Transcript C4D & Child Survival in West and Central Africa

Regional Strategy: Programme
Communication for Child Survival in
West and Central Africa
Neil Ford
Regional Chief, Programme Communication
West and Central Africa
Dakar: 9th April, 2008
Why are large-scale community-based
communication programmes necessary?
• because child survival results depend on adoption of
key behaviours at the household and community
level, not just in zones of convergence but across
entire countries – 90 per cent coverage is necessary.
• Large-scale behaviour change in key practices can
reduce child mortality by 40 per cent (Lancet) - MDG
and AARM commitments can only be achieved if
governments design and deliver nation-wide
behaviour change communication programmes.
• Key behaviours include exclusive breast feeding,
hand washing, using an insecticide-treated net,
treating diarrhoea with ORS, caring for pneumonia.
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Family and community interventions are
the most cost effective
source: draft AU report
Expected Impact on Neonatal, Under Five and Maternal
Mortality and Additional Economic Cost
Phase I : Africa generic
45%
$3.0
40%
Mortality reduction
$ 2.48
$2.5
35%
30%
$2.0
25%
$1.5
20%
15%
$ 1.09
$1.0
$ 0.72
$ 0.67
10%
$0.5
5%
0%
$0.0
Family/community
Outreach/schedulable
Clinical
Total Services
Delivery modes
Neonatal Mortality
Under Five Mortality
Maternal Mortality
Incremental Economic Costs per capita/year
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Programme Communication
Organizing for Large-scale Results
Child Survival
HIV / AIDS
Child Protection
Education
• Small scale programme communication
projects
• Duplication of effort
• Different methodologies and approaches
used by different sections
• Results too small to make an impact on the
MDGs
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Programme Communication
Organizing for Large-scale Results
Child Survival
HIV / AIDS
Child Protection
Education
Horizontal Integration
Vertical Integration
Participatory Research – baseline development
Interpersonal Communication
Community-based media
Mass Media
Public relations campaigns – in partnership with the
private sector
Impact evaluation – using community-based
management of information
What kind of community engagement
strategies will produce results?
The smaller basket of key behaviours that must be
adopted at scale are:
• life-long changes (such as hand washing) instead of
short-term interventions (such as immunization)
• related to culture, gender relations, tradition and social
practice. (The husband might sleep under an ITN instead
of the mother and children. The mother-in-law might be a
determining influence in breast feeding.)
Interventions based on adult learning principles and group
discussion are more likely to produce results than
strategies based on one-way delivery of health messages.
Note: short-term interventions (immunization, vitamin A)
are still necessary. Both must be delivered at scale.
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Improving Programme Communication
for measurable results
• The most successful Prog. Communication strategies have promoted
immunization campaigns– short time frames, with a focus on
information delivery
• Recently – a transition to child health days / weeks. Slightly longer
time frames, focus on service delivery & information
New vision:
1. community learning that is more frequent and longer-term, to
address key behaviours through adult learning and dialogue.
2. communication that address collective social change as well as
individual behaviour change.
3. programmes that acknowledge parents and care givers as the duty
bearers closest to children – they must be able to learn, change
practices and claim rights to service delivery
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Where is the new vision working?
• Tostan - participants meet to discuss human rights,
health and development issues four times a week for
two years, leading to range of child survival results,
including the first successes against FGC.
• Total Sanitation in Bangladesh – reaching 30 million
people by 2011 with a programme for zero open
defecation.
• Breast-feeding in Benin: improving rates of exclusive
breast feeding from 17 to 46 per cent over ten years.
All these programmes require longer time-frames to
achieve results
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Increasing the Quality, Intensity and
Coverage of Programme Communication
On-going approach: communication of health education
messages for behaviour change through health workers
Complementary Approaches to increase quality and
coverage:
• Facilitate face-to-face community dialogue so that care
givers can discuss issues and integrate health information
into their culture, livelihood system and social practice –
using community volunteers and traditional media such as
drama & storytelling
• Establish partnerships with established networks that work
with communities, such as teachers, traditional leaders,
religious leaders, health workers, etc.
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Increasing the Quality, Intensity and Coverage of
Programme Communication - 2
• Strengthen community governance structures to
coordinate large-scale communication programmes
• Increase programme scale and coverage by coordinating
community dialogue with mass media programmes at the
sub-national and national level, using local language
• Forge alliances with the private sector for more effective
public relations and marketing campaigns (e.g. Unilever in
Malawi), and to make use of new technology such as cell
phones or “Wiki” software
An evidence base must be created and good programming
ideas shared
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Coordinating structures, channels
and levels of government
UNICEF must help national governments to design and
deliver effective communication strategies, including:
• A national child survival communication policy and
organisational structure
• Informed, trained health workers
• Engaged mass media at national and community levels
• Large-scale dialogue through networks of trusted
leaders, using schools, churches, mosques and health
centres as entry points
• Traditional media
• Public relations campaigns
• Local governance structures that deliver results at scale
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008
Re-enforcing Human Rights
• Instead of prescribing behaviours or “telling people
what to do” UNICEF should help governments
– Facilitate a process where people freely choose to change
their collective practice and individual behaviour
– Create opportunities for all people to speak and be heard on
CSD issues
– Create opportunities for decision-makers in government to
listen and respond to community issues
• Be guided by the human rights principles of inclusion,
empowerment (particularly of women and youth),
participation and self-determination, not just because
UNICEF is a human rights organization, but to
sustain results after the intervention is over.
WCAR Strategy, Programme Communication
and Child Survival: 08 April 2008