Les membres de la communauté, les
patients se rendent au centre de
santé (le plus proche) dès les
premiers signes de fièvre
Mère ou gardienne d’enfant, chef de ménage, des que ton enfant a le corps chaud, fais-lui un enveloppement humide. Ceci permettra de faire la fièvre en attendant de l’emmener très rapidement chez un relais communautaire ou dans un centre de santé. Mère ou gardienne d’enfant, chef de ménage, tu peux emmener ton
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enfant de six mois a cinq ans qui a le corps chaux chez le relais communautaires proche de chez toi pour le traiter du paludisme simple avec les CTA et il guérira vite. Mère ou gardienne d’enfant, ton enfant de moins de 6 mois qui a le corps chaud doit être pris en charge par un agent de santé. Emmène-le directement dans un centre de santé et il guérira vite. Mère ou gardienne d’enfant, chef de ménage, traite ton enfant qui est malade ou a le corps chaud avec les CTA (Combinaison Thérapeutique à Base d’Artemesinine) en suivant strictement les indications du relais communautaires ou l’agent de santé. Les CTA sont disponibles auprès des relais communautaires et dans les centres de santé. Mère ou gardienne d’enfant, chef de ménage, des que ton enfant présente l’un des signes suivants :
Vomit tout ce qu’il mange
N’arrive pas à téter N’arrive pas à manger Ne réagit plus et
semble endormi Fais des convulsions Parait plus clair que
d’habitude (plus pale) : le paumes de ses mains et ses pieds, ses ongles et ses lèvres sont plus clairs que d’habitude
Commence à respirer très rapidement et difficilement
Emmène-le
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immédiatement au centre de santé ; ainsi il sera vite pris en charge et guérira vite.
Le paludisme se transmet par la piqure de la femelle d’un moustique appelé anophèle. Pendant la nuit, ce moustique pique une personne malade et prend le microbe. Le même moustique va piquer une autre personne qui n’est pas malade et lui donne le microbe qui provoque la maladie.
3. Lutte anti vectorielle -LLIN
Audience Comportements clés Messages clés
Les personnes
en charge des
enfants, parents
(mère et père)
La plupart des mères et les
personnes en charge des enfants
font dormir leurs enfants de moins
de 5 ans sous une moustiquaire
imprégnée d’insecticide
Mère ou gardienne d’enfants de moins de cinq ans, le paludisme est plus dangereux pour ton enfant. Fais-le dormir toutes les nuits sous moustiquaire imprégnée à longue durée d’action ; cela lui évitera le paludisme.
4. Lutte anti vectorielle- IRS
Audience Comportements clés Messages clés
Les personnes
en charge des
enfants, parents
(mère et père),
femmes
enceintes, chefs
de ménage
Les mères et gardiennes d’enfants, et
chefs de ménage couvrent avec un
couvercle touts objets creux pouvant
contenir de l’eau dans la cour de la
maison
Les membres de la
famille/communauté ne salissent ou
cultivent plus à l’intérieur et aux
alentours des maisons
Mère ou gardienne d’enfants, femmes enceinte, chef du ménage, les objets creux pouvant contenir de l’eau dans la cour de la maison favorisent la multiplication des moustiques. Enlève-les de ta maison pour protéger et protéger ta famille contre le paludisme Mère ou gardienne d’enfants, femmes enceinte, chef du ménage, nettoie toujours ton milieu d’habitation et garde-le toujours propre. Tu éviteras ainsi la multiplication des moustiques qui piquent et donnent le paludisme.
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La pulvérisation intra domiciliaire est une stratégie de prévention du paludisme qui complète l’utilisation des moustiquaires imprégnées à longue durée d’action. Elle nécessite certaines précautions pour éviter les risques qui y sont liés.
5.3 Annex C: Information about Benin
Based on the 2002 census, the 2011 projected population of Benin is 9,067,076 with more than 1/3 of
the population (42.4%) living in urban areas. iiThe total surface area of Benin is 114,763 sq. km, and the
country is bordered by the Atlantic Ocean in the south, Togo in the west, Burkina Faso and Niger in the
north and Nigeria in the east. There are 12 Departments (Alibori, Atacora, Atlantique, Borgou, Collines,
Couffo, Donga, Littoral, Mono, Oueme, Plateau and Zou), and 77 communes, three of which have
particular status such as Cotonou, Porto-Novo and Parakou. The 77 communes are divided into 546
arrondissements and 3,743 villages. The population growth rate is 2.8 3percent (WHO, 2012 estimation).
The country has almost 10 ethnic groups. The Fon (46.2%), Adia (15.6%), Yourouba (12%), and Bariba
(8.6%) are the major ethnic groups. Other ethnic groups include Peulh, Betamaribe Yoa, Lokoa and
Dendi. Language barriers between health providers and patients are frequent in Benin, especially in
rural areas. For those rural people, the major barriers in accessing health facility is compounded by their
low level of education and income.
In 2008, there was an estimated one physician per 7,511 inhabitants, one nurse per 2,245 inhabitants,
one midwife per 1,345 women of child-bearing age, and a total of 343 laboratory technicians working in
Benin’s public health system. For the country as a whole, there are an estimated 442 arrondisement-
level health centers, 75 commune-level health centers, and 305 licensed private health facilities iii(HMIS,
2006). The private health sector consists of unlicensed traditional practitioners, private hospitals and
facilities, unlicensed health providers, and unlicensed drug vendors. Unauthorized health providers are
an important source of care for the poor. Although there is a slight improvement in health systems in
general, the country still lack of qualified health staff at the district level and their distribution is uneven.
The health system decentralization is still ongoing. The free Malaria treatment and free mosquitos nets
initiatives for pregnant women and children under 5 years was launched to scaling up of health
interventions and enhance access to health service. Unfortunately, many of the intended target of
these initiatives still don’t know that malaria treatment are free or charge for pregnant women and
children under five in Benin.
3 Source: WHO Country statistics, 2012
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5.4 Annex D: ARM3 Results and Targets
RESULT 1: Implementation of malaria prevention programs in support of the National Malaria
Strategy improved.
Sub-Result 1.1 IPTp uptake increased.
ARM3 Target 1: Women who receive two or more doses of SP during the last pregnancy within the last
two years in intervention areas will be 85%
Sub-Result 1.2 Supply and use of LLINs increased.
ARM3 Target 1: Proportion of pregnant women who slept under an LLIN the previous night in
intervention area will reach 85%
ARM3 Target 2: Proportion of children under-five who slept under an LLIN the previous night in
intervention areas will reach 85%
ARM3 Target 3: Proportion of households with a pregnant women and/or children under five which own
at least one LLIN will reach more than 90 %
Sub-Result 1.2.1 Strengthen the current efforts for social marketing for LLINs.
RESULT 2: Malaria diagnosis and treatment activities in support of the national malaria strategy
improved
Sub-Result 2.1 Diagnostic capacity and use of diagnostic testing improved.
ARM3 Target 1: 85% of health centers will be able to perform RDT or microscopy.
ARM3 Target 2: 95% of patients (all ages) who tested positive (via microscopy or RDT) will receive an
effective anti-malarial.
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ARM3 Target 3: Supervision is provided to at least 90% of health workers nationwide with malaria-
related responsibilities at least once every three months (this target is also applicable to Sub-result 2.2)
Sub-Result 2.1.1 Consortium’s role in policy formulation and in training of government and private
health facilities to improve malaria diagnostics.
Sub-Result 2.1.2 Consortium’s role in the design and implementation of enhanced supportive
supervision (OTSS) to government and private health facilities.
Sub-Result 2.2 Case management of uncomplicated and severe malaria improved.
ARM3 Target 1: Proportion of under-five children with fever in the past two weeks tested for malaria will
be 85%.
ARM3 Target 2: Proportion of under-five children with a positive result treated with ACT’s will be 85%.
RESULT 3: The national health system’s capacity to deliver and manage quality malaria
treatment and control interventions strengthened.
Sub-Result 3.1 National Malaria Control Program’s technical capacity to plan, design, manage, and
coordinate a comprehensive malaria control program enhanced.
ARM3 Target: The NMCP technical working groups (monitoring and evaluation, supply chain,
communication, and case management) are meeting regularly as planned.
Sub-Result 3.2 MoH capacity to collect, manage and use malaria health information for monitoring,
evaluation and surveillance improved.
ARM3 Target 1 The national Routine Malaria Information System and sentinel surveillance sites are
providing high-quality information on a regular and timely basis for decision-making.
Sub-Result 3.3 MOH capacity in commodities and supply chain management improved.
ARM3 Target 1: The national malaria commodity supply chain is functioning with a Logistics
Management Information System (LMIS) providing quarterly and annual reports.
ARM3 Target 2: 85% of PMI-supported health facilities report no stock-outs of malaria commodities in
the last three months.
ARM3 Target 3: Complete implementation of reforms initiated in CAME so as to improve governance and
transparency of its operations.
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ARM3 Target 4: Results from the quarterly End-Use Verification Surveys are analyzed and used to identify
management and operational issues in the commodity supply chain system.
Sub-Result 3.3.1 Technical Assistance to CAME.
Sub-Result 3.3.2 Strengthening of the Health Zone’s malaria supply chain management.
Sub-Result 3.3.3 Strengthening of the Logistics Management Information System (LMIS).
Sub-Result 3.3.4 Support to End-User Verification Surveys.
i Evaluation finale du Projet d’Appuis à la Lutte contre le Paludisme par la méthode MIS. 2010
ii CIA World Factbook, 2012 iii Système National d’Information et de Gestion Sanitaires --Health Management Information System, 2006
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5.5 Annex E: Malaria Safe Guide
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