MALARIA COMMUNICATION STRATEGY - The Compass · giving feedbacks that enriched the final product. A complete list of members of these Technical Working groups is found in annex 1

2010-2014

MALARIA COMMUNICATION STRATEGY

MINISTRY OF PUBLIC HEALTH AND SANITATION

Division of Malaria Control

AchievingProgress and ImpactonMALARIA

Allow your house to be sprayed with long acting

insecticide for malaria control

Allow your house to be sprayed with long acting

insecticide for malaria control

As a pregnant woman visit the

health facility immediately you realize you are expectant to

receive malaria preventive measures

As a pregnant woman visit the

health facility immediately you realize you are expectant to

receive malaria preventive measures

Ensure every member of your

household sleeps under a

insecticide treated net, every night

whatever the season, to

prevent malaria

Ensure every member of your

household sleeps under a

insecticide treated net, every night

whatever the season, to

prevent malaria

When your loved ones develop fever, visit the nearest health

facility fora malaria test.

If malaria is confirmed, seek

the recommended medicine, ACT

(Artemisinin Combination

Therapy)

When your loved ones develop fever, visit the nearest health

facility fora malaria test.

If malaria is confirmed, seek

the recommended medicine, ACT

(Artemisinin Combination

Therapy)

Division of Malaria Control . Malaria Communication Strategy 2010 - 2014 i

Any part of this document may be freely reviewed, quoted, reproduced or translatedin full or in part, provided the source is acknowledged. It may not be sold or used in

conjunction with commercial purposes or for profit.

Malaria Communication Strategy

2010-2014

Division of Malaria Control . Malaria Communication Strategy2010 - 2014ii

Table of contents ii

List of figures & tables iii

Foreword iv

Acknowledgements v

Abbreviations vi

Executive Summary vii

CHAPTER 1

General background and Programme Context 1

CHAPTER 2

Communication Needs assessment 4

Assessment of the current situation 4

Key challenges and implications on the communication strategy 8

CHAPTER 3

The Communication Strategy 11

Strategic Approach 11

Goal of strategy and anticipated outcomes 11

Key Audiences 13

Key Message Themes 14-18

Communication Channels, Tools and Tactics 18

Summary of key messages, communication tools and methods 18

for priority audience groups

Communication support for the launch and implementation 27

of Affordable Medicines for Malaria

Summary of key messages specific to the ACT-m Medicines 31

CHAPTER 4

Implementation Framework 32

Implementation Plan 2010-2014 35

CHAPTER 5

Continuing Research, Strategy Monitoring and Evaluation 36

Continuing Communication/BCC Research 36

Strategy Monitoring and Evaluation 36

ACSM Activity Process and Outcome Indicators 37-38

Annex 1

Members of the ACSM Technical Working Group 39

Annex 2

Current List of Contributors 40

Table of Contents

Division of Malaria Control . Malaria Communication Strategy 2010 - 2014 iii

Figure 1: 2009 Kenya Malaria Risk Map

Figure 2: Uptake Of Malaria Control Interventions

Table 1: Strategic Approach

Table 2: Key Elements of the Model

Theme 1: Malaria prevention and vector control

Table 3 (A): Message theme: Acquisition/ownership and proper and consistent use of

LLINs to prevent malaria infection

Table 4 (B): Message theme: Increased uptake of IPT in pregnancy in endemic zones,

and treatment for malaria in pregnancy

Table 5 (C): Message theme: Encourage acceptance of IRS as preventive strategy

Theme 2: Malaria case management and treatment

Table 6: Message theme: Improve treatment-seeking and appropriate medicine use

Table 7: Target Audience

Table 8: Summary of key messages specific to the ACT-m Medicines

Table 9: Implementation Plan 2010-2014

Table 10: ACSM Activity Process and Outcome Indicators

Table 11: ANNEX 2: List of contributors

1

36

12

12

14

15

16

17-18

26-27

31

35

37-38

40

List of Figures

List of Tables

Division of Malaria Control . Malaria Communication Strategy2010 - 2014iv

This National Malaria Communication Strategy

document (2010 - 2014), which is in alignment

with the Kenya National Malaria Strategy 2009

– 2017 gives strategic directions to guide the

development, implementation and monitoring of the

communication and behaviour change component

of malaria prevention and control.

It provides a planning framework aimed at defining

communication and behaviour change objectives,

the key target groups, messages, channels and

communication interventions at different levels.

It revolves around raising awareness about malaria,

addressing the key determinants in behaviour for

prevention and control interventions with the ultimate

goal of a long-term normative shift in malaria related

behaviours among the key target groups national

wide.

This strategy will be the guiding document for all

partners to implement a unified and cohesive

behaviour change and communication plan and

allow for complementing programmes among

partners

The main malaria control behaviours that need

to be adopted and maintained by individuals,

families and communities include among others

Early diagnosis and effective treatment, Intermittent

Preventive Treatment(IPTp) of pregnant women with

SP and malaria prevention with special emphasis on

consistent use of Long Lasting Insecticidal Nets and

Indoor Residual Spraying(IRS).Particular attention

has been paid to enhance the understanding and

awareness of the benefits of malaria prevention

and treatment and address barriers to community

level actions as enumerated in the National Malaria

Strategy.

Much appreciation goes to all stakeholders who

contributed technically and financially to the

development of this document.

I hope this strategy will raise the profile of malaria

control interventions at all levels and promote the

partnership approach desired

Dr. S. K. Sharif MBS, MBChB, M. Med. DLSHTM. MSc

Director, Ministry of Public Health and Sanitation.

Foreword

Division of Malaria Control . Malaria Communication Strategy 2010 - 2014 v

The Ministry of Public Health and Sanitation is

indebted to many individuals and organizations

without whose support and collaboration the

development of this Malaria Communication

Strategy for Kenya would not have been possible.

We are grateful to Clinton Health Access Initiative

for the financial assistance in the development of

this document.

We greatly appreciate the contributions of the

various malaria Technical Working Groups and

partners who participated in the discussions and for

giving feedbacks that enriched the final product.

A complete list of members of these Technical

Working groups is found in annex 1.

The development of this strategy could not

have been successfully completed without

encouragement and technical support from Dr.

Elizabeth Juma, Head of Division of Malaria Control,

Dr. Willis Akhwale, Head of Disease Prevention and

Control and Dr. S. K. Sharif, the Director of Public

Health and Sanitation.

Finally, we would like to thank in advance all those

organizations and individuals who will work with

the National Malaria Control Programme to realise

the vision of malaria- free Kenya.

Dr. Willis S. Akhwale, MBS

Head, Department of Disease Prevention and Control

Ministry of Public Health and Sanitation.

Acknowledgement

Division of Malaria Control . Malaria Communication Strategy2010 - 2014vi

ACSM Advocacy, Communication and Social Mobilization

ACTs Artemisinin-based Combination Therapy

AMFm Affordable Medicines Facility – malaria

ANC Antenatal Care

AIDS Acquired Immune Deficiency Syndrome

CBOs Community-based Organizations

CHW Community Health Worker

DHMTs District Health Management Teams

DOMC Division of Malaria Control

HIV Human Immune-deficiency Virus

IEC Information, Education and Communication

IPT Intermittent Preventive Treatment

IRS Indoor Residual Spraying

ITNs Insecticide-treated Nets

KNBS Kenya National Bureau of Statistics

KDHS Kenya Demographic and Health Survey

LLINs Long-lasting Insecticidal Nets

MIS Malaria Indicator Survey

NHSSP National Health Sector Strategic Plan

NMS National Malaria Strategy

SP Sulphadoxine-pyrimethamine

TB Tuberculosis

USAID United States Agency for International Development

VCT Voluntary Counselling and Testing

Abbreviations

Division of Malaria Control . Malaria Communication Strategy 2010 - 2014 vii

Executive Summary

The government of Kenya has, over the years, made

malaria control and management a high priority

recognizing it as the primary cause of ill-health

responsible for 30% of all out-patient attendance

and 19% of admissions besides still being the leading

cause of death of children under five. The DOMC has

since its establishment implemented malaria control

interventions as outlined in its operational documents,

including the National Malaria Strategy (NMS) and

the National Malaria Policy. These interventions

include case management; management of

malaria and anaemia during pregnancy; vector

control; and epidemic preparedness and control.

The current national malaria strategy (2009-2017)

has carried on the emphasis on these interventions,

and set targets to be achieved under each in the

8-year period.

To build on its past achievements and meet the

specific goals under the current National Malaria

Strategy, and in line with the recommendations

of the 2009 Programme Performance Review,

the DOMC needs a well-planned and locally

appropriate communication strategy that would

respond well to current priorities. The new strategy

is more integrated and encompasses Advocacy

Communication and Social Mobilization (ACSM)

to bring about sustainable social and individual

behaviour change. It acknowledges challenges in

the areas of prevention and vector control; malaria

in pregnancy and case management and proposes

strategies for effective communication with relevant

stakeholders.

The communication strategy is aligned to the

objectives of the National Malaria Strategy 2009-

2017, specifically Objective 5: By 2014, strengthen

advocacy, communication and social mobilization

capacities for malaria control, to ensure that at

least 80 per cent of people in malaria areas have

knowledge on prevention and treatment of malaria.

This strategy supports the achievement of this

objective through the following approaches:

• Communication, to build on current high

levels of knowledge about malaria prevention;

create awareness about appropriate case

management and health care seeking

behaviour, while addressing barriers to change in

attitudes and practices identified in the situation

analysis. The strategy defines the approaches

that will be used to reach the targeted audience

for maximum benefit and participation in malaria

prevention, treatment and control.

• Advocacy, to secure leadership and commitment

of stakeholders at all levels, and to strengthen

the multi-sectoral response to malaria control

• Social mobilization, to ensure local communities

participation in malaria control initiatives and

continued public education;

• Communication to support the launch and

implementation of the Affordable Medicines

Facility – malaria (AMFm) facility

Division of Malaria Control . Malaria Communication Strategy2010 - 2014viii

The strategy employs the ACSM model that links


to bring about and sustain desired outcomes in the

individual and community. It is anticipated that the

effective implementation of the strategy will lead to:

• Increased demand and use of LLINs

• Improved uptake of IPT in pregnancy

• Increased numbers of people seeking prompt,

appropriate treatment with the right medicines

within 24 hours of onset of malaria symptoms

• Improved adherence to prescribed treatment

by clients

• Increased acceptance of Indoor Residual

Spraying in communities

• Increased involvement of local communities in

malaria control

The strategy carefully delineates the various primary

and secondary stakeholders, their information needs

and recommends the messages and communication

channels tools and tactics that should be used to

reach them and ensure positive behaviour change

that will eventually lead to the realization of the

objectives. It provides an implementation framework

at national, regional and local levels and looks at

the aspects of capacity building for ACSM and the

coordination roles of DOMC and partners. It finally

makes recommendations for the integration of the

proposed activities into other health programmes to

increase their impact.

The process of the development of the

communication strategy involved consultations with

key stakeholders in the private and public sectors as

well as development partners. It took cognizance of

the changes in the malaria control programme in

Kenya such as the change in the treatment policy as

well as the introduction of the Affordable Medicines

Facility – malaria (AMFm); the impact of HIV/AIDS in

the fight against malaria; new knowledge and best

practices in health communication; and changes

in the Kenya communication context over the last

decade or so.

Division of Malaria Control . Malaria Communication Strategy 2010 - 2014 1

Malaria is one of the most serious public health

problems in Kenya, affecting millions of people every

year. Despite considerable efforts to control and treat

the disease, the most recent Kenya Demographic

and Health Survey (KDHS) (KNBS 2010)1 estimates

that about 24 million Kenyans are at risk of infection

each year, with the most affected being pregnant

women and children. Malaria is reported as the

primary cause of ill-health accounting for 30% of

all outpatient attendance and 19% of admissions

(DOMC, 2007) , and is still a leading cause of death

in children under five. The Division of Malaria Control

(DOMC)2 estimates that 29% of the Kenya population

lives in malaria endemic zones, with millions more

exposed to the seasonal transmission of the disease.

Malaria in pregnant women contributes significantly

to negative outcomes for the mother and baby,

including anaemia, low birth weight and infant

deaths, and it is one of the most common causes

of spontaneous abortion. In addition, the ill health

associated with the disease exacts a devastating toll

on social and economic productivity, undermining

local development in some communities.

Over the years, the government, through the

Ministry of Health, has made malaria control and

management a high priority. This commitment

has been articulated in several government

documents and plans, including the National

Health Sector Strategic Plan (NHSSP) I and II, and

Vision 2030. The DOMC has since its establishment

implemented malaria control interventions as

outlined in its operational documents, including

the National Malaria Strategy (NMS) and the

National Malaria Policy. These interventions include

case management; management of malaria and

anaemia during pregnancy; vector control; and

epidemic preparedness and control. The current

national malaria strategy (2009-2017) has carried on

the emphasis on these interventions, and set targets

to be achieved under each in the 8-year period.

The communication challenge

Kenya has made significant gains in fighting malaria

in the last few years, under the leadership of the

DOMC with the support of the different stakeholders

and partners. In April 2001, the DOMC developed a

5-year Information, Education and Communication

(IEC) implementation plan to support the NMS. The

plan focused on broad IEC approaches in support

of the four NMS strategic approaches at the time.

To support its implementation, a communication

strategy was developed to provide a broad

framework to guide communication efforts for

General Background And Programme1

1. KNBS and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-2009. Calverton, Maryland2. Division of Malaria Control. 2007. Kenya Malaria Indicator Survey. Nairobi3. DOMC (2006). Malaria Communication Strategy. Ministry of Health

Figure 1: 2009 Kenya Malaria Risk Map

Division of Malaria Control . Malaria Communication Strategy2010 - 20142

malaria control and support the implementation of

IEC activities. However, anecdotal reports indicate

that this strategy was not rolled out and implemented

as expected. Several reasons were given for this,

including lack of finances to support its dissemination

and systematic implementation.

To build on these past achievements and meet

the specific goals under the current National

Malaria Strategy, the DOMC requires a well-

planned and locally appropriate communication

strategy. The 2009 Programme Performance Review

recommended that the communication strategy be

reviewed and updated to ensure that it responds

well to current priorities. The revised/updated

strategy will aim to support the key objectives of the

malaria control programme as outlined in the 2009-

2017 national strategy.

There has also been changes in the malaria control

programme in Kenya that need to be reflected

in a new communication strategy. For instance,

since the strategy was drawn up in 2006, Kenya’s

treatment policy has changed from use of SP/

Fansidar medicines to the more effective Artemisinin-

based Combination Treatment (ACTs). To enhance

access to ACTs, the Affordable Medicines Facility –

malaria (AMFm) was launched in 2008. The revised

communication strategy needs therefore to include

activities to promote the AMFm.

There has also been a slight change of focus in the

Kenya malaria programme, from increasing use

of LLINs by the population most at risk of malaria

(pregnant women, children under five years of age

and people living with HIV/AIDS) to more emphasis on

universal coverage (one net for two persons). There

is also need to increase awareness and uptake of IPT

as part of focused antenatal care and to promote

acceptance and demand for indoor residual

spraying. The government has also recently created

the Division of Child and Adolescent Health, opening

new possibilities for an expanded programme for

malaria-free schools initiatives through its school

health activities. In addition, in keeping with recent

political developments in Kenya, the Division of

Malaria Control will be decentralising its activities to

county and district level, and this too needs to be

reflected in the new communication strategy.

HIV has also presented an additional challenge

that must be taken into consideration in the fight

against malaria. A report by UNICEF4 highlights

this challenge and cites evidence showing strong

interaction between Malaria and HIV. One of the

key findings as presented in the report is that adults

and pregnant women living with HIV in malaria areas

face a higher risk of symptomatic malaria infection

as HIV suppresses immunity. HIV infection may also

lower the efficacy of malaria treatment. The report

further argues that malaria increases the viral load

in HIV-positive people, which can be detrimental to

their overall health.

4. UNICEF. 2007. Malaria and Children – Progress in Intervention Coverage.


Changes in the Kenya communication context

since 2006 have opened up new avenues and

challenges for malaria communication, which

need to be reflected in an updated strategy. For

instance, opening up of regional radio services,

regional newspapers and increased use of cellular

phones has made it possible for programmes to

communicate with more specific audience groups.

Availability of marketing and media consumption

data and services has also made it possible to

segment audiences in more detail.

Finally, the new/revised communication strategy

needs to reflect new and current knowledge and

best practices in public health communication.

In the last ten years, there has been a steady

shift from purely IEC/product-oriented activities

to more process-driven strategic behavioural

communication approaches. These allow for a

more flexible approach for better identification of

specific target behaviours and barriers, and suggest

communication activities, key messages and support

services needed to achieve and sustain the desired

new behaviour.

In recognition of the fact that behaviour change is

sometimes dependent on the broader social context,

a more integrated strategy that encompasses


(ACSM) is now preferred, to bring about sustainable

social and individual behavioural change. A report

on the 2009 EARN (Roll Back Malaria) mission to Kenya

recommended that the DOMC communication

activities shift focus from IEC to the broader ACSM,

and to reflect the best practices in public health

communications. Advocacy primarily targets

public leaders or decision-makers; communication

generally targets individuals or sub-populations

in the public; and social mobilization aims to

secure support from the broad public and specific

communities. Used together, the interventions are

believed to produce more lasting change. This

updated communication strategy provides the

framework for this integrated approach.


Communication Needs Assessment2

Assessment of the current situation

In order to inform the development of this

communication strategy and to ensure it fully

supports the National Malaria Strategy 2009-2017, an

assessment was carried out to establish the current

situation and practices around the key areas that are

the focus of the National Malaria Strategy – prevention

and control; and effective case management.

The assessment also sought to establish the current

activities and priorities in advocacy, communication

and social mobilization around the key focus areas

and the gaps that need to be addressed through

this strategy. The assessment involved a review of

available published literature, reports and documents

from the Division of Malaria, and key informant

interviews with individuals selected with the assistance

of the Division. Following is a summary of the findings,

and a discussion of the implications of the findings on

the Communication Strategy.

Findings on prevention and vector control

The National Malaria Strategy (2009-2017) targets that

by 2013; at least 80% of people living in malaria risk

areas should be using appropriate malaria prevention

interventions including LLINs. The strategy promotes

four main approaches to malaria prevention:

• Universal coverage with long lasting insecticidal

nets (LLIN) including the malaria free schools

initiative

• Indoor residual spraying

• Providing intermittent preventive treatment (IPT)

in pregnancy; and

• Other integrated vector management strategies

The assessment found that knowledge of malaria illness

(transmission, symptoms, and complications) and

use of bed-nets as a prevention measure has been

consistently high in different parts of the country. For

instance, Njoroge FK et al (2009) found that majority

(86.9%)5 of pregnant women attending antenatal

clinics in Kilifi had adequate level of knowledge

around malaria transmission and prevention.

Opiyo P et al (20076) found that 96% of respondents

in a study conducted in Rusinga Island knew that

young children were at highest risk from severe

malaria; 76% also knew pregnant women were also

at high risk. In the same study, 95% of respondents

correctly identified common symptoms of malaria

onset. A similar proportion knew what caused malaria

(mosquito bites).

However, knowledge of malaria transmission

and acquisition is commonly not matched with

corresponding protective behaviour even in

high malaria risk zones. For example, although in

several studies bed-nets were often mentioned,

use was generally found to be modest. The Kenya

Demographic and Health Survey 2008/2009 indicates

that while 61% households in the nationwide survey

had at least one net, only 47% of children and 49% of

pregnant women who slept under a bed-net used an

ITN. Opiyo et al found that only 58% of respondents in

the Rusinga Island study used bed-nets, and only 37%

had slept under one the night before the survey.

5. Njoroge FK, Kimani VN et al. Use of insecticide treated bed nets among pregnant women in Kilifi District, Kenya. East Afr Med J. 2009 Jul; 86(7):314-22. PubMed abstract accessed online

6. Opiyo, Pamela, Richard Mukabana et al. An exploratory study of community factors relevant for participatory malaria control on Rusinga Island, Western Kenya. Malaria Journal 2007, 6:48. Open Access


Findings on low use of nets were corroborated in

interviews with stakeholders, some of whom felt that

distribution of nets has not been accompanied by

adequate instructions on how to use them:

“The challenge [with nets] comes ... with them

sleeping under these nets. They go to the clinic and

they are given nets ... when they go to the house,

they realize, hey, this net has four corners, my house

is a thatched roof and it has a really high ceiling I

can’t be able to hang it ... So you find that there are

actually issues when it comes to the usage of nets ...

My children sleep on the floor, how do I hang this net

in a way that is not going to be so cumbersome for

me?” (Key informant)

Other key informants expressed concern that in some

communities, symptoms of complicated malaria such

as convulsions and coma often are not associated

with malaria, and instead are attributed to curses

and witchcraft. Such misconceptions affect the

subsequent case management behaviour.

The National Malaria Strategy emphasizes on vector

source reduction to sustain gains made from indoor

residual spraying. However, research shows that

although most communities are aware that removal

of stagnant water helps control mosquito breeding,

this is not widely practised. The Rusinga Island study

found that although 33% of respondents knew this as

a form of controlling mosquito breeding, there was

no corresponding action. In addition, only 16% used

insecticides in the house, although there was high

level of awareness among the respondents.

One key informant revealed that there have been

challenges with Indoor Residual Spraying as a

prevention measure, because it has not been

widely accepted by the local communities: “One

[complaint] being that the chemical we use has an

irritating smell. ... The chemical also does not stop the

mosquitoes coming to the house and also does not

kill other pests like cockroaches”. Other concerns

expressed include community members’ reticence at

allowing strangers into their homes, and re-plastering

of walls in some villages, eroding the protection

offered by the spraying.

IPT in Pregnancy: Government policy directs that all

pregnant women in malaria endemic areas attending

antenatal care services should access at least two or

more doses of SP/Fansidar medicines as a preventive

measure against malaria infection. However, the

2008-20097 KDHS shows that only 14% of pregnant

women reported receiving IPT; Gikandi PW et al8, in

a community survey in four districts of Kenya, found

that only 22% of women who had attended ante-

natal clinic took two or more doses of IPT-SP. Some key

informants felt that IPT in pregnancy is undermined by

women’s tendency to start ANC visits too far into their

pregnancy, such that giving them the recommended

doses becomes a challenge. Other reasons given for

poor uptake of IPT in pregnancy include local beliefs

against discussing pregnancy in its early stages; and

poor attitude of providers to mothers who show up at

the clinics late into their pregnancy. “Sometimes [IPT]

is not seen as a priority for pregnant women; birthing

issues take precedence even with clinic staff” (Key

informant).

Findings on malaria case management

Effective case management of malaria depends

on early, accurate diagnosis with blood tests and

prompt treatment with an effective medicine. In the

7. KNBS and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-2009. Calverton, Maryland8. Gikandi PW, Noor AM, et al. Access and barriers to measures targeted to prevent malaria in pregnancy in rural

Kenya. Trop Med Int Health. 2008 Feb; 13(2):208-17. PubMed Abstract.


National Malaria Strategy 2009-2017, it is anticipated

that by 2013, 80% of all self-managed fever cases

will be receiving prompt and effective treatment,

and that all cases seeking services at health facilities

will receive appropriate diagnosis and effective

treatment. However, the findings of this assessment

indicate that given the current situation, a lot of effort

will need to be made to achieve this objective.

Access to Treatment

Kenya changed the treatment policy to the more

efficacious ACTs in 2006. Although the medicines

have been available since then, the recent KDHS

showed that only 8% of children who got treatment

for malaria received ACT medicines, and only 4%

of these obtained it on same day or next day.

Programme documents from the DOMC also show

that access to ACTs has remained low, at 29%, and

only in 15% of the cases is the treatment sought within

24 hours.

It is evident from studies conducted in various parts

of the country that many Kenyans choose to treat

malaria infection first at home without going to a

health facility, only visiting the health care centre

when the illness becomes severe. A review of

literature by Chuma Jane, Timothy Abuya et al (2009 9) found that in general, most people self-treated

first, and then either sought help from formal health

facilities or traditional healers, or used a traditional

remedy at home. It appears that most people seek

treatment from the health facility on average two

days after the onset of symptoms; Nyamongo (200210)

found that patients in Kisii delayed seeking treatment

from health facility to minimise expenditures incurred

as a result of the sickness. Even in cases of children,

seeking treatment from the health facility is delayed –

a 200111 study in Bungoma found that 47% of children

under 5 years with fever were treated at home and

only received the treatment on the second day after

the onset of the symptoms. According to the DOMC

documents, there have been improvements in the

proportion of children with fever seeking treatment

from health facilities, but few seek treatment within

24 hours.

Sumba Peter et al, (200812 ) did find that adults in

a study in Nandi District were more likely to seek

treatment within a day (24hrs) of onset of malaria

symptoms for themselves than for their children. In

this particular study, the most common source of

first treatment for self-diagnosed malaria in both

children and adults was the health facility. This differs

from findings from trends in other regions, where high

tendency to treat malaria at home first with either

over-the-counter medicines or medicines left over

from a previous malaria episode has been observed.

Diagnosis

Monitoring Outpatient Malaria Case Management

under the 2010 Diagnostic and Treatment Policy

in Kenya January 2010 report revealed that 23% of

patients were tested for malaria prior to treatment

across all facilities. In facilities with diagnostics, 42.5%

of patients were tested. Th low testing rate is further

compounded by the none adherence of health

workers to test results in that 52% of test negatives

receive AL and 635 of all patients who were not

tested also got AL as per the same quality of care

survey January 2010. Regarding laboratory testing to

confirm malaria, some key informants felt that it was

not popular and confirmatory diagnosis Is therefore

not often requested for because people tended to

think they can tell when they have malaria, especially

in malaria-endemic areas. This is worsened by health

workers who do not, in a majority of cases, insist on

9. Jane Chuma, Timothy Abuya et al. Reviewing the Literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets. Malaria Journal 2009, 8:243. Open Access

10. Nyamongo IK. Health care switching behaviour of malaria patients in a Kenyan rural community. Institute of African Studies, University of Nairobi. PubMed abstract accessed online

11. Hamel, Mary J, Amos Odhacha et al. 2001. Malaria Control in Bungoma District: A survey of home treatment of children with fever, bed-net use and attendance at antenatal clinics. Bulletin of the World Health Organization No. 17

12. Peter O Sumba, S Lindsey Wong et al. Malaria treatment seeking behaviour and recovery from Malaria in a highland area of Kenya. Malaria Journal 2008, 7:245. Open Access


tests: “Health workers are themselves not all that

convinced of the need for [laboratory testing] so

will tend to diagnose based on the presentation of

symptoms.” (Key informant)

Types of medicines used in treatment

Kenya introduced the more effective artemisinin-

based combination therapy (ACT) in 2006 as part

of its malaria treatment package, replacing SP

medicines as first line of treatment medicines. The

current malaria strategy promotes increased access

to ACTs through the AMFm facility. However, although

the medicines have been available since then, the

recent KDHS showed that only 8% of children who

got treatment for malaria received ACT medicines,

and only 4% of these obtained it on same day or next

day. The Malaria Indicator Survey 2010 showed that

of all antimalarials prescribed, amodiaquine was

highest at 35.2%, ACT followed at 28.7, SP was at 11.2

and other antimalarials at 13.8%. Chloroquine and

Quinine were also used to manage uncomplicated

malaria at 7.5% and 3.6% respectively. Programme

documents from the DOMC also show that access

to ACTs has remained low, at 29%, and only in 15%

of the cases is the treatment sought within 24 hours.

Although the GoK provides ACTs in public facilities

for free, Chuma et al cite a study that showed that

they are not given to clients, even when in stock,

for a variety of reasons, including fear of stock-outs

and providers’ own biases regarding which patients

deserved to get it due to its perceived cost.

Other findings regarding ACTs include the following:

• Stock-outs means that the medicines are

sometimes in short supply, which can undermines

access to it in health centres.

• The government has mainly concentrated

training, support supervision and advocacy

efforts on the public and mission sector leaving

out private practitioners who as per the malaria

indicator survey 2010 constitute a third of

treatment seeking options vis a vis the public

sector which constitutes 59%.Chemists and other

medicine vendors continue to prescribe malaria

medication even though they are not trained to

do so, posing a risk to correct use and adherence

to medicines.

In addition, ACTs have been perceived as generally

expensive for the health sector: “Current prices for

the medicines in private facilities is prohibitive and

affects their uptake; in some cases, the medicines cost

over Ksh 600 per dose which is unaffordable to most

people” (key informant). According to Dr Desmond

Chavasse of Population Service International, the

high cost of the medicines could threaten the fight

against malaria13. However, it is expected that the

AMFm facility will make the medicines available to

more Kenyans who seek treatment in private health

facilities and pharmacies, where they will now be

available at a much reduced cost.

Adherence to malaria treatment

Improper use of treatment medicines has direct

impact on their effectiveness, and could lead to

future resistance. Unfortunately, it appears that

malaria treatment generally has high levels of

non-adherence – clients do not take medicines as

prescribed and inappropriate use is widespread,

regardless of where the treatment was obtained.

Chuma et al found in their literature review that only

12% of clients reported proper use in home treatment;

only 2% of children in Kilifi given chloroquine bought

from shops got the adequate dose. More often than

not, adherence instructions are not followed; 40%

13. http://www.capitalfm.co.ke/news/Kenyanews/WHO-sounds-fresh-malaria-alarm-6363.html


of caretakers taking children for malaria treatment

at a health facility in one of the studies reviewed by

Chuma et al could not recall the correct dosage

instructions moments after leaving the pharmacy.

In relation to ACTs, it was found that some clients

continued to prefer the older SP medicines

because of their ‘perceived’ simple dosage (ACTs

were considered cumbersome). Key informants

interviewed also gave this as a reason for poor

adherence:

“Once they are given this medicine [AL], the

adherence to the three day dosage, when you

are given the regime of how you are supposed to

take the medication, you find that some of these

rural women get challenged in terms of if they are

supposed to wake up at night and give their child

medicine. Because there is the 8 hours, then 12

hours, the morning and evening and so it becomes a

challenge. (Key Informant)

Key challenges and implications on the

communication strategy

In summary, the results of the assessment show the

following behaviours are still persisting, which will

have to be addressed through the communication

strategy:

Prevention and vector control:

• Despite high knowledge of malaria (transmission,

symptoms, complications), low use of the

insecticide-treated bed-nets persists. Lots of

people, including less than half of young children

and pregnant women in malaria zones are still

not using nets correctly and consistently. The

communication activity will build on the existing

high awareness levels to help communities move

to practising protective behaviours–consistent

and appropriate use of LLINs.

• Environmental management–the communication

strategy will address the lingering challenges

of draining stagnant water to reduce mosquito

breeding grounds, and also dispel the

misconceptions around clearing of bushes.

• Indoor residual spraying - there were expressed

concerns that some communities have not fully

understood the protective benefits of IRS, and

there are concerns about some of the products

used for spraying. The communication strategy

will address these, and promote acceptance of

IRS in the areas where it is being offered.

Malaria in pregnancy*:

• The assessment results show poor uptake

of IPT in pregnancy, attributed to general

poor attendance for antenatal services, and

the tendency to present for ANC late in the

pregnancy. The communication strategy will

address this with messages specifically targeting

mothers and community in areas where IPTp is

recommended, and promote early initiation of

antenatal care, and making at least four visits

during the pregnancy. The strategy will also

address fears around taking malaria medicines

while pregnant.

Case Management

Recognition of malaria symptoms and delay in seeking

treatment is still a concern. The communication

strategy will seek to increase correct symptoms

recognition, and encourage early initiation of

diagnosis and treatment, as well as acceptance and

demand of laboratory diagnosis.

*Only Applicable in Western, Nyanza and Coast Provinces


• Health workers should practice diagnosis based

treatment hence there is need to increase testing

rate and adherence to test results so that only

test positives are treated and the negatives

investigated further for other illnesses.

• Private practitioners (30%) and shops (12%) still

constitute a large proportion of treatment seeking

options ( MIS 2007) Current treatment seeking

behaviour in communities is heavily tilted towards

home-treatment, including for children. The

communication strategy will address the need to

visit a health facility to receive a correct diagnosis

through laboratory testing, and to receive the

approved treatment.

• The communication strategy will also address

medicine adherence – promote correct use of

medicines, discourage discontinuation before

the dose is complete.

• ACTs – the assessment showed that there is

need to increase awareness of ACTs in local

communities, and among service providers, and

to address concerns about their effectiveness,

affordability, and access.

The communication strategy will also need to

address service provider concerns and increase

their awareness that ACTs are the recommend

first-line treatment medicines for proven malaria,

and not any other medicines. The perception that

ACTs have ‘complex’ dosage instructions will also

need to be addressed so clients understand how

to use them easily. The strategy will also support the

public education activities around ACTm-branded

medicines, and will include advocacy messages/

activities to ensure sustainable supply of the right

medicines in the healthcare system.

Other factors identified through the assessment

that need to be considered in the design of the

communication strategy include the following:

• Length of communication campaigns - there has

been lack of continuous/sustained messaging

about malaria in the past; longest campaign lasts

3 -6 months, not long enough to produce lasting

change in attitudes and behaviour.

• Using local terminologies for fever and malaria

is important, and taking into consideration low

literacy levels in some communities. A study in


Tanzania14 concluded that the lack of a local term

for IPT had probably led to the low awareness of it

among women who had received ANC services.

• Direct communication with community members

will be needed, to influence treatment-seeking

behaviour, and clarify the need for lab testing.

Some patients were reported to confuse tests

for HIV and malaria because they both require

drawing blood.

• Focusing on men through messages specific to

them is important because they have influence

on their families’ decisions around malaria.

• Disseminating the Ministry of Health’s policy

treatment guidelines to all health workers – health

workers will need to access and understand the

current treatment guidelines and how to apply

them.

• It may be necessary to use community medicine

vendors as a special channel of communication

and information dissemination relating to malaria

case management.

Other findings that have implications on the

communication strategy

Advocacy

The assessment also highlighted the following issues

that the DOMC needs to address through sustained

advocacy and communication:

1. Continued support for universal distribution

as part of the public health programmes: It is

important that the DOMC secures commitment

and resources so that universal distribution of LLINs

is not disrupted, and can be sustained through

government’s own funding.

2. Improved distribution of LLINs through integration

into all health and social services including

maternal and child health services; school

system; community networks and all public health

campaigns. The DOMC needs to secure and

increase resources for public health education

through leveraging resources and skills available

in partner agencies and other government

departments.

3. The availability of Indoor Residual Spraying

– DOMC needs to secure more resources to

expand it beyond the current coverage and

to increase community acceptance, sensitize

leaders in IRS regions and use them to educate

their communities.

4. ACTs – continued advocacy is needed to sensitize

policy makers and leaders on the need to further

reduce costs of the medicines, and to allow rapid

diagnosis kits into the hands of the community-

based health workers, to increase access to

proper diagnosis.

Stakeholders currently implementing malaria

activities in Kenya

The Division of Malaria currently coordinates a wide

network of partners involved in malaria control and

management activities through the various working

groups. These networks are part of the existing systems

and infrastructure that the Division can leverage in

implementing the communication strategy for better

results.

14. Mushi, Adiel, Joanna Schellenberg et al. 2008. Development of a BCC strategy for a vaccination-linked malaria control tool in southern Tanzania. Malaria Journal 2008, 7:19. Open Access


The Communication Strategy3

Vision A malaria free Kenya

Purpose

This communication strategy is aligned to the

objectives of the National Malaria Strategy 2009-

2017 and supports their achievement through the

following approaches:

• Communication, to build on current high levels

of knowledge about malaria prevention; create

awareness about appropriate case management

and health care seeking behaviour, while

addressing barriers to change in attitudes and

practices identified in the situation analysis. The

strategy defines the approaches that will be used

to reach the targeted audience for maximum

benefit and participation in malaria prevention,

treatment and control.

• Advocacy, to secure leadership and commitment

of stakeholders at all levels, and to strengthen the

multi-sectoral response to malaria control.

• Social mobilization, to ensure local communities

participation in malaria control initiatives and

continued public education;

• Communication to support the launch and

implementation of the Affordable Affordable

Medicines Facility – malaria (AMFm)

Goal and anticipated outcomes

This strategy supports the achievement of the

objectives of the National Malaria Strategy by

ensuring that by 2013 at least 80% of people in

malaria-prone areas will have adequate knowledge,

right attitude and behaviour on prevention and

management of malaria.

Anticipated outcomes

• Increased demand and use of LLINs

• Improved uptake of IPT in pregnancy in malaria

endemic zones

• Increased numbers of people seeking prompt,

appropriate treatment with the right medicines

within 24 hours of onset of malaria symptoms

• Improved adherence to prescribed treatment by

clients

• Increased acceptance of Indoor Residual

Spraying in communities

• Increased involvement of local communities in

malaria control

Strategic Approach

The ACSM model evolved from development

programmes, where it has been used for social

transformation. The three components – advocacy,

communication and social mobilization - link to

bring about and sustain desired new outcomes

in individuals and the community, and can be

perceived as follows:


Advocacy

• Government and partners make malaria control high priority• Government and partners ensuer adequate and consistent supply of resources

for malaria control and treatment• Government develops policies supportive of stronger malaria prevention,

control and treatment activities.

Communication• Communication learn about malaria prevention, symptoms, risks, and correct

management, and adopt appropriate behaviour• People with malaria-like symptoms seek prompt and appropriate care

Social mobilization

• Communication work with the government and partners to adopt measures to eliminate malaria infections

• Communications take responsibilty to ensure appropriate malaria prevention and treatment in their location

Belief Concept Application to malaria communication

Perceived susceptibility – one’s opinion of risk of getting a condition

• Provide key messages on prevention and control measures

Perceived severity – one’s opinion of seriousness of a condition and consequences

• Provide key messages on consequences of untreated malaria, and/or using wrong medicines

Perceived benefits – one’s opinion of the effectiveness of the recommended action to reduce risk or severity of condition

• Provide information on diagnosis and proper treatment

Perceived barriers- opinion about tangible, psychological, social costs of taking the recommended actions

• Address fears and misconceptions around adopting the recommended preventive behaviour including IPT in pregnancy

• Provide info on where to get recommended treatment, about affordability and ease of use of the recommended medicines

Cues to action – strategies to encourage action

• Provide info on preventive measures, where to get treatment, how to use treatment; how to manage environment

Self-efficacy – confidence in one’s ability to take the recommended action

• Messages that explain ease of use of medicines; demonstrate how to use LLINs correctly;

The needs assessment revealed that while

knowledge and awareness of malaria, its causes

and consequences are high among the populations

living in malaria zones, practice of the key protective

behaviours promoted by the Malaria Control

Programme is not as widespread. The choice of

communication activities and key messages in this

strategy targeting malaria prevention, control and

management are therefore informed by primarily

by the Health Belief Model, which recognises and

addresses people’s perceptions of disease threat,

and the recommended behaviour for preventing

the problem. It is helpful in understanding people’s

inaction or non-compliance to new health

behaviours, and in identifying the messages that can

persuade individuals to make healthy decisions. The

key elements of the model15 and their application to

key messages are as follows:

15. Source: Glanz, Karen, Barbara Rimmer and Sharyn Sutton. 1993. Theory at a Glance – A guide for health promotion. National Institutes of Health, Bethesda, (adapted from the ACSM Framework for TB, 2006, WHO):

Table 1: Strategic Approach

Table 2: Key Elements of the Model


Key Audiences

The following are the primary and secondary

audiences for this communication strategy.

PRIMARY AUDIENCE

1. The general population and communities living in

malaria-prone areas in the country. To encourage

widespread use of LLINs and increase the general

awareness of the malaria menace, it is important

to have communication activities that target the

general population.

2. Pregnant women living in malaria risk areas:

Pregnant women in highly endemic areas can be

asymptomatic of malaria infection and may not

recognise that they are at risk group for malaria.

3. Care givers in households with children less than

five years in malaria endemic zones. Children

under five years are the most vulnerable group

to malaria. Caregivers are critical to significantly

reducing illness and death in infected children.

Caregivers need communication to improve

symptoms recognition and the subsequent care-

seeking behaviour.

4. Heads of households in malaria areas. Particularly

targeting men as they play a critical role in their

family’s decisions around healthcare, including

providing money for travel to health care

facilities for treatment. They can also have a

positive influence on their families’ use of LLINs,

acceptance of IRS, and can influence their wives’

ANC attendance behaviour.

SECONDARY AUDIENCE

1. Health service providers - nurses, clinicians and

laboratory technicians. They are an influential

source of information to communities, and their

knowledge, attitudes and behaviours can affect

uptake of services and their role in the community.

2. Community leaders. This includes village elders,

chiefs, elders, religious leaders and politicians/

political players. They have influence on what

their communities do, and can play a significant

role in encouraging the adoption of protective

behaviours in the malaria programme. They are

also usually better skilled and educated and can

be a useful channel for delivering information to

the rest of the community.

3. Community health workers – this includes

community health workers, village health

volunteers, extension workers, and public health

technicians. As Level 1 service providers, they

are in close touch with the community and can

influence their behaviour significantly.

4. Pharmacists– they provide an important ‘first

contact’ with the community members and can

be useful channels for disseminating information

about correct case management.

5. Members of District Health Management Teams in

malaria-prone and risk districts – it important that

they understand the key issues around malaria

prevention and appropriate treatment so that

they can include promotion activities in their

work-plans


6. Policy makers in government (central and regional government) and political leaders – this will be a

target audience for advocacy messages identified in the needs analysis.

7. Local media – national and community media

8. Staff from NGOs, professional bodies and community groups working in malaria or related areas.

Key Message Themes

The following tables summarise the key message themes for each of the communication strategy’s group of

audiences. These were drawn from the knowledge and practice gaps identified in the needs assessment.

Theme 1: Malaria prevention and vector control

Table 3 (A): Message theme: Acquisition/ownership and proper and consistent use of LLINs to prevent malaria

infection

Audience group Key messages Desired behaviour outcome

Families/general population, pregnant women, caregivers and heads of households in malaria-prone areas

• Where to obtain LLINs• How to use - Hang LLINs correctly over

sleeping space• Consistent use

Audience uses LLINs consistently and correctly

Health service providers, health volunteers, community-based health workers and public health technicians

• Promote use of LLINs at every opportunity (at ANC visits, well-baby clinic visits, home visits etc)

• Give information on how/when to use LLIN, including demonstrating how to hang it correctly

• Distribute information materials available for the community on where to get LLINs

Health workers promote LLINs to all clients visiting health facility

Community leaders, and staff of organizations implementing malaria control activities in malaria-prone areas

• Promote LLINs at every opportunity (community meetings, child health days, etc) and special events

• Demonstrate use, hanging, etc.

Community leaders and staff of CBOs support and promote use of LLINs

Policy makers and political leaders, and members of DHMTs in malaria areas

• Ensure adequate supplies are available at facilities in malaria areas and in the community

• Support a coordinated and harmonized LLIN distribution strategy at national level and in the local community

Leaders support universal distribution of LLINsLeaders support and promote use of LLINs


Table 4 (B): Message theme: Increased uptake of IPT in pregnancy in endemic zones, and treatment for

malaria in pregnancy

Audience group Key messages Desired behaviour outcome

Pregnant women, and their family members in malaria-prone areas

• Attend ANC in first trimester; make at least four visits to clinic during each pregnancy and take anti-malarial medicine provided, as prescribed

• Benefits of IPT for mother and baby, and safety of the medicines provided

• Seek early treatment for malaria-like symptoms from health facility

Pregnant women accepts and seeks IPT during pregnancy

Pregnant women recognize malaria symptoms, and seek early treatment from health facility

Health service providers

• Understand current IPT in pregnancy policy, why, when, dosage

• Encourage early ANC attendance; give appointments for next visit

• Educate clients on malaria in pregnancy; role of IPT, and anticipated side-effects of the treatment

• Encourage early treatment seeking for malaria-like symptoms

• Monitor foetus and follow-up

Providers give IPT and counselling to clients as recommended in current guidelines

Policy makers and members of the DHMT in malaria prone districts

• The dangers of malaria during pregnancy • The need to enforce the national IPT in pregnancy

policy • The need to simplify IPT guidelines and disseminate

to health staff

Audience promotes IPT in pregnancy and enforces policy

Audience promotes early treatment seeking for malaria-like symptoms


• Ensure adequate supplies are available at facilities in malaria areas and in the community

• Support a coordinated and harmonized LLIN distribution strategy at national level and in the local community

Leaders support universal distribution of LLINsLeaders support and promote use of LLINs

Community leaders in malaria prone areas

• Understand the dangers of malaria in pregnancy and benefits of IPT

• Encourage mothers to attend ANC• Support local health facilities outreach activities to

promote IPT in pregnancy

Audience supports and encourages mothers in community to seek ANC early and accept IPT


Table 5 (C): Message theme: Encourage acceptance of IRS as preventive strategy

Audience group Key messages Desired behaviour

Community members and families in IRS-designated zones

• The benefits of IRS in the community• Preparing homes before spraying • Acceptance of sprayers inside home • Discourage re-plastering or covering of walls

after spraying

Accept IRS, and allow spraying of their homesAvoid re-plastering or covering


• Support IRS and discuss its benefits at health talks with community

Promote IRS in community

Policy makers and members of the DHMT in malaria prone districts

• Understand and explain the benefits of IRS • Include funding for IRS as a malaria prevention

strategy in local district plans

Promote IRS for malaria controlSecure resources for

Community leaders in malaria prone areas

• Support and facilitate spraying within their communities (planning, discussing with community, etc.)

• Encourage households to allow spraying• Discourage re-plastering or covering of sprayed

walls

Promote IRSAdvocate for IRS in communityMobilise community to

D: Message theme: Encourage appropriate environmental management and adoption of other vector-control

measures to discourage mosquito breeding

Target: All audiences

Desired new behaviour: Communities and families adopt better management of the home environment

to eliminate breeding grounds for mosquitoes; communities and families adopt alternative approaches to

eliminating mosquitoes

Key messages:

1. Drain stagnant water around the community to discourage mosquito breeding;

2. Use personal protective measures like clothing, repellents, or house-screens

3. Practice space-spraying and larviciding

4. Clearing bushes is hazardous and does not have effect on mosquito breeding


Theme 2: Malaria case management and treatment

Table 6: Message theme: Improve treatment-seeking and appropriate medicine use


Families/general population, caregivers and heads of households in malaria-prone areas

• The symptoms of malaria infection in adults and children; signs of severity and complications

• Early treatment from a health facility as soon as symptoms start; within 24 hours; avoiding home-treatment

• Laboratory testing to confirm malaria• Appropriate medicines use; recommended

medicines for malaria (ACTs) • ACTs affordability, effectiveness, and

availability from local health centre and pharmacy

Target audience recognizes malaria symptoms and danger signs;

Affected audience seeks prompt and early seeking of health care services

Affected audience knows that ACTs are the most effective treatment for uncomplicated malaria, that they are affordable and where to access them from

Affected audience adheres to prescribed dosage and regimen


• The current treatment policy on malaria • To educate clients on benefits of ACTs• To provide accurate information on medicine

use and dosage, in simple language• To discontinue dispensing outdated medicines

All service providers practice diagnosis based treatment, give the recommended treatment for confirmed malaria, and educate clients on case management

Health volunteers, community based health workers and public health technicians

• Encourage community members to seek early, prompt treatment for malaria symptoms from a health facility

• Discourageself and symptomatic management of malarial fevers without confirmed diagnosis

• Educate community on value of laboratory testing

• Understand the current treatment policy on malaria

• Educate community members on benefits of ACTs

Health workers educate community on appropriate management of malaria

Chemists and pharmacists

• Sell only the prescribed malaria medicine and not to sell non recommended medicines

• Ensure the subsidized medicines reach clients• Encourage clients to seek laboratory testing for

confirmation of malaria• Provide client with clear information on

medicine use, in simple language• Ensure uninterrupted supply and stocking of

the correct malaria medicines

Audience sells only the approved malaria medicines; ensures subsidized medicines reach clients

Audience provides information on appropriate case management to clients

Audience takes measures to ensure uninterrupted supply of correct malaria medicines


Table 6: Message theme: Improve treatment-seeking and appropriate medicine use (Continued)



• Focus of the current malaria treatment policy;• Why they should support the policy on ACTs

and to educate the public on their benefits• Need to secure financial resources to further

lower the cost of ACTs, and to provide free access for the poor

• Ensure uninterrupted supply and stocking of the correct malaria medicines

• Enforce the policy on diagnosis based treatment

Policy makers support the current treatment policy and take action to lower further the cost of ACTs

Audience takes measures to ensure uninterrupted supply of correct malaria medicines

Audience ensures that health workers are practicing diagnosis based treatment

Community leaders, and staff of organizations implementing malaria control activities in malaria-prone areas

• Encourage community members to seek early, prompt treatment for malaria symptoms from a health facility

• Educate community members on benefits of the new, improved therapy (ACTs)

Leaders promote early and appropriate treatment of malaria symptoms in community

PLWHAs in malaria areas

• Encourage early seeking of treatment for malaria-like symptoms

PLWHAs seek prompt treatment for malaria symptoms

Communication Channels, Tools and Tactics

The key messages will be delivered through the following strategies, to ensure that the primary and secondary

audiences are reached effectively in order to achieve the communication objectives. In selecting the

communication methods and tools that will be employed in this strategy, lessons and evidence from public

health promotion activities on what works best have been considered. As the results of the assessment showed,

knowledge of malaria infection, symptoms, and complications are high among the residents in malaria-prone

areas, but preventive and case management behaviour is weak. The methods employed in delivering the key

messages in this strategy on prevention, control and case management will therefore need to be delivered in

the most effective and mutually reinforcing manner possible through a multiplicity of channels known to have

significant impact on behaviour.

Information, education and communication

Information, education and communication (IEC) activities not only raise awareness and knowledge, but can

also change attitudes and move people to a new behaviour, to continue an existing positive behaviour, or

to adopt a new innovation. Experience from HIV/AIDs and TB programmes have shown that this is the case

when the IEC strategies are well-planned and execute. The Soul City programme in South Africa is one of the

best-documented health communication initiatives, and has been evaluated over time.


A 200716 evaluation showed that the programme’s

IEC approach – using print, radio, TV content - had

led to a 21% increase in condom use with a regular

partner for HIV protection; in addition, some 31% of

those who had read Soul City print materials had

taken a HIV test in the preceding year compared to

23% in a matched control group. Radio and TV drama

have also been used elsewhere to decrease stigma

and improve prevention behaviours among youth.

A report17 on an IEC activity using local radio

drama (Tsha-Tsha) from South Africa, reports that

viewers were more likely to practice HIV preventive

behaviours, (abstaining from sex, being faithful to

one partner, using a condom to prevent HIV) after

exposure to the program. In addition, those who

heard the programme were more likely to undergo

Voluntary Counselling and Testing (VCT) to determine

their HIV status. In Kenya, an IEC campaign using

radio (drama and call-in guest show) and supported

by print materials distributed in the community led

to a significant increase in young people seeking

reproductive health services from youth-serving

clinics. The campaign, the Youth Variety Show, was

broadcast over the Kenya Broadcasting Corporation

radio over several years; after only one year of

implementation, a national survey found that 56% of

young people aged 15 to 24 years had been listening

to the program (source: www.jhuccp.org/programs).

Under this communication strategy, IEC activities

will be used to improve the flow of information on

prevention to key target audiences, raise awareness

and knowledge on symptoms recognition, and to

reinforce positive behaviour in treatment-seeking,

timely initiation of treatment and completion of

treatment. Intensive community-based information

dissemination and interpersonal communication

activities will be implemented in the malaria-prone

regions in Kenya.

IEC Tools and approaches

The IEC strategy will use the following tools and

approaches. A summary of the various IEC tools and

products that will be used for each audience group is

included at the end of this chapter.

1. Mass media – local/regional radio, newspapers

and television: The DOMC and partners will use the

established media in Kenya to disseminate the key

messages targeting the primary audience as well

some of the secondary audiences. The message

format will vary, to suit the different groups, but

will include TV and radio spots, advertising,

news coverage on malaria, special programme

productions, interactive talk-shows and guest/

expert appearances in call-in programmes. With

print media, the message format will include

advertorials, features, and special coverage.

• Radio: In Kenya as in other parts of Africa, radio

is the most frequently cited source of information

for many and presents the most efficient way to

reach millions at once. An analysis of access and

exposure to the mass media in the 2008/2009

KDHS showed that radio was the most popular

medium for both men and women - 77% of

women surveyed, and 90% of the men listened to

the radio at least once a week. A 200918 study by

a US-based project, Audiencescapes, had similar

findings – 89% of adult Kenyans get news and

information from the radio at least once a week.

The study also found that majority of listeners

(97%) rated information received from the radio

as ‘Trustworthy’. The study also found that 74% of

those surveyed received information on malaria

through the radio.

16. Soul City – It’s real. Series 7 Evaluation Report. Health and Development Africa Pty (Ltd) and Soul City, Institute, 2007. Accessed online

17. Communication Impact, June 200618. Audiencescapes. 2010. African Development Research Series: Kenya. Accessed online at www.

audiencescapes.org


The DOMC will take advantage of this

established popularity and work with

selected stations to disseminate information

on malaria. The number of radio stations

has grown steadily over the last few years,

targeting different groups of audiences.

Besides stations with national coverage,

there are several regional stations,

targeting local communities and using

local content and language. For instance,

the AudienceScapes survey found that

82% of respondents from Nyanza Province

mentioned Ramogi FM as their primary

source of information and news. Through

its decentralized approach, the DOMC will

take advantage of the regional stations to

reach communities in the different malaria

zones with messages appropriate for those

zones.

• Television:

Television offers the DOMC yet another avenue

to reach its primary and some of the secondary

audiences with the key messages on malaria.

Although not as widely accessible to most

Kenyans as radio, television offers the opportunity

for creative programming targeting very specific

groups – for instance, the recent KDHS shows

that significant proportions of residents in urban

areas and those with highest levels of education

(secondary school -plus), as well as those in the

higher economic groups watch TV at least once

a week; 48.9% men and 34.1% women watch TV

at least once a week. TV will be especially helpful

in supporting national level activities, including

advocacy.

• Daily and Weekly Newspapers:

Although fewer people in Kenya receive

information and news through newspapers

compared to radio and TV, these are important

in reaching some groups of audiences, including

men as heads of households, leaders and policy

makers. The recent KDHS found that 46% of men

had regular access to a newspaper. There is a

wide variety of newspapers in the country that the

DOMC can work with to disseminate information

to special interest groups.

• Mobile cinema and Road shows:

This is a medium that has been used before by

the health and other sectors to disseminate

information as part of community outreach

activities. Typically, a mobile cinema will pitch

camp in a village and in between entertainment

programmes, provide information and/or engage

audiences in discussion about the issue of the

day. In communities where the majority does not

have access to other entertainment media, such

as TV, mobile cinema will be used with carefully

selected content and scheduling to reach the

most of the primary audiences.

2. Culturally appropriate information materials:

The DOMC will also produce information

materials which will be distributed in the

communities through various channels, to

further disseminate information and reinforce

positive behaviours around malaria. In

developing the materials, DOMC will consider,

among other factors, cultural appropriateness

in regard to specific communities, and literacy

levels. For instance, only 21% of women in

North-Eastern Province, an area of intense


transmission during the rainy season, is literate

(KDHS 2008/9); the majority in the province,

both men and women, cannot read at all, and

would therefore not benefit from information in

a booklet.

The DOMC will therefore produce a range of

print and audio-visual materials, including low-

literacy products, which will be pre-tested in

collaboration with the local communities to

ensure they meet their information needs, and

which can be adapted by local partners and

DHMTs as needed.

3. Inter-personal communication

Inter-personal sources have been found to be

a significant source of information for many,

is associated with increased discussion of

certain issues in communities. For instance,

the 2009 Audiencescapes study cited earlier

found that friends or family member and

medical staff were the second and third

most frequently cited source of information

on HIV, Malaria and TB. About 47% and 31%

of respondents cited friend or family member,

and medical staff, respectively as their source

of information on Malaria. In addition, 94%

of respondents considered medical staff as

trustworthy sources of health information; 82%

also considered friend or family member as

trustworthy sources. The DOMC will build on this

positive perception to strengthen information

dissemination by health staff both in facilities

(through health talks and group counselling)

and during community meetings. Providers

will be trained and given simple and easy-to-

use counselling tools with the key messages

on malaria, for use in patient education

and counselling. These will be supported by

distribution of the IEC materials. Providers

will also receive simplified malaria treatment

guidelines, including information on medicines

and malaria in pregnancy for their reference.

4. Special thematic campaigns and public

events

The DOMC will schedule and launch

thematic campaigns around specific themes

in control, prevention and treatment, and

run these for a reasonable length of time for

public education and to further influence the

public’s knowledge and behaviour. These will

be scheduled as necessary over the three

years period, and will be set to coincide with

the observation of World Malaria Day.

Social mobilization

Social mobilization is a development technique,

which allows programmes to engage communities

in discussions and activities to reinforce their support

and involvement in planning and implementing

better health initiatives. It is defined as “the process

through which community members, groups or

organizations plan, carry out, and evaluate activities

on a participatory and sustained basis to improve

their health and other conditions, either on their own

initiative or stimulated by others” (USAID/ACCESS,

200719). The strategy has been used in different

health programmes to rally communities around a

common issue and increase uptake of services. In

polio eradication programmes, for instance, social

mobilization has increased the uptake of oral polio

vaccines in hard-to-reach areas, and to address

local resistance to polio immunizations. In an article

published in the Journal of Health Communication

19. USAID/Access. 2007. Demystifying Community Mobilization – an effective strategy to improve maternal and newborn health. Technical Brief


(Obregon and Waisbord, 201020), social mobilization

is reported to have led to an increased perception

of polio risk in children who had not received the oral

vaccine in Uttar Pradesh, India; in Pakistan, 79% of

households resisting the polio vaccine accepted it

after repeated visits by a social mobilization team.

In the malaria programme, social mobilization will

help create community will and commitment around

disease control and prevention through increased

discussions and consensus on desired new behaviours

within the affected communities. One key informant

stressed this in the needs assessment, saying “We

need for more social mobilization efforts to increase

community participation and ownership above what

is spelled out in the current strategy,” (key informant).

Social Mobilization Activities and approaches

1. Establishing community networks and

structures: As a first step, the DOMC will conduct

a survey to identify appropriate CBOs and other

networks/groups that it can collaborate with in

conducting community mobilization activities.

In each malaria zone, a directory will be set up

of organizations and other agencies active in

the area, and their current scope in malaria

activities. A programme of local activities will

then be developed in consultation with the

local communities and organizations, and

implemented over the three-year period. The

respective DHMTs will be trained and given

support to monitor the implementation of the

ACSM activities in their areas.

2. Active engagement of local leaders: It is

important to engage community leaders,

because they can galvanize their communities

to be more involved in and receptive of the

program activities. The DOMC and partners will

strengthen existing structures in the community

which include village health committees, local

administration and networks of volunteers,

to enhance coordination of the malaria

control interventions, and to include malaria

communication messages and materials in

their activities. The local leaders will be trained

so they understand the issues in malaria control,

prevention and treatment, and given material

and technical assistance to reach out to their

communities.

3. Other activities: The following activities will also

be implemented and will be supported by

distribution of IEC materials in the community:

• Community-based interpersonal communication

20. Obregon, Rafael and Silvio Waisbord. The complexity of social mobilization in health communication – top down and bottom-up experiences in polio eradication. Journal of Health Communication, Vol 15:1. Accessed online


through sensitization meetings and barazas

for local leaders and community members.

Experiences from development programmes

show that these are effective in winning

support, because they provide opportunity

for the leaders and community to express their

concerns, learn together and reach consensus

on issues that are important to them. These will

be especially necessary in improving treatment-

seeking behaviour for malaria, and increased

acceptance of IRS.

• Road shows, community theatre and cultural

shows, which combine entertainment and

education to communicate the key messages.

Public celebrations to observe World Malaria Day

will also be used as mobilization channels.

• School outreach activities, to reach young

people, who in turn can influence their family’s

knowledge and behaviours;

Home visits by community health workers/

volunteers, which include demos can be effective

in increasing appropriate use of LLINs, as most

people have difficulty hanging them or are not

familiar with retirement practices and a practical

demonstration would help. Door-to-door visits

by community leaders and other implementers

will also be used to explain IRS and assist health

workers in gaining access to houses for spraying.

The DOMC will provide the following standard

package of materials to those implementing the

activities; these materials can be localized as needed

by the DHMTs:

a. Printed information materials and audio-visual

resources for the public and key audiences

covering the key areas of prevention and

treatment

b. Simple counselling guides for use by

community health workers in their interaction

with community members

c. Simplified guides on malaria treatment for

community-based health workers

Capacity-building of healthcare service providers

and medicine vendors

Training is an important part of health communication

to ensure that activity implementers receive the

appropriate skills and information. Under this

strategy, healthcare service providers, community

health workers, and pharmacists/chemists will be

trained to increase their knowledge on current

malaria preventive and treatment measures and to

strengthen their skills in community/client education

and counselling. Supportive job aids and information

materials will be given to enable them counsel clients

appropriately. The national treatment guidelines will

be simplified and translated into local languages,

and disseminated to the health staff to understand

and use accordingly. Training will also be provided

to local partners, including members of DHMTs, local

NGOs, on how to implement and monitor malaria

control communication and social mobilization

activities.

Advocacy

Advocacy is the process of communicating with

target groups to gain their support for an issue.

Communication is essential to advocacy, to enable

a programme place issues high on the agenda of

policy makers and other decision-makers, to foster

political will, and increase and sustain financial and

other resources. In Kenya, sustained advocacy with


policy makers and members of parliament led to

the inclusion in 2006 of a budgetary allocation in

the national budget, for the first time, to cover the

purchase of family planning/contraceptive products,

in order to expand coverage of family planning

services (source: Division of Reproductive Health

briefing materials). In malaria programmes, sustained

advocacy will help achieve support for the following

issues identified in the needs assessment:

• Continued support for universal distribution as

part of the public health programmes

• Improved distribution of LLINs through integration

into all health and social services including

maternal and child health services; school

system; community networks and all public health

campaigns.

• Addressing the challenge of MIP in areas where

women do not use ANC services very well, and

exploring alternative means of providing the

service, if necessary, within the community.

Trained community health workers may be

needed to promote IPT in pregnancy.

• Expanding coverage, availability, and

acceptance of Indoor Residual Spraying.

• ACTs – sensitizing policy makers and leaders on the

need to further reduce costs of the medicines, to

support effective medicines availability through

the private sector, and to allow rapid diagnosis

kits into the hands of the community-based health

workers, to increase access to proper diagnosis.

Communication will be used to draw the attention

of policy makers and political leaders to these

issues, and win their active support for malaria

control programmes in general. The communication

objectives in undertaking advocacy are:

• To sensitize leaders and policy makers about

malaria control in general and the specific issues

that need to be addressed for a successful

programme;

• To create a sense of urgency in policy makers

and persuade them to prioritise malaria control

initiatives and take action to promote them.

Key messages to policy makers and political leaders

will highlight the socio-economic cost of malaria to

the country and the challenges and opportunities

under the current treatment and management of

malaria. The decision makers will be reached and

mobilised into action through events and meetings,

and through dissemination of advocacy briefs

(handouts, presentations, technical papers) that will

demonstrate the challenges and opportunities of

controlling and managing malaria and how they can

participate. The DOMC will also support the current

Malaria Ambassador to carry out advocacy, and

provide information materials needed to support his

work.

At community levels, leaders will be urged to use

their positions of power and influence to make

malaria a public issue and support recommended

prevention and control practices. Members of DHMTs

will be lobbied to use their structures and resources to

address malaria control, and will be supported with

information materials and skills building.

Branded communication platform

To increase coordination, visibility and recognition of

the malaria national communication initiatives, these

activities will be delivered on a branded platform.

Branding provided free of charge in public and

faith based health facilities. An evaluation of an HIV

communication project in Kenya published in AIDS


Care journal found that exposure to generic messages

as opposed to specifically branded messages was

less frequently associated with positive health beliefs;

those groups exposed to branded messages were

significantly more likely to consider themselves at

higher risk of acquiring HIV and to believe in the

severity of AIDS, than those who were not. Exposure

to branded messages was also associated with

a higher level of personal self-efficacy, a greater

belief in the efficacy of condoms, a lower level

of perceived difficulty in obtaining condoms and

reduced embarrassment in purchasing condoms.

Branding can promote preventive malaria behaviour

as an attractive lifestyle choice and thus influence the

development of positive perceptions and attitudes.

The current malaria control programme identity

(logos, colours and ‘Komesha Malaria, Okoa Maisha’

slogan) have been in use since 2006, and will be

reviewed, to reflect new energy and focus under

the new strategic direction, and to counter potential

campaign fatigue in the target audiences.

21. Agha S. The impact of a mass media campaign on personal risk perception, perceived self-efficacy and on other behavioural predictors. AIDS Care. 2003 Dec;15(6):749-62.) Abstract acc

AL Adult dose


Audience group Key message themes Tools/methods

Primary Audiences

General population; Care-givers of young children;Heads of households in malaria-prone areas

• Encourage acquisition/ownership and proper use of LLINs

• Appropriate environment management• Recognition of malaria symptoms and

prompt seeking of healthcare services from health facility

• Acceptance and demand for IRS• Availability and affordability of ACT-m

branded medicines

IEC materials - Posters, brochures, booklets, factsheets, etcMass media – local and community radio and newspapersInter-personal communication through healthcare providers, local leaders, CHWs and at local meetings

Pregnant women and their partners in endemic areas

• Encourage acquisition/ownership and proper use of LLINs

• Recognition of malaria symptoms and prompt seeking of healthcare services from health facility

• Benefits of and access to IPT in pregnancy through early ANC visits

IEC materials - Posters, brochures, booklets, factsheets, low-literacy products etcInter-personal communication through healthcare providers, local leaders, CHWs and at local meetings

Secondary Audiences

Policy makers, national and regional political leaders, members of DHMTs in malaria areas

• Support for universal distribution of LLINs• Promotion of IPT in pregnancy and

enforcement of current policy• Support for IRS, and allocation of enough

resources for it• Support for ACTs, and ACT-m branded

medicines

Advocacy briefing materials, IEC materials and convened meetings Mass media

Health service providers, community-based health workers, health volunteers, and public health technicians

• Promote LLINs to every client• Provide IPT in pregnancy as recommended • Provide recommended diagnosis and

treatment of malaria according to current policy

• Educate clients on medicines adherence• Prescribe and promote ACT-m branded

medicines • Promote IRS in community

Training materialsJob aids and IEC materials Simplified treatment guidelines

Table 7: Target Audience


Audience group Key message themes Tools/methods

Local community leaders, and staff of organizations implementing malaria control activities in malaria-prone areas

Support and promote use of LLINs Encourage mothers to seek ANC services early and to accept IPTPromote early treatment seeking for malaria-like symptomsPromote IRS in appropriate regions, mobilise communities for actionPromote availability, affordability and use of ACT-m branded medicines

Training in key messagesEC materials

Pharmacists, chemists and local medicine vendors

Sell only approved medicines for malariaEncourage clients to seek laboratory diagnosisProvide clear info on medicine use, adherence Availability of subsidized branded medicines for malaria

Training and sensitization on ACT-mEC and ‘detailing’ training and materials on ACTs and ACT-mSimplified treatment guidelines and counselling tools/job aids

Local news media

Promote acquisition/ownership and proper use of LLINsExplain benefits of and access to IPT in pregnancy through early ANC visitsPromote appropriate environment managementUnderstand malaria symptoms and need for seeking healthcare services promptly from health facilityUnderstand role and benefits of IRSAvailability and affordability of ACT-m branded medicines

Training and background materialsMedia engagement/liaison for improved coverage

People living with HIV in malaria prone areas

Encourage care and treatment seeking for malaria symptomsv

IEC materials - Posters, brochures, booklets, factsheets, etcInter-personal communication through healthcare providers, local leaders, CHWs and at local meetings

Communication support for the implementation of Affordable Medicines Facility for Malaria

In 2006, the Government introduced artemisinin-based combination therapies (ACTs) for the

treatment of malaria in all public and faith based health facilities. ACTs are currently recommended

and are the best available treatment for malaria. The cost of ACTs is high, however they are

provided free of charge public and faith based facilities unlike in the in the private sector where nearly 40%

of Kenyans seek treatment, leading the majority of patients opting to use cheaper but also less effective

medicines. The Affordable Medicines Facility – malaria (AMFm) is an innovative financing mechanism bringing

together a global public-private partnership, to subsidise the cost of ACTs in both public and private sector

to enhance access to effective treatment and reduce the use of ineffective malaria mono-therapies. This

communication strategy will support the launch of the affordable ACTs in Kenya and the implementation of

equitable access to ACTs in the country.

Table 7: Target Audience (Continued)


Overall communication objective:

• To increase awareness, knowledge and

acceptability of recommended ACTs for malaria

treatment and promote prompt access to

affordable and effective malaria medicines.

Specific objectives:

• To create the awareness and knowledge of the

general public of the existence of subsidized ACTs

• Create awareness about the ‘green leaf’ and

ACTm logos that identify the affordable, quality

ACTs

• To increase awareness in the general public of the

need to respond quickly to symptoms associated

with malaria and on the need to adhere and

comply with treatment instructions as prescribed;

• To create demand for the ACTm-branded ACTs

in the private sector (pharmacies and health

facilities)

• To build support for the AMFm among policy-

makers in government, and other leaders in

politics, health, development and social sectors

Primary Audiences:

1. General public, heads of families and care-givers

of young children – all people at risk of malaria

infection, who will require prompt treatment with

an effective medicine.

Secondary audiences:

1. All health service providers in both public and

private sector facilities

2. Pharmacists/medicine distributors/stockists

including those attached to private health

facilities

3. Policy makers in government (health, planning

and social sectors)

4. Community leaders

Anticipated challenges to communication about

affordable ACTs

The needs assessment conducted for this strategy

established the following challenges to ACTs in

general in Kenya, which will have a bearing on the

communication messages and activities undertaken

to promote the malaria medicines bearing the ACTm

logo:

• Client tendency to seek health care late after

onset of malaria-like symptoms and only after self-

medication and home-treatment have failed to

reduce fever.

• Chemists and other medicine stockists prescribing

malaria medication based on symptoms only

Failure among health workers across all sectors to

practice diagnosis based treatment.

• Perceived high cost of ACTs in the private sector

makes them beyond the reach of most people,

thus patients opting for cheaper and ineffective

anti-malarials.

In addition, the subsidised ACTs for the private sector

will be introduced alongside free distribution in public

facilities and into a setting where private pharmacies

currently sell unsubsidised ACTs. It is possible that

the pharmacists and other medicine sellers could

feel threatened because of the subsequent loss of

business and may advance arguments to discredit

the introduction of the new cheaper but effective

treatment therapy.

Communication tactics/tools

The communication activities to support the

implementation of the ACTm branded ACTs will

seek to establish high visibility of the brand, while

creating demand through increased awareness and

knowledge.


1. Public Relations and Marketing communications

campaign - The branded products and the facility

will be introduced into Kenya through a high profile

information and marketing campaign, using a

multiplicity of media and scheduled to run over 9

months. While mass communication campaigns

have been shown to be very effective in creating

awareness and knowledge, they need to be

sustained so that the audiences have time to

process the messages and act on them. Longer

duration also allows for community processes

necessary for the adoption of new behaviours

to take place, such as consensus building and

collective learning. The campaign will use

advertising (radio and television commercials and

print ads), and will be supported by IEC materials

for communities, including posters, brochures,

fact sheets, and billboards. Radio will also be

used to disseminate information, on national

and vernacular stations with high listenership for

6-9 months. The campaign will target all the key

audiences identified for this activity.

2. Strategic media engagement – News media will

be leveraged to include information on subsidized

ACTs bearing the “green leaf” logo and ACTm in

their news content, and in special programming.

To sensitize health and news journalists on the new

initiative and equip them with information for their

audiences, a short workshop will be organized,

focusing on the role of subsidized medicines in

fighting malaria in Kenya.

3. Training and sensitization of health service

providers, particularly those in the private

sector, on current guidelines for the diagnosis

and treatment of malaria, and dissemination of

simplified treatment guidelines and IEC materials.

Counselling tools and other job aids will be

developed and provided for their use during

interaction with clients.

4. Community outreach activities, to create

awareness and increase knowledge of ACTs.

This will be achieved through road shows and

other community enter-educate events, and

through community health workers, who will be

given training and IEC materials to educate their

communities about the branded products.

5. Advocacy, to secure political leaders support

for the AMFm initiative, and to help popularise

the ACTm-branded products. This will be

achieved through holding briefing meetings with

the political leaders, including the Parliament

Committee on Health, DHMTs in malaria areas,

and production and dissemination of advocacy

briefs for leaders, detailing the key issues around

ACTs, and why leaders need to support the AMFm

and ACTm-branded products. The DOMC will

also collaborate with the National Coordinating

Agency for Population and Development,

which runs an active health policy advocacy

programme targeting national leaders, and use

their meetings and events to reach out to this

particular audience.

Advocacy activities will also be directed at

the pharmaceutical industry leaders and

players, to win their support and commitment

to adhere to agreed prices for subsidized ACTs.

These activities will include holding technical

briefing meetings, making presentations at

scheduled meetings on the industry calendar,

and through materials produced specifically

for this audience. The malaria ambassador, key

players in the Kenya Private Sector Alliance,

academic and research institutions and


civil society organizations will participate in

outreach to key players in the pharmaceutical

and health sector to win their support.

6. Active engagement of the private sector

through consultative and planning meetings,

the engagement of the private sector on the

AMFm project will go a long way in improving the

access to these medicines. It is in such meetings

that there can be dialogue to encourage first line

buyers to stock the subsidized ACTs and to allay

their fears about loss of business. Planning for

phase out of monotherapies and expensive ACTs

can also be done when all first line buyers know

when the mass media campaign and training of

health workers will have been achieved.


The following table summarises the key messages and tools/methods that will be used under this communication

strategy to promote subsidized ACTs.

Table 8: Summary of key messages specific to the ACT-m Medicines

Audience group Key messagesCommunication

method/toolDesired behaviour outcome

General population, Families, caregivers, heads of households in malaria-prone areas

• Effective medicines to treat malaria are available at affordable prices

• In case of fever and other malaria-like symptoms, seek treatment from a health facility as soon as possible, within 24 hours

• Laboratory testing is needed to confirm malaria

• Request for ACT-m branded medicines for malaria from the service provider

• Use the prescribed medicines for malaria as prescribed by health staff; return to clinic if symptoms persist

Public relations and marketing campaignIEC materialsCommunity outreach activities by partners and community health workersMedia outreach

Audience recognizes malaria symptoms and danger signs, and seeks prompt health care services, within 24 hrsAudience recognizes the green leaf logo and demands for ACTm branded medicinesAudience adheres to prescribed dosage and regimen

Health care service providers in private facilities and Chemists/pharmacists and drug distributors

• ACTs are currently the most effective first line treatment for malaria.

• ACTs are now available at subsidized prices in private health facilities including chemists through the AMF-m facility

• All subsidized ACTs are of the highest quality and the quality will be regularly monitored by both local and international agencies.

• Encourage clients to seek laboratory testing for confirmation of malaria

• Provide client with clear information on medicine use, in simple language

Training and sensitization on green leaf logo and ACTmIEC and ‘detailing’ materials on ACTs and ACTmDisplay kits/units of logo at all medicine outlets selling subsidized ACTsSimplified treatment guidelines and counselling tools/job aids

All pharmacists and medicine stockists recognise the green leaf logo and the ACTm brand as quality and effective medicine All pharmacists and medicines stockists sell only the approved drugs for malaria treatmentAll health providers prescribe the recommended ACTs for confirmed malaria cases, and provide correct information on case management to clients

Policy-makers and leaders in community, DHMTs in malaria areas

• ACTs are currently the most effective first line treatment for malaria.

• ACTs are now available for free at government health facilities

• ACTs can be bought at subsidized prices at private sector facilities carrying the ACTm green leaf logo

• Provision of affordable ACTs through private sector will enhance achievement of universal access to malaria treatment by those in need.

Advocacy briefs and technical papersPresentations by DOMC staff and partners including Civil Society Organizations, and the Malaria AmbassadorMedia outreach

Policy makers and leaders support the AMFm, recognize the ACTm brand and advocate for adherence to pricing guidelines by all partiesPolicy makers and leaders popularise availability of affordable ACTs to their communities


This strategy will be building on on-going activities,

and will be implemented at three levels: national,

regional and local. At local and regional levels, the

choice and focus of specific communication activities

will depend on what else is happening in that specific

context. For instance, some regions may choose to

implement social mobilization, to complement on-

going IEC activities. The implementation approach will

use capacity building, coordination and programme

partnerships/integration.

1. Capacity building for Advocacy, Communication,

and Social Mobilization: To implement this

strategy, the DOMC will seek to build the capacity

of local partners and communities in malaria

communication. For instance, health workers

may need training in community mobilisation,

client counselling and on how to communicate

the right information using targeted key

messages to community and individuals and

to conduct follow up for action. Technical

assistance will be provided to organisations and

groups implementing malaria programmes, local

community groups and DHMTs in malaria areas

on how to plan and conduct ACSM activities.

The DOMC will also support health educators in

the districts to effectively coordinate and mobilize

support for malaria communication within their

areas. As a first step in the implementation of

this strategy, the DOMC will support the different

malaria regions to plan and set priorities on their

specific communication activities. DOMC will also

provide standardised IEC materials which can be

adapted for local use by the partners and local

groups.

2. Coordination and resource mobilisation: To

make the best use of the available resources for

malaria communication and behaviour change

activities in implementing this strategy, the DOMC

will coordinate the different partners through the

ACSM working group. The working group is a good

platform for DOMC to share information and to

promote its priorities as well as gain the support

of the partners. In the districts, the coordination

role will be conducted by the DHMTs – the DOMC

will be responsible of making sure that DHMTs

in malaria zones understand this role and carry

it out. DOMC will also work in coordination with

other GOK departments, leveraging other health

promotion and communication activities as much

as possible and creating a strong multi-sectoral

approach.

Coordination roles for the DOMC:

• Define priority areas for ACSM interventions

• Mobilise resources from partners to support

communication activities

• Maintain inventory of ACSM partners,

activities and materials and identify gaps

• Set up and maintain information and

knowledge sharing platforms and tools for

the malaria sector

• Identify, document and share best practices

• Oversee the development of consistent and

standardized messages

• Coordinate joint planning with stakeholders

where possible to reduce overlaps and

encourage scale up

• Provide leadership in policy advocacy.

Undertake advocacy, capacity and

Implementation Framework4


technical skills building at all levels to ensure

successful implementation of ACSM activities

• Ensure quality of ACSM activities

• Monitor and evaluate implementation

progress

• Conduct media outreach and advocacy to

improve information dissemination through

press

Roles of Partners:

• Provide technical and resource support, and

advice to DOMC on ACSM

• Assist the implementation of ACSM strategy

• Contribute best practices and lessons learnt

to DOMC planning processes and inventories

• Assist the development of consistent and

standardized messages

• Support qualitative and quantitative

research for the development of ACSM

interventions and messages and for

measuring effectiveness of various program

interventions

• Assist in building partnership with the media

and local communities

Integration/programme partnerships:

To increase the impact of the communication activities

outlined in this strategy, they will be integrated into

other health programmes as much as possible: For

instance, health providers will be trained to integrate

malaria control and prevention key messages into

the health talks delivered at facilities and during

client counselling. Providers will also be trained and

encouraged to distribute information leaflets, or show

videos as the clients wait for services. The DOMC will

also collaborate with other government departments

to ensure that malaria messages are included into

public health activities implemented by Division of

Health Promotion, Division of Community Health,

Division of Reproductive Health, Division of Adolescent

Health, and other GOK partners. DOMC will also use

partnership with other organisations to incorporate

malaria messages in workplace health programmes

and private sector health education initiatives in

malaria-prone areas. DOMC will provide technical

guidance, support and materials in implementing the

interventions.


35

Table 9: Implementation Plan 2010-2014

Activity Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16

IEC for BCC

Revamp the current malaria control identity tore-energise it

x x

Hold messages development workshops in prevention, control and case management

x x x x

Produce and disseminate IEC materials on prevention, control and case management

x x x x x x x

Engage local media in communication x x x x x x x x x x x x x x

Train health care providers and community leaders in key message Themes

x x x x x x x

Social Mobilization

Identification of community-based partners and agencies in malaria control

x x

Support partners and local leaders to plan and implement community mobilization activities

x x x x x x x x x x x x x

Disseminate IEC materials to partners and local leaders x x x x x x x x x x x x x

Capacity building for health providers and drug sellers

Conduct communication training needs assessment of providers and medicine vendors

x x

Plan and implement communication and health promotion training

x x x x x

Develop and disseminate simplified versions of local treatment guidelines and counselling aids for service providers

x x x x x x x x

Disseminate IEC materials to health providers and medicine sellers

x x x x x x x x x x x x x x

AdvocacyProduce and disseminate information materials for decision makers on challenges and opportunities in malaria control


Advocacy

Organise advocacy forums and events for policy makers and politician on key issues


Lobby DHMTs to support ACSM activities x x x

Support Malaria Ambassador in advocacy activities x x x x x x x x x x x x x x

ACSM activities coordination

Disseminate communication strategy to partners and implementers

x x x x x x

Develop and disseminate “how to” guides for use by organisations implementing this strategy at different levels

x x x x x x

Hold quarterly meetings of malaria ACSM groups at all levels


Provide support to implementing partners on communication initiatives


Document malaria control best practices x x x x x x x x x x x x x x x

Publish quarterly newsletters and annual reports x x x x x x x x x x x x x x x

Conduct impact evaluation of the ACSM strategy x

ACTm/AMFm Communications

Conduct public communication campaign and related activities x x x x x x x x x x x x x x

July 2011-June 2012July 2010-June 2011 July 2012-June 2013 July 2013-June 2014


Continuing Research, Monitoring And Evaluation5

Continuing Communication / BCC Research

DOMC will support continuing research to better

understand community perspectives around malaria

control and prevention practices that impact

on the success of the national programme. For

instance, the literature review did not reveal any

community knowledge, attitudes and beliefs towards

indoor residual spraying and malaria diagnosis

through laboratory testing. DOMC will continue to

identify researchable issues around malaria and

communication, and commission studies on them.

This will also include operations research to test

innovative ACSM strategies and contribute to the

existing knowledge base, as well as evaluations of

existing strategies to measure impact. DOMC will also

continue to identify and document best practices

and success stories in health communication and

malaria in particular and contribute these to the

current knowledge base.

Monitoring and Evaluation

Monitoring and evaluation will be essential

to objectively establish progress towards the

achievements of the objectives of this communication

strategy and in tracking the performance of the

programme. The key aspects of the M&E framework

for this programme include:

• Monitoring of the implementation of the activities

as they happen

• Assessing the outcomes and the contribution of

communication activities to the NMS targets at

regular intervals (e.g. population based surveys

to assess changes in knowledge, attitude,

behaviours and practices)

• Adding results to the national records and any

new information into the health information

management system

The communication process and outcome indicators,

Figure 2: Uptake Of Malaria Control Interventions.


and data sources are outlined as follows; these are aligned to the National Malaria M&E Plan. DOMC and

the ACSM Working Group will develop appropriate reporting tools to track implementation, and provide

assistance to local partners on using them. Where possible, indicators on communication activities will be

included in current systems and tools used to report on malaria activities. To evaluate the impact of the

strategy, an impact assessment will be conducted at the end of the implementation period (Q12).

Table 10: ACSM Activity Process and Outcome Indicators

Activity Indicator Data source

IEC for BCC

Identify the key messages in prevention, control and case management

Key messages developed

Communication strategy; programme activity reports

Revamp the current malaria control identity to re-energise it

Existing logo and colours redesigned and launched

Activity reports

Produce and disseminate IEC materials on prevention, control and case management

Number and type of IEC materials produced and disseminated

Activity reports

Engage local media in communication

Media engagement strategy developed;Number of media outlets carrying malaria content;Number of malaria articles and programmes produced;Number of journalists sensitised on malaria reporting

Activity reports

Train health care providers and community leaders in key messagethemes

Number of providers trainedNumber and type of IEC materials disseminated to providers

Activity reports

Social Mobilization

Identify community-based partners and agencies in malaria control

Number of partners and agencies identified

Activity reports

Support partners and local leaders to plan and implement community mobilization activities

Number of partners and leaders supported to plan and conduct mobilisation

Activity reports

Disseminate IEC materials to partners and local leaders

Number and type of IEC materials disseminated to partners and local leaders

Activity reports

Capacity building for health providers and medicine sellers

Conduct communication training needs assessment of providers and medicine vendors

Training needs assessment conducted and report developed

Activity reports

Plan and implement communication and health promotion training

Number of providers and vendors trainedNumber and type of IEC materials disseminated

Activity reports

Develop and disseminate simplified versions of local treatment guidelines and counselling aids for service providers

Simplified guidelines developed;Number of copies of guidelines produced and disseminated

Activity reports

Disseminate IEC materials to health providers and medicine sellers

and type of IEC materials disseminated

Activity reports


Table 10: ACSM Activity Process and Outcome Indicators (Continued)

Activity Indicator Data source

Advocacy

Produce and disseminate information materials for decision makers on challenges and opportunities in malaria control

Number of advocacy events organisedNumber of leaders reachedNumber and type of info materials distributed

Activity reports

Organise advocacy forums and events for policy makers and politician on key issues

Number of advocacy events organisedNumber of leaders reachedNumber and type of info materials distributed

Activity reports

Lobby DHMTs to support ACSM activities

Number of DHMTs sensitizedNumber of district plans including ACSM activities

Activity reportsDistrict Annual Operational PlansDHMT minute records

Support Malaria Ambassador in advocacy activities

Number of meetings organised Number and type of info materials produced

Activity reports

ACSM activities coordination

Disseminate communication strategy to partners and implementers

Number of partners receiving communication strategy

Activity reports

Develop and disseminate “how to” guides for use by organisations implementing this strategy at different levels.

Number and type of guides developed and disseminated

Activity reports

Hold quarterly meetings of malaria ACSM groups at all levels

Number of working group meetings held

Activity reports

Provide support to implementing partners on communication initiatives

Number of partners receiving Support

Activity reports

Document malaria control best practices

Number of best practice case studies documented Number of best practice case studies disseminated

Activity reports

Publish quarterly newsletters and annual reports

Number of publications printed, and disseminated

Activity reports


ANNEX 1: Members of the ACSM Technical Working Group.

Division of Community Health Services

Department of Health Promotion

Department of Information and Public Communications

Division of Malaria Control (DOMC)

Division of Reproductive Health

Ministry of Education

AMREF

C-change

Clinton Health Access Initiative – CHAI

Kenya Red Cross

KeNaaM – Kenya NGO Alliance Against Malaria

Merlin

MEDS

President’s Malaria Initiative and USAID

PSI

UNICEF

WHO

World Vision


Table 11: ANNEX 2: List of contributors.

No. Name Organization

1 Agneta Mbithi DOMC

2 Akpaka Kalu WHO Kenya

3 Andrew Nyandigisi DOMC

4 Andrew Wamari DOMC

5 Angela Ngetich DOMC

6 Beatrice Machini DOMC

7 Ben Adika C-Change

8 Daniel G. Wacira USAID/PMI

9 David Odhiambo Otieno Kenya Red Cross Society

10 Dorothy Memusi DOMC

11 Edward Mwangi KeNAAM

12 Elizabeth Juma DOMC

13 Grace Miheso UNICEF

14 Jacinta Opondo DOMC

15 James Sang DOMC

16 James Sekento DOMC

17 Joel Karogoi DOMC

18 John Logedi DOMC

19 John Moro DOMC

20 Joseph Kamotho PRO-MOPHS

21 Julius Kimitei DOMC

22 Kaendi Munguti USAID/ke

23 Mildred Shieshia MSH/SPS

24 Milka Njunge Sumitomo

25 Nancy Njoki PSI/Ke

26 Patricia Njiri CHAI

27 Peter Njiru DOMC

28 Phares Nkari DHP

29 Rebecca Kiptui DOMC

30 Sanyu Kigondu Jhpiego

31 Terry Muchoki PSI/Ke

32 Valerie Munyeti RTI

33 Victoria Kimotho AMREF HQ

Ministry of Public Health and SanitationDivision of Malaria ControlPO Box 19982 KNHNairobi 00202, KenyaEmail: [email protected]://www.nmcp.or.ke

Documents

MALARIA COMMUNICATION STRATEGY - The Compass · giving feedbacks that enriched the final product. A complete list of members of these Technical Working groups is found in annex 1