Final APR communicaiton strategy master copy (002)

INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION

STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’

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Integrated Advocacy, Social Mobilization and Communication Strategy & Action Plan for

‘A Promise Renewed’

Led by - Sheeba Afghani, Communication for Development (C4D) Specialist Supported by – Miriam Lwanga Communication for Development (C4D) Officer



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Contents Executive Summary ................................................................................................................................. 4

List of Acronym ....................................................................................................................................... 5

Key terms ................................................................................................................................................ 6

CHAPTER I................................................................................................................................................ 7

INTRODUCTION, RATIONALE AND PROCESS............................................................................................... 7

1.1 Background: .......................................................................................................................................... 7

1.2. Rationale for Communication framework and structure ...................................................................... 8

1.3. Development process .......................................................................................................................... 9

CHAPTER II ............................................................................................................................................ 10

OVERALL FRAMEWORK FOR THE INTEGRATED STRATEGY ..................................................................... 10

2.1 Communication Framework ................................................................................................................ 10

2.2. The Package: ..................................................................................................................................... 10

2.3. Communication Goal, objectives (Roadmap Materanal & Neonatal Mortality & Morbidity) ............. 11

2.4. Target audience and behavioral analysis .......................................................................................... 12

Chapter III .............................................................................................................................................. 18

STRATEGIC COMMUNICATION INTERVENTIONS ....................................................................................... 18

3.1. Communication Strategies ................................................................................................................. 18

3.2. Behavior Change Communication (BCC) .......................................................................................... 18

3.3. Social mobilization with specific focus on the hard to reach ............................................................ 20

3.4. Advocacy: .......................................................................................................................................... 22

Chapter IV ............................................................................................................................................. 24

SPECIAL STRATEGIES - MALE INVOLVEMENT, HEALHT WORKERS MOTIVATION, HARD TO REACH ... 24

4.1. Male Involvement ............................................................................................................................... 24

4.2. Health Workers Motivation ................................................................................................................. 26

4.2. Specific activities for Hard to reach: .................................................................................................. 27

4.3. Collaboration and Networking: .......................................................................................................... 28

CHAPTER V ............................................................................................................................................ 29



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TRAINING AND CAPACITY BUILDING .......................................................................................................... 29

5.1. Training and capacity building; ......................................................................................................... 29

5.2. Training of Trainers (TOT): ................................................................................................................. 29

5.3. Training of District Health Management Teams (District Health Educator, District Health Inspector and District Health Visitor): ........................................................................................................................ 29

5.4. VHTs, LC1s, Chiefs, religious leaders, teachers, TBAs and health assistants: ................................ 29

Appendices ............................................................................................................................................ 35

Annex 1: INTEGRATED ACTION PLAN 2014-2015 ....................................................................................... 35

Annex 1: Stages of Behavir change ............................................................................................................... 42

Annex 2: Social ecological model .................................................................................................................. 43

Annex 5: Matrix for assessing Demand side barriers (adapted) ................................................................... 44

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Executive Summary

The integrated Advocacy, Social Mobilization and Communication Plan aims

to support the new priorities highlighted in the ‘A Promise Renewed;

Reproductive Maternal, Newborn and Child Health Sharpened Plan For

Uganda (2013)’ and other priorities outlined in ‘Roadmap for accelerating

the reduction of Maternal and Neonatal Mortality and morbidity in Uganda

(2007-2015)’ and ‘National Child Survival Strategy (2009 -2015).’

The communication strategy takes an integrated approach to maternal and

child health and focuses on the critical time period on the continuum of

care, consistent with the priorities underlined in the Sharpened Plan.

Building on the ‘Stages of Change’ and ‘Social Ecological Model for

Behavioral Change’, the Strategy gives clear strategic direction on achieving

key behavioral objectives. Although formative research has not yet been

conducted, target audiences and barriers have been identified after a

comprehensive research of secondary sources and the best practices

documented in various toolkits developed by partners.

The behavioral analysis and the resulting behavioral objectives are presented

for key target audiences; Primary, Secondary and Tertiary. This analysis gives

a robust way forward on priority strategies, activities and messages to reach

main stakeholder groups for RMNCH.

The ‘Strategy’ also aims to optimize the use of innovations in communication

technologies like mtrac, VRS, edutrac, in support of RMNCH, with specific

focus on real time data collection and utilization for monitoring purposes.

The key strategies include behavior change communication, social

mobilization and Advocacy. The strategy also prioritizes male involvement

and health workers motivation as key strategies to improve RMNCH

outcomes. Gender transformative and gender sensitive communication

approaches are envisaged to improve adoption of key behaviors among the

target audiences.

The roll out of this integrated communication strategy will also entail a robust

capacity building and training component with specific focus on building

capacity at the district and community levels.



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List of Acronym

ANC Antenatal Care

APR

BCC

C4D

A Promised Renewed

Behavior Change Communication

Communication for Development

DHT District Health Team

DMHT District Management Health Team

HMIS Health Management Information System

EPI Expanded Programme on Immunization

FBO Faith Based Organizations

IEC

IMR

Information Education and Communication

Infant Mortality Rate

IPC Interpersonal communication

MDG Millennium Development Goals

MMR Maternal Mortality Ratio

MOH Ministry of Health

M&E Monitoring and Evaluation

MCH Maternal and Child Health

PSA Public Service Announcement

RNMCH

SM

Reproductive New-born Maternal Child Health

Social Mobilization

UDHS Uganda Demographic Health Survey

VHT Village Health Team

WASH Water Sanitation And Hygiene



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Key terms 1.1. Communication for Development: refers to a planned, evidence-based

strategic process for promoting positive and measurable individual behavior

and social change that is an integral part of development programmes,

policy, advocacy and humanitarian work. This process is crucial for social

transformation and operates through three main strategies namely;

advocacy for raising resources, political and social leadership commitment,

social mobilization for wider participation and ownership and programme

communication for bringing about changes in knowledge, attitudes and

practices among specific participants in programmes (UNICEF, 2001).

1.2. Programme Communication/ Behavior Change Communications (BCC):

Is designed to achieve measurable objectives. It shifts the emphasis from

making people aware to bringing about new attitudes and practices. It is a

process that uses various strategies, communication processes, and media to

persuade people to increase their knowledge and change risky behavior

(UNICEF, 1999b). It uses an appropriate mix of interpersonal, group and mass

media channels including participatory methods.

1.3. Community Mobilization: Uses deliberate participatory processes to

involve local institutions, local leaders, community groups, and members of

the community to organize for collective action toward a common purpose

(CEDPA,2000).

1.4. Social Mobilization: Aims to muster national and local support for a

general goal or programme, in order to create an enabling environment and

effect positive behavior and social change (Mckee, 1992). It also refers to a

process of bringing together all feasible intersectoral social partners and allies

to identify needs and raise awareness of, and demand for, a particular

development objective. It involves enlisting the participation of such actors

(including institutions, groups, networks and communities) in identifying,

raising and managing human and material resources, thereby increasing and

strengthening self-reliance and sustainability of achievements made.

(UNICEF, 1992).

1.5. Advocacy: Is a process that involves a series of actions conducted by

organized citizens in order to transform power relations. The purpose of

advocacy is to achieve specific policy changes, or allocation of resources

that benefit the population involved in the process (CEDPA, 2000 ).

1.6. Empowerment: is a process of facilitating and enabling people to acquire

skills, knowledge and confidence to make responsible choices and

implement them.(UNICEF, 1992)



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CHAPTER I

INTRODUCTION, RATIONALE AND PROCESS

1.1 Background: As the global community rolls out action plans to improve maternal,

newborn and child survival, Uganda has developed its own strategy entitled

‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health

Sharpened Plan for Uganda (2013)’. The ‘Sharpened plan’ is not meant to

replace the existing ‘Roadmap for accelerating the reduction of Maternal

and Neonatal Mortality and morbidity in Uganda (2007-2015)’ or the ‘National

Child Survival Strategy (2009 -2015)’ but to catalyze them.

The Sharpened Plan has identified five strategic shifts to avoid business as

usual; 1. Focus Geographically 2. High burden populations 3. High impact

solutions 4. Education Empowerment, Economy, Environment and 5. Mutual

accountability. The Sharpened Plan places a strong emphasis on

accountability and monitoring mechanisms and partnerships for social

mobilization. Over the past 15 years Uganda has made modest progress in improving

health and development indicators. However, maternal and infant mortality

and morbidity remain unacceptably high and as a result Uganda is not on

track to achieve MGD 4&5. Nationally, maternal mortality is estimated at 438

deaths per 100,000 live births. This MMR translates to 6000 women dying every

year from pregnancy related causes.

Uganda’s under- five mortality also remains high at 90, while it’s infant and

newborn mortality 54 and 27 deaths per 1,000 live births, respectively (UDHS

2011). Therefore, Uganda’s maternal mortality ratio (MMR) and under five

mortality rate still remains well off track the MDG 5 and MDG 4 targets of 131

deaths per 100,000 live births and 56 deaths per 1,000 live births respectively

by 2015.

Key challenges experienced in the health system and barriers to Uganda’s

path to achieving the MDGs include inadequate skilled birth attendants

which leaves many pregnant women dying at home due to lack of access to

health care, prompt decision making, difficulties in transportation and lack of

emergency obstetric care services at the referral level. Other key challenges

in maternal, newborn and child health include lack of health personnel, poor

health service delivery, low VHT (Village Health Team) coverage, as well as

frequent stock out of essential drugs in remote and difficult to reach areas.

On the demand side several barriers exist to the utilization of RMNCH service.

Women often lack knowledge and decision making power to avail critical



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RMNCH services before during and after delivery. Women who may face

complications often are not part of the decision regarding the potential

course of action1.

In addition, several religious and cultural practices exist in many parts of

Uganda that threaten maternal and neonatal survival2; Ingestion of herbs to

quicken labor, refusing caesarian section on the pretext that women need to

deliver normally to prove woman hood and culture of silence/non expression

of pain3.

Evidence based communication strategies to increase knowledge and

change attitude, behavior norms at individual, community and societal level

are essential to eliminate key demand side barriers. However, in the past

communication initiatives have focused on individual and household level

behavior change leading to strategies that provided only short term,

fragmented and limited behavior change.

1.2. Rationale for Communication framework and structure

The rationale for this framework is to;

Support the new priorities highlighted in the ‘A Promise Renewed;

Reproductive Maternal, Newborn and Child Health Sharpened Plan

For Uganda (2013)’ and other priorites outlined in ‘Roadmap for

accelarating the reduction of Maternla and Neonatal Mortality and

morbiditity in Uganda (2007-2015)’ and ‘National Child Survival

Strategy (2009 -2015)’

To build strong partnerships in support of RMNCH program across

different levels; national, district and communities and highlight

exisiting resources and structures within and outside the health system

that can be mobilized in support of an integraed RMNCH Program.

To highlight and address key cultural and socio economic barriers

impacting women’s abiliity to access RMNCH services. Specific focus

1 Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’, page 13 2 Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’, page 13 3 Kyomuhendo GB 2000, Ndyomugyenyi 1998)



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on the three delay model and involving communities in planning and

management of RMNCH activities.

To Support the roll out of key innovations in communication

technologies in support of RMNCH program; mtrac, VRS, edutrac and

U Report.

Show case special strategies for engaging with the male populations

by highlighting gender transformative communication strategies

To focus on capacity building of community based VHTs in

interpersonal communication in support of RMNCH

To facilitate resource generation for communication actvities in support

of integarted RMNCH program.

1.3. Development process The draft strategy has been developed in-house by UNICEF ALIVE section to

guide the communication support for ‘A Promise Renewed; Reproductive

Maternal, Newborn and Child Health Sharpened Plan for Uganda (2013)’ and

the ALIVE Program as a whole. The draft will be shared broadly with partners

for review and revision; MOH, development partners, parliamentarians, district

and sub county stakeholders. A series of consultative workshops from the

national to the district and sub district level are envisaged for the roll out of

this strategy. The feedback will further inform the implementation down to the

community level.



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CHAPTER II

OVERALL FRAMEWORK FOR THE INTEGRATED STRATEGY

2.1 Communication Framework The communication strategy is based on the theories of ‘Stages of Behavior

Change’ and Social Ecological Model. The Stages of Behavior Change theory

views behavior change as a process rather than an event. The main tenet of

this Model is that an individual (or a stakeholder group) goes through several

stages from non-practice to practicing or adopting a desired behavior. These

stages including Knowledge, Approval, Intention, Practice, and Advocacy

are so strongly associated with the new behavior that he or she becomes an

advocate). This model helps to explain where the individual or a stakeholder

group is in relation to a specific behavior and in relation to other stakeholder

groups and gives direction on the types of strategies to move them along the

ladder to the desired behavior (See Annex 1).

The Social Ecological Models explain the link between the individual behavior

and the enabling environment. In the past, development approaches

focused on individual behavior change. But since then we have learnt that

individuals often do not or cannot change behavior without support from the

environment around them; Parents, spouses, peers, friends, community and

religious leaders etc. Factors such as family pressure, community norms, and

the larger policy and legal environment can affect the health related

behaviors an individual engages in. Thus an individual’s behavioral choices

should be seen in the larger context of his or her environment. Hence,

interventions are needed at different levels of the environment to facilitate

behavior change (See Annex 2).

2.2. The Package:

The communication strategy takes an integrated approach to Reproductive

Maternal, Newborn and Child Health and focuses on the critical time periods

on the continuum of care. The target audience information needs will

include messaging on the following;

Table 1

Life stage priority area for

Programming

Health priority area linked to RMNCH

New born, Infant and Child - New Born Care

- Early initiation of breastfeeding

- Exclusive breastfeeding

- Acute Respiratory Tract infections

- Diarrhea



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- Immunization

- Vitamin A deficiency

- Growth monitoring

- Infant and young child feeding practices

- Under -utilization of health services

- High reliance on traditional practices

Adolescent - Nutrition

- Health care counselling and services Life skills

- Spacing of children and planning a

manageable family

- STDs/HIV AIDS,

- Complications due to unsafe abortions

-

Pregnant Women;

Delivering;

Postnatal Care

- High fertility Rate

- Low contraceptive prevalence rate

- Early initiation of breastfeeding

- Exclusive breastfeeding

- Birth preparedness

- PPH – Post Partum Hemorrhage

- Under Utilization of RMNCH services during

ANC, Delivery and PNC

- Nutrition and iron for pregnant and lactating

women

- Stop Smoking and tobacco use

- Malaria prevention in endemic areas

(Importance of IPT)

- Sexually transmitted infections/HIV AIDS

- Complications due to unsafe abortions

- Gender based discrimination; work burden,

harmful social norms, limited decision making,

gender based violence

2.3. Communication goal, objectives and overall strategic focus

Goal: To promote, support and ensure adoption of appropriate health

seeking behavior among pregnant and lactating women, their families

and communities4.

Strategic Objective: Create Demand for Quality RMNCH services at the

community level to ensure continuum of care.

Communication Objective: 90% Pregnant & Women of CBA and Men adopt key RMNCH behaviors

(time frame sharpened plan)

4 ‘Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’, page 7



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Indicators

o % Pregnant & Women of CBA who adopt key RMNCH behaviors

o % of Men who adopt key RMNCH behaviors

Overall Strategic Approach:

Mobilize and Empower key decision makers and communities across

sectors to ensure a continuum of care between the household and heath

facility and create demand for RNMCH services in line with the APR

priorities;

1. Roll out a National advocacy movement for Reproductive, Maternal,

Newborn & Child health across all sectors; Health, education, agriculture,

gender, private, finance, local government), cultural &religious leaders,

development partners, private sector, media

2. Review and harmonize integrated RMNCH IEC tool kit for all health

facilities, community health workers, communities and key stakeholders

4. Build proactive and sustainable partnerships with key stakeholders at

national, district, sub county and parish levels in support of RMNCH

5. Use Gender Transformative communication approaches and messages

to address child marriage, educating girls and women, women’s decision

making with specific focus male involvement in RMNCH

6. Engage mothers and communities to utilize innovative platforms (mTrac,

Mobile VRS, U report, Mother Reminder) for collection and use of real time

data to promote accountabilities at all levels.

2.4. Target audience and behavioral analysis

Although formative research has not yet been conducted, the following

target audiences and barriers have been identified after a comprehensive

research of secondary sources and the best practices documented in various

toolkits developed by the partners.

Generally, the following target audiences were identified:

Primary

Household level: Women (Caretakers, married/stable relationships,

adolescents, Husbands/Spouses.

Community Level: LCs, Religious leaders, VHTs, Teachers and TBAs.

Secondary



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Health facility level: Health Unit Management Committees, Health

workers (Doctors, Nurses and Midwives)

District level: Politicians such as Resident District Commissioners, LC - V

Chairpersons

Community level: Chiefs, local councils, VHTs, NGOs/CBOs such as Red

Cross, religious organizations such as (ADRA), Schools, Parents

&Teachers Associations, Community volunteers, community leaders,

Traditional Birth Attendants and extension workers.

Tertiary

National Level:

Ministry of Health taking the lead and other relevant line ministries

complementing its efforts such as: Ministry of Education, Ministry of

Finance and Planning and Ministry of Local Government;

Members of Parliament, Religious and Traditional leaders, Media houses

and service organizations such as Rotary and Lions Clubs and NGOs

such as Uganda Red Cross Society.

Professional bodies such as Uganda Medical and Dental Association,

Uganda Pediatric Association, Uganda Nursing Council, Uganda

Health and Allied Professionals Association; religious organizations,

through their medical Bureau such as Catholic, Protestant, Muslim and

Orthodox Medical Bureau.

Development partners such as USAID, DFID, KOICA, CIDA, JICA and

others.

Table 2: Target Audience & Behavior/participant analysis

Target Audience

Current behavior Barriers to desired

behavior (causes)

Behavioral objectives (2017)

Primary

1. Women of Child

Bearing Age,

Pregnant and

lactating women,

husbands and

caretakers

Women of

Child bearing

Ages, Pregnant

and Lactating

Women not

practicing Key

RMNCH

Behaviors

Knowledge Barriers

Inadequate knowledge

on benefits of RMNCH

(ANC, birth preparedness,

emergency readiness,

skilled birth attendance at

delivery, PNC, Early

initiation of Breastfeeding,

maternal nutrition,

immunization, HIV, hand

washing).

Only 21 % male partners

80% target women,

husbands and caretakers

understand the

importance, birth

preparedness, ANC,

danger signs and three

delays , institutional

deliveries, PNC and

(annex for detailed

package)



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Target Audience


behavior (causes)


have knowledge on

ANC

Attitude barriers

- Pregnancy considered a

normal practice in many

communities And women

who deliver at home

without medical

assistance held in high

regard5

- Limited decision making

power of women during

pregnancy, Child Birth

and postpartum period

- Religious and traditional

beliefs; Ingestion of herbs

to quicken labor, refusing

caesarian section on the

pretext that women are

supposed to deliver

normally to prove woman

hood and culture of

silence/non expression of

pain 6

Practice barriers

Only 58% of births

attended by skilled birth

attendants (UDHS 2011)

Only 48% women are

having four or more

ANCs visits

80% of mothers, husbands

and caregivers recognize

pregnancy as a special

period requiring special

care and consider women

who deliver in facilities as

positive role models

80% women involved in

decisions regarding

pregnancy, child birth

and postpartum

80% of target populations

shun practice of herbs for

quicken labor and

appreciate the

importance of caesarian

in case of obstructed

labor

70% births attended by

skilled birth attendants

70% mothers seek all four

ANC visits

70% women receive

postnatal care in the first

two days after delivery.

5 Kyomuhendo GB 2000, Ndyomugyenyi 1998) 6 Kyomuhendo GB 2000, Ndyomugyenyi 1998)



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Target Audience


behavior (causes)


Only 33% women receive

postnatal care in the first

two days after delivery.

Secondary:

2. VHTs VHTs do not

mobilize

communities for

RMNCH services

Knowledge Barrier

- Inadequate knowledge

on benefits of Key RMNCH

practices

Attitude Barrier

- Lack of motivation to

promote RMNCH services

Practice Barrier

- Do not mobilize

communities to avail

RMNCH services

80% VHTs have

knowledge on key

RMNCH practices

80 % of functional VHTs

mobilize communities for

availing the RMNCH

services

3. Health unit

management

committee (HUMC)

HUMC members

do not attend

regular quarterly

meetings to

discuss health

issues and support

community

activities

Knowledge Barrier

Lack of knowledge on

the importance of

RMNCH service for

maternal and child

survival

Attitude Barrier

Lack of motivation to

attend meetings

concerning health issues

Practice Barrier

In adequate supervision

monitoring support at

the community level

80% HUMC are

functional and members

regularly attend

quarterly meetings and

80% functional HUMC

engaged in monitoring

and supervision at

community level

4. Health workers Health workers do

not counsel

mothers or give

complete

information to

mothers regarding

RMNCH package

Knowledge Barrier

Inadequate

interpersonal

communication skills

e.g. counselling skills

Attitude barrier

In appropriate

treatment of parents

80% Health workers

trained in counselling

and interpersonal skills

80% health workers treat

parents with respect

80% of health workers

counsel women on key



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Target Audience


behavior (causes)


(often rebuke parents)

Practice barrier

Health workers do not

counsel women on Key

RMNCH services.

RMNCH services

5. Traditional and

religious leaders

Tradition and

religious leaders

not engaged in

RMNCH promotion

Knowledge Barrier

Lack of knowledge on

the importance of and

Attitude Barrier

Existence of traditional

beliefs (Ingestion of herbs

to quicken labor, refusing

caesarian section on the

pretext that women are

supposed to deliver

normally to prove woman

hood and culture of

silence/non expression of

pain 7

Practice barrier

Traditional and religious

leaders do not promote

RMNCH services

80% of all major religious

association oriented on

RMNCH package and

engaged in social

mobilization for RMNCH


association shun

traditional practices

harmful to maternal,

new born and child

health


association oriented on

RMNCH package and

promote RMNCH

services

6. Media National and

district media do

not adequately

cover RMNCH

activities

Knowledge Barrier

- Lack of knowledge and

capacity to present

RMNCH issues and

resulting maternal and

child mortality as a news

worthy

Attitude barrier

Little interest in

80% 0f all key national

and district media

oriented on RMNCH

80% 0f all key national

and district media

oriented on RMNCH

report and cover key

RMNCH activities

7 Kyomuhendo GB 2000, Ndyomugyenyi 1998)



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Target Audience


behavior (causes)


comprehensive coverage

of RMNCH

Practice barrier

National and district

media do not adequately

cover RMNCH activities

7. National and district

policy makers/ leaders

• National and

district leaders

not aware their

role in

mobilization

and promotion

of RMNCH

• Knowledge Barrier

Inadequate knowledge

and orientation of policy

makers /influential leaders

on their role in

mobilization and

promotion of RMNCH

Attitude Barrier

National and district

leaders have the

tendency to be donor

dependent and do not

take the lead

Practice Barrier

Leaders not performing an

oversight function in their

constituencies and districts

80% National and district

leaders oriented on

RMNCH package and

their role in mobilization

and promotion of

RMNCH

80% of the oriented

national and district

policy makers and

leaders engage in

oversight functions in

their constituencies and

districts

8. Development

partners

• Uncoordinated

sector support

by donors

• Practice barrier

Uncoordinated sector

investment

80% donor funds

coordinate through the

sector coordination

committee



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Chapter III

STRATEGIC COMMUNICATION INTERVENTIONS

3.1. Communication Strategies

The development and implementation of this strategy is based on the

recognition that behavior change communication can be effective when

planned and implemented using a combination of communication

approaches with appropriate behavior change models.

Relevant behavior change approaches, models and theories were identified

and applied to analyze the behaviors of primary, secondary and

tertiary/advocacy target audiences. This analysis provided insight into the

behaviors of individuals and factors responsible for the less than optimal

uptake of RMNCH services. This has enabled the identification and design of

relevant interventions and messages to address the problem behaviors.

In order to achieve the communication and behavioral objectives, a three

pronged Communication for Development approach with three main

strategies will be used, namely;

Behavior Change Communication

Social mobilization

Advocacy

3.2. Behavior Change Communication (BCC)

BCC interventions will be implemented at the household level through IPC

involving VHTs, Scouts / Girl guides, LC1s, and through mass media (radio

spots/talkshows. Although mothers are the primary target at household level,

recent research and experiences have shown that there are structural

barriers to women’s decision making. Hence, the household will be further

segmented to include other decision makers; such as mothers,

husbands/fathers, grandparents, aunties, mothers-in-law and fathers-in-law.

Health promotion interventions will target the specific behavioral barriers at

the family/household level and create awareness through the following

interventions:

IPC through IEC materials



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The VHTs will have the main responsibility for IPC using IEC packages

supported by health assistants. The IEC packages will include pictorial cards

and informative leaflets covering important aspects of RMNCH; these will

provide information on birth preparedness, Antenatal care, delivery,

postnatal care, early initiation of breastfeeding, infant and young child

feeing, family planning, pneumonia, malaria and diarrhea prevention,

hygiene, sanitation, nutrition etc. IEC materials in addition to being used in

individual and group counseling can also be used for training purposes.

Information materials will also be developed for promotional activities

conducted by health workers, LCs, Scouts/Girl Guides, religious leaders and

teachers.

Mother to mother education and women’s group

This strategy has been used in many countries with significant results and the

most effective application of peer- to –peer education. Mothers will be

trained to advise other mothers and pregnant women on key RMNCH

practices.

Mass Media:

Mass Media will be used to make Public Service Announcements (PSA) by

government agencies. These are very important in keeping messages in

public eyes. Short spots, talk shows, PSA and jingles to promote RMNCH will be

developed for airing on radio and TV. PSA messages will create awareness

and understanding regarding importance of RMNCH and motivate people to

adopt positive behaviors.

Innovative use of mobile health and related information communication

technologies:

The focus will be in enhancing health literacy and care seeking among

mothers through provision of relevant health information to pregnant women

and new mothers using personalized text or voice messages encouraging

them to visit the local health facility for antenatal care, immunization or

remind them to complete birth plan and go for skilled delivery and post natal

care. Existing mobile health initiatives like mTrac and community

engagement initiatives like U Report will be utilized for real time reporting on

existing gaps and barriers to RMNCH at all levels.

Disease prevention and patient self-management will also be supported

through short messages no more than sixty characters or less to enrolled

mobile phone users. Options will also be explored to use SMS system to

connect remote populations to their health providers.

Involvement of goodwill ambassadors:



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The involvement of goodwill ambassadors for promotion of social causes has

been found to be very effective and bears positive results the world over.

Well-known and popular personalities and media stars possess charisma and

charm that is needed to add visibility and credibility to the cause.

In a bid to make the RMNCH communication more persuasive and relevant

to the target audiences, a panel of goodwill ambassadors belonging to

different walks of life (sports stars, media celebrities, religious leaders and

doctors) will be selected in consultation with partners to promote RMNCH

services.

Programme Communication Activities:

Mapping of active VHTs nationwide

Training / Orientation of VHTs on key messages for RMNCH

Awareness raising through individual/Group counseling sessions

Awareness raising through Public Service Announcements, TV, talk

shows, Radio spots/jingles, DJ mentions, children’s voices and

testimonies from satisfied users of immunization services.

Dissemination of messages in newspapers through articles and strip

adverts.

Development and dissemination of SMS messages

Sensitization sessions with Goodwill Ambassadors

Promotional visits by Goodwill Ambassadors to communities

3.3. Social mobilization with specific focus on the hard to reach areas

Social mobilization will operate at the district, sub district and village level. In

addition to parents, it will target local politicians, religious leaders, traditional

leaders, opinion leaders, community groups, and teachers. Social

mobilization is not only crucial for sustainable behavioral change, it is also an

effective strategy for community empowerment and participation. It will

create awareness and seek to change people’s behavior at village level and

will entail the following activities.

Formation of Alliances/Support Groups

The District Health Management Team (DHMT) with the help of local

volunteers (teachers/health-workers) will be responsible for forming support

groups at the community level, to advocate and participate in program

activities. The support groups will include local religious leaders, health

workers, teachers, NGO/CBO representatives. These support groups will

provide an excellent venue for imparting knowledge on RMNCH. These



21

groups will meet on a regular basis and plan how to provide solutions with

mutual understanding and sharing of experience.

Community Based Participatory Activities: Activities will be organized and

supervised by DHMTs. IPC through the VHTs and partner NGOs supported by

IEC materials will be the main channels of communication for these activities.

Informative/educational materials will be designed and developed for

various members of the support groups. The materials developed for

traditional and religious leaders will be designed to directly address any

cultural constraints and false religious beliefs, and will be in the form of fact

sheets and videos.

Community and school based sports and other info- entertainment activities:

This component will focus on educating and mobilizing communities around

RMNCH through community and school based sports activities. These

activities will entail massive community interest and involvement. The

teachers will be involved in school based interactive/informative activities for

promotion of RMNCH. Focal persons and sports champions will be identified

in each community to support future activities. Drama groups will be trained

in each community and school on key RMNCH messages. Community

screening of relevant documentaries etc. will also be part of this component.

Social Mobilization Activities:

Community sessions and dialogue/group discussions with various target

groups organized by DHMTs/DHE

Alliances formed with community leaders, NGOs, religious/cultural

leaders

Revitalization of Health Unit Management Committees (HUMCs) to

support linking services with communities

Community based media activities; music, dance and drama

performances as well as puppet shows on RMNCH by DHMTs

Establishment of community radio listeners’ groups by VHTs to mobilize

the communities, listen and participate in radio discussion programmes

on RMNCH

Conducting sensitization sessions with religious, traditional and

community leaders

Conducting sensitization sessions with teachers to create awareness

School based activities conducted by teachers



22

Additional activities may include street theatre, community meetings,

sports days, school-based activities, and seminars, celebration of

important health events e.g. World Health Day, Child Days Plus

3.4. Advocacy:

Advocacy will target individuals involved at all levels of policy and decision

making. At the National level it will target ministers, MPs, and other relevant

people in the ministries. At the District level it will target the district councils

and heads of departments. The district level advocacy will entail dialogue

with District Health Officers (DCOs), heads of departments and councilors.

Media agencies and their representatives at national and district levels will

also be targeted.

Newspaper articles, seminars and workshops/meetings will be employed to

make policy makers more aware of the magnitude of risks associated with

low RMNCH service utilization; of the immediate and secondary (including

economic) benefits; and of the potential action to be taken by them such as

supportive legislation and its enforcement. National commitments to

international conventions like the Rights of the Child will be used to legitimize

demand for government support.

The advocacy component will focus on the following:

Policy/Legislation:

Ensure that the government and parliament set up a strong enforcement,

regulatory and monitoring system for RMNCH.

Capacity Building:

Build the capacity of policy makers, parliamentarians at national and district

level for implementing the advocacy strategy. Also, advocacy capacity of

the NGOs and the media will be strengthened to effectively publicize and

promote RMNCH services.

Awareness Raising:

Raise awareness of government officials and affiliated partners about the

consequences of un skilled birth attendance, low antenatal and post natal

visits, lack of early initiation of breastfeeding, low immunization coverage.

Partners will also be given an orientation on means of achieving RMNCH

targets.



23

Advocacy Activities:

Develop/adapt advocacy kit for political leaders, traditional and

religious leaders at national and district levels.

Conduct high level advocacy meetings to revive the support and

commitment of political, religious and traditional leaders for

RMNCH/APR.

Seek endorsement statements from credible authorities in government,

traditional and religious organizations and medical professionals in

support of APR.

Meetings on key RMNCH concerns with district leaders, heads of

departments, religious and traditional leaders and key partners.

Launch the Communication strategy by a key figure in government,

either the First Lady or Minister of Health.

Capacity building of policy makers to develop supportive policy and

implementation

Sensitization/Capacity Building sessions with media representatives



24

Chapter IV

SPECIAL STRATEGIES - MALE INVOLVEMENT, HEALHT WORKERS MOTIVATION, HARD TO REACH

4.1. Male Involvement

Men are critical players in decision making regarding major RMNCH

practices; contraceptive use, maternal nutrition, institutional deliveries etc.

However, despite recognition of the urgent need for male involvement, both

globally and at the National level, limited attention has been given to

engagement of this critical target group.8 Hence, at the community level

lack of comprehensive knowledge of key RMNCH practices and low male

involvement leads to poor utilization of the RMNCH services9.

The communication strategy aims to use gender transformative (that

confronts and transforms gender norms) and gender sensitive (that is aware

of the gender norms in a specific context and how these impact gender

relations and decision making) approaches to involvement of men in

RMNCH.

The messages and training tools developed will enable the communities to

explore and understand how gender roles can impact health outcomes and

how male involvement is critical for positive RMNCH outcomes.

Research conducted by WHO - Promundo and UNFPA literature review of

Men’s role in gender equality highlight two main areas that gender

transformative programs could use to increase male involvement in RMNCH;

1. Engaging men as partners in reproductive health.

2. Engaging men as agents of change in RMNCH10.

4.2. Key Strategies

Following key strategies will be used;

8 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO 9 ‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health Sharpened Plan for Uganda (2013)’. 10 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO



25

4.2.1. Group Education Using traditional approaches like story-telling, dance groups, mimes etc. the

group education sessions will have a high entertainment component. The

three core activities under the group activities will include;

Gender Roles and expectation

The group will jointly examine gender roles, expected gender behavior ‘Act

like a man’, Act like a woman’ and gender relations in their community and

how these impact both male and female reproductive health and RMNCH

outcomes.

Child care: Using role plays and simple games like ‘passing the crying doll’

representing a ‘new born baby’ teach men essential ‘child care’. The focus

should be on educating them on joint child care and showing that although

it seems simple, child care is extremely tiring a woman (mother) needs

support of her partner.

Key Barriers:

Key barriers identified for each region will be further explored; No

communication between couples on pregnancy, pregnancy considered a

normal practice and women delivering at home without medical assistance

held in high regard, Limited decision making power of women during

pregnancy, child birth and postpartum period, religious and traditional

beliefs; Ingestion of herbs to quicken labor, early marriage, girl education etc.

4.2.2. Selection of Male change agents

The use of men as change agents for promotion of RMNCH has proven useful

in different context in increasing male involvement in RMNCH. The male

change agents will be chosen from ordinary fathers, religious cultural leaders,

parliamentarians etc. Tools and materials will be developed for building their

capacity on promoting and mobilizing for RMNCH.

4.2.3. Campaigns and community mobilization

As mentioned earlier the strategy will use gender transformative

communication messaging and approaches. In addition to community level

tools and materials, a mass campaign will be designed around male role in

child caring and raring and in the broader RMNCH programme. The

campaign will move beyond the individual and target how parents, religious

cultural leaders and communities perceive gender norms and roles around

RMNCH.



26

4.2.4. Health Workers attitude

Health workers attitude has been highlighted as a key factor in impacting

male participation in RMNCH and PMTCT.11 A checklist will be developed

to assess health facility friendliness to male and female clients. Specific

focus will be training health workers in dealing with the needs of male

clients and engaging them in RMNCH. Some of the areas of focus will

include; health workers behavior towards male clients;12 harsh behavior

from skilled health workers a big barrier for male clients returning

(especially PMTCT). Quality of care; Health workers are often burdened

and taking care of participating male members is considered an

additional burden. Hence, need to build their knowledge on the

importance of male involvement. Lack of space and resources; Clinics

often have limited space to accommodate male partners who may be

discouraged from accompanying women to clinics.

4.3. Health Workers Motivation Health workers motivation is a critical factor impacting the quality of services.

The health care workforce, the foundation of the health system, is under

increasing pressure to perform higher quality of work with limited resources.

Under the current circumstances, a focus on knowledge and skill base alone

cannot remove many of the bottlenecks faced in the delivery of quality care.

Simple, low cost catalytic interventions focusing on putting in place incentive

mechanisms for staff motivation need to be explored as the MOH and

partners prepare for the national scale critical RMNCH services. This is

especially crucial with promotion of institutional deliveries. Recent research

shows that although distance is a key factor inhibiting institutional deliveries,

mothers and caregivers are willing to travel longer distance if the facility is

perceived to provide good quality service13.

Activities

Creating a non-monetary incentive mechanism for health workers to

Incentivize Implementation of the RMNCH package based on the

RMNCH score card. An in-depth study conducted recently in Uganda

‘Our side of the story’ clearly identifies motivators and bottlenecks to

health facility staff performance. Majority of the motivators are

11 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO

12 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO

13 Assessing access to barriers to maternal health care; measuring bypassing to identify health center needs in rural Uganda, Justin O Parkhurst and Freddie Ssnegooba, 20 April 2009



27

unrelated to financial incentives (pride, prestige, trust,

acknowledgement etc.). A second study, ‘non-financial incentives for

health workers retention in Uganda’ will also inform this component.

Improve the quality of service by putting in place a ‘Certification

Mechanism’ for health facilities. A major factor impacting RMNCH

services is the variation in services between facilities and no

differentiation between well performing and poor performing health

facilities. A district based certification component will ensure

recognition of compliant facilities and will also regulate the huge

variation in quality of service across various districts and health facilities.

This will greatly enhance staff motivation

Leader boards will be set up in each district highlighting the top

performing health facilities based on the score card. The leader boards

will be updated quarterly. The leader board data will be shared widely

and will be published quarterly in newspapers. The feedback to the

health facilities will ensure a health competition within health facilities.

This data will also be shared on the LCD screens in the health ministry

and on a public website.

Using mTrac a SMS based disease surveillance, medicines tracking

system for removing ‘Supply Side Bottlenecks' to health workers’

motivation. Stock out of medicines and other essential commodities

has been identified as a huge de- motivator for the health facility staff.

mTrac data is now fully incorporated into the MoH’s Surveillance Unit’s

weekly news bulletin and reports of drug stock-outs, and is being

integrated into the national DHIS2 database. The system will build

accountabilities on all sides.

4.2. Specific activities for Hard to reach:

In line with the Sharpened Plan the communication strategy focuses on high

burden districts and within these districts on the underserved and hard to

reach communities. The districts are being supported by MOH and partners to

map hard to reach populations in their social maps and micro plans. These

populations usually require additional resources extra planning to be

reached. Some additional activities are listed below.

Identify the hard to reach and underserved populations and their

locations

Rapid assessment on the reasons why particular special groups do not

believe in and utilize RMNCH services



28

Identification of grassroots NGOs and FBOs and engage them to

mobilize the hard to reach communities in coordination with DHMTs

Intensive use of mass media and community radio with emphasis on

interactive radio discussion programmes especially on local FM and

community radio stations

Intensive community mobilization using film vans, street bashes/road

shows/market days to mobilize and sensitize communities on

RMNCH/APR

Establish outreaches and or mobile service teams to cover hard to

access populations

Formation of District Communication Committee

Identification of focal person within the District Health Management

Team (Health Education Officer/other)

Identification of local volunteers (teacher/health-worker) and

formation of support groups at community level to advocate and

participate in program activities

4.3. Collaboration and Networking:

Collaboration and networking is an important component of the

communication strategy as it will strengthen alliances and partnerships

among duty bearers and partners so they can implement advocacy, social

mobilization and communication interventions that promote RMNCH services.

Activities:

Revise Terms of reference for the social mobilization subcommittee to

address issues on mobilization for RMNCH.

Conduct monthly social mobilization sub-committee meetings to

review progress on action items and plan for continuity in mobilizing for

RMNCH. Hold joint planning meetings to develop the annual

communication implementation plan.

Conduct joint workshop to develop M&E communication indicators

Conduct joint monitoring and support supervision of communication

and advocacy activities.

Conduct behavioral research to guide monitoring and evaluation of

communication interventions



29

CHAPTER V

TRAINING AND CAPACITY BUILDING

5.1. Training and capacity building;

The implementation of the communication strategy requires strengthening

communication capacity in immunization at all levels.

5.2. Training of Trainers (TOT):

A pool of Master trainers will be trained at the national level in social

mobilization/advocacy, design and implementation of the strategy. Further

cascade training conducted at the district level. The Master Trainers will be

nominated by the Ministry of health at the national level.

5.3. Training of District Health Management Teams (District Health Educator, District Health Inspector and District Health Visitor):

Capacity building of the district health management teams in

communication is crucial for the implementation of the RMNCH social

mobilization strategy at the district/implementation level. This will not be a

one- time activity but a series of participatory workshops will be conducted to

equip them with the necessary communication and mobilization skills for

RMNCH.

5.4. VHTs, LC1s, Chiefs, religious leaders, teachers, TBAs and health assistants:

For sustained behavior change at community and household level,

interpersonal communication and counseling skills of the service providers at

community level such as VHTs and LC1s are extremely important. They will be

trained to enhance their interpersonal communication and counseling skills,

and in the use of IEC materials related to RMNCH. They will also receive basic

training in community mobilization to form local alliances/support groups.

Activities:

Develop/update training manual/guidelines on communication for

RMNCH services

Conduct training/orientation of service providers on communication,

counselling and mobilization skills for promotion of RMNCH

Facilitate the development of action plans on mobilization of

communities for RMNCH



30

Conduct follow-up and provide support supervision to the trained

service providers to monitor implementation of community mobilization

activities.

Conduct meetings with Health Unit Management Committees and the

community to provide feedback on challenges and success stories on

mobilization for RMNCH services.

Conduct quarterly review meetings with DHMTs to share experiences

and update plans for timely implementation



31

Chapter VI

Strategy Implementation

6.1. Implementation Modalities

The implementation of this strategy will be executed at different levels to

promote advocacy, social mobilisation and behaviour change

communication interventions. At national level, the strategy will be used as a

resource mobilisation tool and implementation guide at various levels. As a

resource mobilisation tool, it will be presented to government and

development partners to mobilise financial resources to support

implementation of RMNCH activities.

A phased approach to implementation will be applied based on the

understanding that it is not possible to do everything in this strategy at once.

Activities will be implemented in a phased manner in consideration of what

priority activities should precede others and build momentum for subsequent

activities over the period of five years. Special emphasis will be laid on high

burden districts in line with the priorities of the Sharpened Plan.

The phasing of implementation will provide a balanced approach towards

addressing issues in a gradual process while building on the achievements of

the previous phases and strengthening the effectiveness of each phase.

Some preparatory activities will be implemented during the first year of the

strategy such as development of IEC materials/messages and training

guidelines, putting in place the M&E framework as well as training service

providers. These will build a foundation that will support implementation of

subsequent activities. It is important to point out that the phasing of

implementation will mean giving some activities more focus/intensity and

others low focus /intensity depending on the period of implementation during

the five year period.

For example, during the first year, in addition to preparatory activities, other

activities such as advocacy with key partners national and district, mass

media campaigns, mapping of community resources will be undertaken with

high intensity to build momentum, while community based activities will take

time to build momentum. In the second year to third and fourth years of

implementation, activities of the first year will have built momentum and

community level implementation will be of high intensity. During the fifth year,

there will be greater focus to gear up for evaluation of communication and



32

advocacy interventions. The table below illustrates how key activities in the

communication strategy will be implemented in phases with varying degrees

of intensity in a period of five years.

Table 3: A Phased Approach to implementation of the RMNCH

Strategy TIMELINE AND LEVEL OF FOCUS FOR IMPLEMENTATION

Communication

Approach

Major Activities Year 1 Year 2 Year 3 Year 4 Year 5

Programme

Communication

Conduct formative research

Develop IEC materials and

messages

Conduct mass media activities

Conduct community outreach

activities

Social Mobilisation

Develop/update

communication training

guidelines

Train service providers (VHTs,

Health Educators)

Develop M & E communication

indicators

Conduct support supervision

Conduct monitoring and

evaluation

Conduct quarterly review

meetings

Advocacy

Develop advocacy kit

Conduct advocacy meetings

for national and district level,

political leaders and other

leaders

Launch Communication

Strategy

Low Intensity Monitoring and Evaluation

High Intensity Monitoring



33

The communication strategy will be implemented as follows:

3.1Dissemination of strategy to partners and stakeholders

Once the communication strategy is approved by MOH, UNICEF, UNFPA,

WHO and other partners, it will be launched by a high level profile leader in

government to relevant key partners and stakeholders who include policy

makers at the highest level in the relevant ministries and development

partners. This will be done to solicit their support and buy-in for support to

RMNCH programme by advocating for allocation of adequate financial

resources. This will be done at national and district levels.

3.2 Development of annual communication plan

The HP&E Division will develop an annual implementation plan that provides

a framework for operationalising implementation of the communication

strategy for RMNCH at different levels. The plan will highlight communication,

social mobilisation and advocacy activities to be implemented at national

and district levels.

3.3 Development and production of training and IEC materials/messages

Effective communication and advocacy outcomes will be achieved with

support of well-targeted and focused IEC materials, messages and training

guidelines/manuals which will enhance knowledge and understanding of

RMNCH among parents, caretakers and service providers. The training

materials will be used to equip service providers with knowledge and skills in

mobilization, communication and counselling for RMNCH while IEC materials

and messages will be used to create/increase awareness and knowledge on

RMNCH among parents, caretakers and members of the community. Once

the training guidelines have been developed/adapted, training of service

providers will commence at regional level in preparation for countrywide

mobilization for RMNCH services.

3.4 Coordination and management of the strategy

Implementation of communication and advocacy activities needs to be

managed and coordinated to ensure stakeholders execute their roles more

effectively through partner complementation. The implementation of the

communication strategy will be managed by HP&E Division and coordinated



34

through the Social mobilisation sub-committee. This committee will advise on

technical issues related to communication and advocacy for RMNCH.

INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A

PROMISE RENEWED’

35

Appendices

Annex 1: INTEGRATED ACTION PLAN 2014-2015

EXPECTED RESULTS OF C4D INTERVENTIONS FOR APR IN UGANDA

High impact behaviors Pregnant women go for at least 4 antenatal check-ups (ANC+) and 4 post natal visits (PNC)

Pregnant mothers and Families accept skilled birth attendance and referral for institutional deliveries

Lactating mother breastfeed within one hour (feed colostrums) and exclusively breastfeed for the first 6 months

Child care givers provide infants appropriate complementary feeding from 6 months

Family members practice hand washing with soap/ash at four critical times and stop open defecation

Child care givers manage diarrhea at home through correct use of ORT and recognize early signs of dehydration

Family members practice appropriate care seeking behavior for pneumonia and neonatal conditions

Families have their children immunized against preventable diseases

Families use iodized salt, iron folate, and vitamin a supplementation to protect mothers and children against micronutrient deficiencies


PROMISE RENEWED’

36

Strategic Objective C4D Approach

Activities Participant Group Time frame

Communication Materials

Responsible Agency

2014

2015

NATIONAL LEVEL

Launch a national sensitization and advocacy campaign for maternal and newborn health to ensure high level commitment by government, political and religious leaders.

Advocacy

1.1. National launch ceremony to introduce and sensitize decision makers and policy makers at national level on APR

Parliamentarians, GoU officials, key stakeholders, development partners, national other opinion leaders

Do

ne

201

3

Speeches/Talking points Advocacy package - 1 File folder, - Brochure - Media kit: FAQs, stories/ articles written by UNICEF

UNICEF/MOH

1.2. Orientation session with parliamentarians on integrated maternal and child survival package

Parliamentarians

Talking points Media Kits: FAQs Feature stories Speeches

1.3. Orientation session with faith based leaders on integrated maternal and child survival package; Specific focus on skilled birth attendance

Religious leaders from all faiths

Presentations Briefing Kits. FAQs

1.4. Orientation sessions with National traditional herbalist and healers association; their role in support of RMNCH

Traditional healers and herbalists

Presentations Briefing Kits. FAQs

1.5. Media engagement and regular interaction - Partner with

Daily monitor; other print media;

Invitations in advocacy, social mobilization


PROMISE RENEWED’

37




Responsible Agency

national daily newspaper, national radio to cover nutrition and EPI

Medical Review NTV-TV/radio

events; Q&A’s; interviews;

1.7. Private sector engagement with Private not for profit (PNFP) organizations implementing RMNCH.

Private not for profit (PNFP)

Draft MoA, Briefing materials (flyer/brochure)

1.8. Advocacy meetings with corporate groups for sharing corporate social responsibility as part of public-private partnership

Corporate groups: petroleum companies;

Draft MoA, Briefing materials (flyer/brochure), backdrop, banners Q&A’s RMNCH

1.9. Negotiation meetings with mobile telephone corporation managers. Partnership with mobile telecom companies in RMNCH program for rapid info dissemination during the FHDs/CHDs and rapid monitoring.

CSR Telecommunications

Company

Invitation letter Memo of agreement with mobile phone company

1.9. Develop and implement a health workers motivation strategy; Design incentive package, integrated quality assurance elements, client/mothers satisfaction surveys to rate facilities

UNEPI, WHO,UNICEF & technical partners

MOH

Incentive package, leader boards, brochure

District Level

Advocacy Develop integrated communication micro plans for APR focused districts Update existing micro pans for Polio, FHDs/ CHDS to develop integrated micro for the RMNCH

Template


PROMISE RENEWED’

38




Responsible Agency

Include RMNCH in the agenda of all regular monthly meetings to be held at district level (e.g. DHMTs, Health Unit Management Committees meeting, Health Sector Working groups)

Letter from DG; DHOs on prioritization of RMNCH.

Orientation with DHMTs on health workers motivation strategy package and indicators for tracking progress.

Presentation

District Level Mobilize and sensitize communities, particularly at sub county level, on maternal and newborn health.

Social Mobilization

Revitalization of HUMCs to link services with communities; community sessions, defaulter tracking etc.

DHMTs, Health facility in charges

Posters

Cascading National Coalition on RMNCH to sub national level and development of a work plan for the alliance in focused districts Representation from religious leaders, CSOs/NGOs health professionals, media, school teachers

Religious leaders, NGOs/CSOs, teachers, health professionals public/private, media/cable operators

Infor Kit; rationale, FAQs, actions to be taken by each group

DHMT/NGO partner

Quarterly review of the alliances to update on the work plan In line with the work plan alliance members to hold meetings in their respective sectors

Religious leaders, NGOs/CSOs, teachers, health professionals public/private, media/cable

Presentations,

Mobilize schools and use NGO/UJL, DHMT, Flyers, Banners


PROMISE RENEWED’

39




Responsible Agency

school children and sports based activities for social mobilization to communicate with mothers and caregivers on important RMNCH issues

Teachers

Use of mobile technology (e.g. mtrac) for reaching mothers and fathers with a full package of RMNCH messages. Including development of voice content and delivery mechanism

Mothers, fathers, Short messages

Establishment of community radio listeners’ groups by VHTs: to mobilize the communities, listen and participate in radio discussion programmes on immunization.

Mothers, fathers, faith based leaders

Script for Radio program

Household/Community

Review, develop and disseminate health promotion materials on birth preparedness, danger signs, emergency preparedness including emergency transportation

Behavior Change Communication (BCC)/ Community engagement

Review and revise materials on RMNCH to prepare new interactive materials; pictoral cards, videos, SMS messaging on birth preparedness, danger signs, emergency preparedness,

MOH,UNICEF, UNFPA,WHO,USAID/MCHIP

Presentations, Communication material for review

Developing and airing radio messages on key RMNCH practices with specific focus on ANC/PNC and skilled birth attendance

MOH,UNICEF, UNFPA,WHO,USAID/MCHIP

Radio script

Public announcements and messages on mass media and endorsement by good will

Mothers, father, caretakers

Script


PROMISE RENEWED’

40




Responsible Agency

and communication system at the community level.

ambassadress

One day refresher training on IPC. Community dialogue and social mobilization for RMNCH for frontline workers at district and community level

VHTs,LC1s, Scouts, vaccinators NGO/CBOs,

Training Manual

One day training for peer to peer education mothers trained on advising mothers and pregnant women on key RMNCH practices

Mothers Training Manual

Mobilization for community mapping to identify, include and support underserved poor families and disadvantaged pregnant women, lactating mothers, un-immunized/ defaulting children

Community, families, health facility staff

Mapping Template

Register families/caregivers with U5 children and pregnant mothers and use SMS/ other mobile telephony solutions to remind mothers of RI+ , antenatal schedule and to give educational tips messages on NBC, RI/PCV, EBF, WASH, IYCF.

Families/ husbands/ mothers/ caregivers With mobile phones

2013-2015

Prepared messaging for transmission as scheduled (long term) TBD


PROMISE RENEWED’

41




Responsible Agency

Group and individual counselling sessions with mothers, fathers and other care givers by VHTs/LC1s, Scouts to motivate mothers, caregivers on RMNCH, reinforcing mass media messages and addressing queries

Mothers, caregivers VHT manual Integrated flip chart One page leaflet on key RMNCH Scripts and lyrics for folk song for community meetings,

Completion of Birth preparedness plan for each pregnant mother; Delivery date, ANC visits, transportation, cash, name of health worker etc. (Health facility midwives with family support groups)

Mothers, husbands, family, community

Birth plan

Mobilization through churches and mosques; Sunday and Friday sermons

Community Families

Brochure for Imam Masjid

Enhancing health literacy and care seeking among mothers through SMS. Provision of relevant health information to pregnant women and new mothers using personalized text or voice messages

Mothers, pregnant women

Script


PROMISE RENEWED’

42

Annex 1: Stages of Behavir change

The Stages of Behavior Change theory explains the various steps an individual or stakeholder group goes in order to change behavior. Individuals and organizations start at different steps and they may not go through each of step of the process or in the same order or at the same speed. They can leap up or move down several steps at a time. Once they have moved up there is no guarantee that they will not move back. Hence, sustained effort is needed to keep y target audiences on an upward path. Different strategies will help stakeholders move up the ladder; knowledge through media, friends, trusted cultural and religious leaders etc. Therefore it is extremely important to know what stage the majority of a particular target groups is at in order to employ the right strategy. For example if majority of mother lack knowledge on key RMNCH practices the first important strategy to reach this group may be mass media for fast dissemination of information. However, as people move up the ladder they may have more questions regarding the new behavior and in this case more interpersonal strategies will be effective.


PROMISE RENEWED’

43

The social ecological models explain the link between the individual behavior and the enabling environment. In the past development approaches focused on individual behavior change. But since then we have learnt that individuals often do not or cannot change behavior without support from the environment around them; Parents, spouses, peers, friends, community and religious leaders etc. Factors like such as family pressure, community norms, and the larger policy and legal environment can affect the health related behaviors an individual engages in. Thus and individuals behavioral choices should be seen in the larger context of his and her environment. Hence, interventions are needed at different levels of the environment to facilitate behavior change.

Annex 2: Social ecological model


PROMISE RENEWED’

44

Annex 5: Matrix for assessing Demand side barriers (adapted14)

14

Documents

Final APR communicaiton strategy master copy (002)