C-Picks E-magazine

C-Picks 23 - Tools and Technical Assistance from C-Change

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Date: 
April 11, 2012

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 23 | April 11 2012

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A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

Tools and Technical Assistance from C-Change

This issue of C-Picks highlights SBCC tools, guides, and strategies developed by C-Change. The first summary is a tool that C-Change recently completed - the SBCC Capacity Assessment Tool (SBCC CAT) for Individuals - to assist individuals to measure their knowledge and competencies in SBCC. The second item discusses C-Hub, the repository of health and development materials for development from C-Change, which has been redesigned and recently released. The third section highlights the recent set of guides and tools added to the Voluntary Medical Male Circumcision (VMMC) Communications toolkit that C-Change and others developed in Kenya. The fourth section presents the final evaluation study and the training materials of an implementation in Lesotho to reduce concurrency, a leading driver of HIV. The fifth section highlights the national reproductive health/family planning communication strategies developed in Malawi and Kenya with technical assistance from C-Change. The sixth section looks at C-Change's SBCC work in Democratic Republic of the Congo (DRC) to combat school-related gender-based violence. The seventh item, from the FHI 360 Alive & Thrive project, highlights "how-to" web-based video materials that show why using research is important when developing a communication strategy and more. The final section points to a few recent additions to the C-Picks website.

The C-Picks website will continue to grow with the addition of C-Change tools and materials in the coming months. Please check in frequently to the C-Picks website. See also these related sites: C-Capacity (capacity strengthening and SBCC) and Soul Beat Africa's Malaria theme site (SBCC and malaria prevention and control in Africa).


In This Issue

I. C-CHANGE CAPACITY ASSESSMENT TOOL

1. C-Change Capacity Assessment Tool for Use by Individuals

II. C-HUB: AN ONLINE REPOSITORY OF HEALTH AND DEVELOPMENT COMMUNICATION MATERIALS

2. C-Change Has Recently Launched a New and Improved C-Hub Website

III. VMMC COMMUNICATION TOOLKITS: KENYA

3. Voluntary Medical Male Circumcision Communication Toolkit

4. VMMC Adaptation Guide

5. VMMC Media Guide

6. VMMC Video Guide and Video

7. Luo (Kenya) Version of VMMC Toolkit

IV. COMMUNITY DIALOGUES IN LESOTHO TO DISCUSS AND REDUCE MULTIPLE CONCURRENT PARTNERSHIPS FROM C-CHANGE

8. Using Community Dialogue to Reduce Concurrency in Lesotho

9. Relationships: Intimacy Without Risk - Community Dialogues Programme in Lesotho

V. C-CHANGE'S TECHNICAL ASSISTANCE TO MALAWI AND KENYA IN ROLLOUT OF NATIONAL FAMILY PLANNING / REPRODUCTIVE HEALTH STRATEGIES

10. Malawi Guidelines for Family Planning Communication

11. Kenya Reproductive Health Strategy Implementation Guide

VI. C-CHANGE SCHOOL-RELATED GENDER-BASED VIOLENCE (SRGBV) PROGRAMME IN DRC

12. Materials from an Intervention to Prevent School-Related Gender-Based Violence in Katanga Province, DRC

VII. ONLIINE VIDEO-BASED TOOLKIT ON DEVELOPING MATERIALS AND STRATEGIES GROUNDED IN SOCIAL AND BEHAVIOUR CHANGE PRACTICES AND THEORIES

13. Research to Action: Designing Communication on Child Feeding in Bangladesh

VIII. NEW ON THE C-PICKS WEBSITE

14. Communication Guides for Facilitators: HIV Prevention Series

15. Program Improvement Through Use of Process Evaluations

16. Stigma Action Network (SAN) Website and e-Library

17. Development and Public Health Communication


I. C-CHANGE CAPACITY ASSESSMENT TOOL

1. C-Change Capacity Assessment Tool for Use by Individuals

AssessmentToolC-Change recently released the Individual version of the SBCC Capacity Assessment Tool (CAT) to help individuals assess their SBCC knowledge and skills. Organisations can also use the tool to assess the SBCC competencies of their staff. The tool includes a pre- and post-scoring sheet, which is useful for assessing skills learned during a C-Module training across the 5 steps of implementing an SBCC programme: 1) understanding the context through situation analysis, 2) focusing and designing the communication strategy, 3) creating interventions and materials, 4) implementing and monitoring, and 5) evaluating and replanning. C-Module training is available online, free of charge, and self-paced here.

This is the third version of the SBCC CAT. The other 2 versions were developed to assist organisations to measure their technical capacity and needs in SBCC, as well as donors and networks to assess their capacity and that of the partners they support and manage.

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II. C-HUB: AN ONLINE REPOSITORY OF HEALTH AND DEVELOPMENT COMMUNICATION MATERIALS

2. C-Change Has Recently Launched a New and Improved C-Hub Website

CHubC-Hub is a global online resource for health and development communication materials. The goal of C-Hub is to provide a free and open repository for health and development communication practitioners. C-Hub includes communication materials in areas such as HIV and AIDS, Sexual and Reproductive Health, Environmental Health, Maternal and Child Health, Nutrition, Infectious Diseases including Zoonotics, and Malaria Prevention and Control.

You can browse, preview, and download health and health communication materials in print, audio, and video formats. You can also contribute materials to C-Hub and share your work with the global health and development community.

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III. VMMC COMMUNICATION TOOLKITS: KENYA

3. Voluntary Medical Male Circumcision Communication Toolkit

Rolled out in 2010, the Voluntary Medical Male Circumcision (VMMC) Communication Toolkit was developed to create and sustain demand for male circumcision (MC) and reinforce the fact that, while MC reduces risk for men, it does not prevent HIV and must be combined with other prevention behaviours to be effective. Presented here are additional tools - an adaptation guide, media guide, and video guide - to support continued rollout. Also presented is a Luo language version of the toolkit, the language of the major ethnic group in Kenya's Nyanza province.

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4. VMMC Adaptation Guide

AdaptationGuideThis resource from the C-Change project provides guidance to other programmes on adapting materials for VMMC that ensure informed demand and promote safer sex following circumcision, particularly for those situations where expertise and internal resources are not readily available. The guidance is based on C-Change's experience with the VMMC programme in Kenya.

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5. VMMC Media Guide

MediaGuideBased on work in Kenya, this guide was developed by C-Change for VMMC programme directors, communication managers, and others who engage the media and foster positive relationships to get accurate and increased coverage of VMMC issues. Geneses of this guide were consultations held on behalf of the Kenya National VMMC Task Force and the Nyanza Provincial VMMC Task Force, as well as a one-day workshop with 22 journalists from 11 media houses (3 newspapers, 2 television stations, and 6 radio stations) in Nyanza Province.

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6. VMMC Video Guide and Video

VideoGuideThis discussion guide and the accompanying video (a 10-minute, 3-episode video that illustrates the critical role that women can play in discussing the benefits of VMMC and advocating with their partners and within their communities) are designed to be integrated into existing HIV prevention activities at the community level. Intended users of the guide include community-level professionals and workers (community mobilisers, peer educators, VMMC advocates, HIV counsellors, and communication specialists) who are promoting VMMC and HIV prevention. This guide is intended to facilitate discussions, reflection, and debate about VMMC and on the video's storyline and contents. Click here to watch the video and read a synopsis.

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7. Luo (Kenya) Version of VMMC Toolkit

LuoVCMMC-Change adapted (and translated into Luo) a set of Toolkit components - guidance documents, posters, and leaflets - for use in western Kenya's Nyanza Province.

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IV. COMMUNITY DIALOGUES IN LESOTHO TO DISCUSS AND REDUCE MULTIPLE CONCURRENT PARTNERSHIPS FROM C-CHANGE: A curriculum for the community level to tackle concurrency (a driver of HIV) and the qualitative study of the intervention

8. Using Community Dialogue to Reduce Concurrency in Lesotho

LethosoReportThis final qualitative study evaluated C-Change's community dialogue intervention, Relationships: Intimacy Without Risk, and gathered and analysed the perspectives of participants in 5 districts in Lesotho. The study assessed whether the dialogues had been effective in improving communication concurrency and cross-generational and transactional sex and the effect in reducing these HIV risk behaviours.

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9. Relationships: Intimacy Without Risk - Community Dialogues Programme in Lesotho

IntimacyRiskThe Relationship: Intimacy Without Risk programme includes a facilitator's guide and a training manual and materials to train local Sesotho facilitators to carry out discussion sessions that aim to stimulate deeper dialogue and discussion around relationship issues, such as multiple concurrent partnerships, and the risks of HIV.

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V. C-CHANGE'S TECHNICAL ASSISTANCE TO MALAWI AND KENYA IN ROLLOUT OF NATIONAL FAMILY PLANNING / REPRODUCTIVE HEALTH STRATEGIES
The following two implementation guides for national reproductive health strategies in Malawi and Kenya were developed with technical assistance from C-Change.

10. Malawi Guidelines for Family Planning Communication

MalawiGuideThe Malawi Guidelines for Family Planning Communication provides the framework for implementation of family planning (FP) communication programmes in Malawi and supports the aim of Malawi National Reproductive Health Strategy to promote through informed choice: safer reproductive health practices by men, women, and young people, including increased use of high-quality, accessible reproductive health services. The Guidelines were developed through an interactive, participatory process by the Task Force on Family Planning Communication under the leadership of the Health Education Unit with technical support from C-Change.

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11. Kenya Reproductive Health Strategy Implementation Guide

KenyaGuideThis implementation guide supports the rollout of Kenya's National Reproductive Health (RH) Communication Strategy at district, regional, and national levels. Its overall purpose is to ensure coordination of SBCC in RH programming and to assist implementing partners in Kenya in operationalising the strategy. A collaborative effort of partners and Kenya's Division of Reproductive Health of the Ministry of Public Health and Sanitation, C-Change developed and produced the guide.

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VI. C-CHANGE SCHOOL-RELATED GENDER-BASED VIOLENCE (SRGBV) PROGRAMME IN DRC

12. Materials from an Intervention to Prevent School-Related Gender-Based Violence in Katanga Province, DRC

DecreaseSRGBVC-Change is implementing a comprehensive approach to prevent and mitigate school-related, gender-based violence (SRGBV) among students, ages 10-14, attending primary and secondary schools in Katanga Province in Democratic Republic of the Congo (DRC). The programme utilises radio, television, educational comic books, and other community channels to create awareness of the issues related to SRGBV and youth. It reaches out to students, school administrators, teachers, parents, and community members. The approach uses the United States Agency for International Development (USAID)'s "Safe Schools Doorways I and III" modules.

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VII. ONLIINE VIDEO-BASED TOOLKIT ON DEVELOPING MATERIALS AND STRATEGIES GROUNDED IN SOCIAL AND BEHAVIOUR CHANGE PRACTICES AND THEORIES

13. Research to Action: Designing Communication on Child Feeding in Bangladesh

VMCCThis online toolkit Research to Action from the FHI 360 Alive & Thrive project for improving infant and young child feeding, funded by the Bill & Melinda Gates Foundation, provides what are intended to be instructive and engaging "how-to" web-based videos and supporting materials to illustrate why using research is important when developing a communication strategy and how concept testing and pretesting sharpen a final product - in this case, a TV spot. Also download a sample pre-test discussion guide and compare "before" and "after" scripts.

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VIII. NEW ON THE C-PICKS WEBSITE

14. Communication Guides for Facilitators: HIV Prevention Series

From Capable Partners (CAP) and FHI 360, this group of communication guides, published in June 2011, is designed to provide clear, focused behaviour change messages to individuals to promote adoption of safer behaviours to prevent and reduce HIV transmission. The structured teaching aides are meant to assist a community outreach facilitator to guide a small-group session to raise awareness of key drivers of HIV using interactive activities.

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15. Program Improvement Through Use of Process Evaluations

From Capable Partners (CAP) and FHI 360, this June 2011 publication is part of a Capacity Building Series documenting the experiences of the CAP Botswana project in organisational development, and building the technical capacity of local civil society organisations in HIV Prevention, from 2008-2011. The purpose of the programme is to strengthen community-based responses to HIV prevention implemented by civil society organisations (CSOs), and help the organisations develop into strong and effective partners in the national HIV and AIDS response. This publication describes the CAP project annual process evaluation methodology, outlines the implementation processes, details the major activities and tools used, and shares key results.

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16. Stigma Action Network (SAN) Website and e-Library

Created by the Stigma Action Network (SAN), this website and e-library are designed to be a "one-stop shop" for affected populations, programme designers and implementers, researchers, advocates, trainers, and donors to learn about the latest tools, technical resources, research findings, best practices, and new initiatives in reducing HIV-related stigma and discrimination. SAN hopes to facilitate networking, dialogue, partnerships, and knowledge sharing among diverse stakeholders around the world.

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17. Development and Public Health Communication

Published in August 2011, this book offers an understanding of the links between communication, health, and personal and social development through: a tabular summary of development communication paradigms; sections that orient the reader in terms of the different paradigms; examples of Southern African case studies that relate theory to practice; and points to consider, activities, and further reading designed to broaden knowledge on development and health communication.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com


SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).


FHI 360 has acquired the programmes, expertise, and assets of AED.


Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com

C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks 22 - SBCC for Communities

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Date: 
February 6, 2012

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 22 | February 6 2012

Subscribe to C-Picks
View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

SBCC for Communities: HIV and MARPs; Girls and Boys and GBV; and Male Circumcision

C-Picks #22 begins with a focus on HIV prevention programmes and social and behaviour change communication (SBCC) for most-at-risk populations (MARP). C-Change conducted Action Media workshops in Jamaica and The Bahamas, in which participants - men who have sex with men (MSM) and sex workers - were involved in developing the concepts and ideas for HIV prevention communication materials. Reports from the two workshops provide more information.

This issue also explores several programmes to mitigate gender-based violence and change social norms to protect school-aged girls and boys. C-Change has implemented an initiative to lessen school-related gender-based violence (SRGBV) in 31 schools in Katanga Province in Democratic Republic of Congo (DRC). See C-Hub for more information.

The final section highlights the communication components of Voluntary Medical Male Circumcision (VMMC) programmes being implemented in eastern and southern Africa as part of a comprehensive approach to HIV prevention. C-Hub has a Special Collection of MC Communication materials, developed by organisations that participated in the UNAIDS-PEPFAR Southern & Eastern Africa Region Male Circumcision Communication Meeting in Durban, South Africa in September 2010. C-Change was a key presenter at that meeting and a member of the Kenya National Task Force on VMMC.




In This Issue

SBCC and HIV PREVENTION FOR MOST AT RISK POPULATIONS

1. HIV Communication for MSM, PLHIV, and Sex Workers in The Bahamas

2. HIV Communication for MSM, PLHIV, and Sex Workers in Jamaica: Action Media Findings and Communication Brief

3. PRASIT: Using Strategic Behavioral Communication to Change Gender Norms in Cambodia

4. Empowering Men Who Have Sex with Men to Live Healthy Lives in Colombia

5. Legal Environments, Human Rights and HIV Responses among Men Who Have Sex with Men and Transgender People in Asia and the Pacific: An Agenda for Action

GENDER EQUITY, GENDER-BASED VIOLENCE, SCHOOL YOUTH, AND THEIR COMMUNITY

6. Intervention to Decrease School-Related Gender-Based Violence (SRGBV) in Katanga Province, DRC

7. Gender Equality in Education: Resources from the Safe Schools Program: Pilot Phase

8. "Vrai Djo" Project: Final Report

9. Stop Violence Against Girls in School Project

10. The Girl Effect: What Do Boys Have to Do with It?

COMMUNICATION FOR MALE CIRCUMCISION AND HIV PREVENTION

11. Communication Guide: Voluntary Medical Male Circumcision (VMMC)

12. Special Collection of Male Circumcision (MC) Communication

13. Southern and Eastern Africa Region Male Circumcision Communication Meeting: A Joint UNAIDS & PEPFAR Coordinated Meeting, September 22-24, 2010




C-HubC-Hub is an online repository for health and development communication resources. C-Hub will have a New Look and Enhanced Features in February.

Users are encouraged to join the C-Hub community and share communication resources that their projects have developed. Users can search for communication resources by topic, country, language, and producer. Users can also sign up for regular updates, and connect with C-Hub via Facebook and Twitter, to learn about new resources added to the site. Find out more here.




SBCC and HIV PREVENTION FOR MOST AT RISK POPULATIONS

1. HIV Communication for MSM, PLHIV, and Sex Workers in The Bahamas

HIVBahamasThis November 2011 report highlights the Action Media methodology utilised by C-Change during a workshop in The Bahamas in September 2011 with most-at-risk populations (MARP): men who have sex with men (MSM), individuals engaged in sex work (SW) contexts, and people living with HIV (PLHIV). Action Media is a participatory research methodology that integrates the perspectives of focal audiences in the development of social and behaviour change communication (SBCC) resources and tools. "The methodology worked consistently well with all groups, achieving high levels of participation and generating a range of creative concepts in a short space of time. Participants appreciated the opportunity for open discussion and interaction on issues that directly affect them."

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2. HIV Communication for MSM, PLHIV, and Sex Workers in Jamaica: Action Media Findings and Communication Brief

AlcoholHIVThis March 2011 report highlights the Action Media methodology used by C-Change for workshops in Jamaica in November 2010 with MSM, SWs, and community educators to inform the development of SBCC resources to support and strengthen HIV prevention interventions. During the workshops, an experimental approach was taken towards understanding participant perspectives on material design. Findings from these workshops will be used to inform the development of a package of SBCC materials for peer educators and others interacting with SWs and MSM. Additional materials/media created will aim to increase the reach of these smaller group interventions by appealing to a wider set of SWs and MSM (e.g. social media activities, word of mouth campaigns, etc.).

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3. PRASIT: Using Strategic Behavioral Communication to Change Gender Norms in Cambodia

From USAID's AIDSTAR-One, this case study examines a 4-year programme that works to prevent HIV in Cambodia by reaching out to entertainment workers (EWs), their mainly middle class and male clients, and MSM using strategic behaviour communication. For example, the MStyle programme projects the image of positive, knowledgeable MSM who know how to protect their sexual health. PRASIT workers also conduct monthly outreach to MStyle members, so that each person receives an individual contact up to 7-8 times annually. Sample impact: "Vishnai, a 24-year-old noodle seller at the old Sai market, is a regular at the MStyle club....'My friends in the park told me about the club. I already used a referral from the club to visit a nearby clinic to get a health check-up, and the staff were very friendly. Now I feel confident about my health. Coming to the club has given me the skills to negotiate with my partner about condom use. I had no idea how to do it before coming to the club. I'm very happy because my partner has agreed to go for a health check-up as well'."

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4. Empowering Men Who Have Sex with Men to Live Healthy Lives in Colombia

From September 2011, this case study from AIDSTAR-One explores one effort to reach out to and include members of the lesbian, gay, bisexual, and transgender (LGBT) community in Colombia, who are often marginalised due to "pervasive stigma and discrimination". It examines the efforts of Bogotá's Colombia's Lesbian, Gay, Bisexual, and Transgender Community Center (LGBT CC) to provide a social and educational base for its clients (MSM) while also advocating for their rights. According to this case study, what has worked well includes: (i) Filling a service gap for LGBT individuals in Bogotá: "Both staff and users of the community center emphasized the value that the psychological services alone provide to community center users; MSM said that the center has helped them to accept their sexual orientation and gender identity, and to understand and defend their rights as MSM. The community center added more space in response." (ii) HIV prevention through social and political action: "The value of the space and support that the community center offers for reflection, organizing, and empowerment cannot be overestimated in terms of its contribution to HIV prevention and mitigation."

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5. Legal Environments, Human Rights and HIV Responses among Men Who Have Sex with Men and Transgender People in Asia and the Pacific: An Agenda for Action

From the United Nations Development Programme (UNDP), this July 2010 study of legal environments affecting HIV responses among MSM and transgender people was undertaken to fill gaps in knowledge about: (i) the effects of laws and law enforcement policies and practices on HIV responses among MSM and transgender people, and (ii) the role of civil society organisations, governments, donors, United Nations (UN) agencies, and other multilateral agencies in supporting improvements to legal environments affecting MSM and transgender people. According to the study, the experience of many countries of Asia and the Pacific is that repressive legal environments can result in a range of adverse consequences for HIV responses. Actions for advocacy in Asia Pacific region governments are offered, as well as recommendations for donors and multilateral organisations.

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GENDER EQUITY, GENDER-BASED VIOLENCE, SCHOOL YOUTH, AND THEIR COMMUNITY

6. Intervention to Decrease School-Related Gender-Based Violence (SRGBV) in Katanga Province, DRC

DecreaseSRGBVC-Change is implementing a programme to reduce school-related gender-based violence (SRGBV) in 31 schools in Katanga Province in Democratic Republic of Congo (DRC). The programme: uses the USAID Safe Schools Doorways program in schools; has developed radio spots that confront harsh school discipline and attitudes about education for girls and air on several local radio stations in Swahili; has developed advocacy materials, including comic books; and has promoted the formation of student clubs and parent groups to address violence in the school, community, and home. The materials and radio spots are available for download on C-Hub.

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7. Gender Equality in Education: Resources from the Safe Schools Program: Pilot Phase

A number of resources, manuals, and publications were produced as part of the United States Agency for International Development (USAID) Safe Schools Program, which worked from September 2003 to November 2008 to reduce school-related gender-based violence in selected schools in Ghana and Malawi to support the longer-term goal of improving educational and health outcomes for girls and boys.

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8. "Vrai Djo" Project: Final Report

This July 2011 report shares an evaluation of "Vrai Djo", a behaviour change communication (BCC) campaign designed by the Search for Common Ground (SFCG) launched to promote positive male role models in the fight against sexual and gender-based violence (SGBV) in the Democratic Republic of the Congo (DRC). The aim of this campaign, which uses short films (public service announcements, or PSAs) featuring a DRC celebrity (Celeo Scram, "a superstar of Congolese music...[who] has not succumbed to negative temptations and his behaviour is considered to be exemplary for a Congolese music star") in order to contribute to a change in male attitudes towards more positive and constructive behaviour towards women. In short, the evaluation found that the "Vrai Djo" campaign has contributed to a change in male behaviour.

For more information on the Vrai Djo" ("Real Man") PSA Campaign, please click here.

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9. Stop Violence Against Girls in School Project

Launched by ActionAid and local partners in Ghana, Kenya, and Mozambique, this initiative uses a combined approach consisting of community-level initiatives, research, and advocacy to empower girls and reduce violence against girls in schools (VAGS). Project activities fall under 4 broad categories: creating girl-friendly environments; training and capacity building; raising awareness and campaigning; and advocating for change in policy and practice.

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10. The Girl Effect: What Do Boys Have to Do with It?

From October 5-6 2010, the International Center for Research on Women (ICRW) with support from the Nike Foundation convened a gathering of experts to share research and programmatic experiences of working to engage girls and boys as "change agents" for a more equitable world. This briefing note for that meeting explores "the girl effect", defined as "the unique potential of 600 million adolescent girls to end poverty for themselves and the world". Amongst the conclusions from the report: school-based and community-based programmes are the most common points of entry for adolescent programmes.

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COMMUNICATION FOR MALE CIRCUMCISION AND HIV PREVENTION

11. Communication Guide: Voluntary Medical Male Circumcision (VMMC)

VMCCC-Change worked with the Kenya National Task Force on Voluntary Medical Male Circumcision (VMMC) and developed a communication guide for Nyanza Province and communication materials (billboards, posters, videos, radio spots, fact sheets, dialogue cards, a handbook for community mobilisers, and more) for the rollout of the medical male circumcision programme in Nyanza Province in western Kenya. Download the materials and a video from C-Hub.

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12. Special Collection of Male Circumcision (MC) Communication

C-HubThe Special Collection of Male Circumcision (MC) Communication materials is available on C-Hub. It includes communication materials developed by the partners working on Voluntary Medical Male Circumcision (VMMC) communication in southern and eastern Africa, who participated in the September 2010 UNAIDS-PEPFAR Male Circumcision Communication Meeting in South Africa The materials promote MC as a proven HIV prevention intervention and have been used in Botswana, Kenya, Namibia, South Africa, Swaziland, Tanzania, and Zambia. The communication materials are in eight languages, with most in English and Swahili. Click here to access the materials.

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13. Southern and Eastern Africa Region Male Circumcision Communication Meeting: A Joint UNAIDS & PEPFAR Coordinated Meeting, September 22-24, 2010

From the United States Agency for International Development (USAID), the President's Emergency Plan For AIDS Relief (PEPFAR), and the Joint United Nations Programme on HIV/AIDS (UNAIDS), this report records the experience of the UNAIDS-PEPFAR Southern and Eastern Africa Region Male Circumcision (MC) Communication Meeting that brought together 117 health professionals from 14 countries in East and Southern Africa and international experts from Europe and North America. The meeting aimed to advance knowledge and to share promising experiences and communication materials for adolescent and adult MC in 3 key areas: demand creation, client counselling, and advocacy.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



FHI 360 has acquired the programmes, expertise, and assets of AED.



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks 21 - C-Modules and Tools for HIV Prevention

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Date: 
December 5, 2011

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 21 | December 5 2011

Subscribe to C-Picks
View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

C-Modules and Tools for HIV Prevention

C-Picks #21 features information about the online version of the C-Modules course (on SBCC) developed by C-Change. SBCC tools for practitioners engaged in HIV prevention activities are also highlighted.

The online C-Modules: A Learning Package for Social and Behavior Change Communication (SBCC) was launched in October in two versions–facilitated and self-paced–by C-Change and Ohio University. Available at no cost to participants, the self-paced course is designed for journalists, researchers, students, and government and non-governmental organisation (NGO) health and development practitioners. The goal of the 6-module course is to develop and strengthen organisational and individuals' competencies in planning, implementing, monitoring, and evaluating SBCC activities. To sign up for the self-paced course, click here.

Also featured from C-Change is the Community Conversation Toolkit for HIV Prevention, available in nine languages for use across seven countries in southern Africa, and three of C-Change's activities in Namibia. They include two campaigns on HIV prevention–one to reduce multiple concurrent partnerships and the other to reduce alcohol abuse–and a set of tools developed for a participatory quality improvement approach to strengthen the SBCC capacity of small to large organisations working in health.

A C-Change report on best practices and effective approaches in HIV prevention for sex workers and men who have sex with men (MSM) is informing C-Change programming in Jamaica and the Bahamas.




In This Issue

C-MODULES – COURSE ON SBCC

1. C-Change and Ohio U. Launch Online C-Modules Course

HIV COMMUNICATION: PROCESSES AND TOOLS FROM NAMIBIA

2. Break the Chain MCP Picture Codes

3. Stand Up Campaign in Namibia: Alcohol and HIV Prevention

4. C-Change Namibia's Approach to SBCC Capacity Strengthening: A Quality Improvement Process

5. AIDSTAR-One - Namibia's Prevention Planning Process: Successful Collaboration for a National Combination HIV Prevention Strategy

PREVENTING HIV AMONG VULNERABLE GROUPS

6. Community Conversation Toolkit for HIV Prevention

7. Global Best Practices: Effective Approaches to Inform SBCC Programming and Reduce HIV Risk (from C-Change)

8. Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico

9. Guidelines: Prevention and Treatment of HIV and Other Sexually Transmitted Infections among Men Who Have Sex with Men and Transgender People

10. Don't Stop Now, Finish the Job!: Making HIV Prevention Funding Work




C-MODULES – COURSE ON SBCC

1. C-Change and Ohio U. Launch Online C-Modules Course

Modules2

C-Change and Ohio University recently launched the C-Modules course on SBCC in two versions - facilitated online and self-paced online. The goal of the 6-module course is to develop and strengthen competencies in the planning, implementation, and monitoring and evaluation of SBCC activities. To enroll in the self-paced course or to find out more about future facilitated courses, click here. Visit the C-Change website for detailed information on the C-Modules and other SBCC tools that the project has developed to strengthen the capacity of organisations and individuals to carry out SBCC.

Modules

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HIV COMMUNICATION: PROCESSES AND TOOLS FROM NAMIBIA

2. Break the Chain MCP Picture Codes

BreakChainAs part of Break the Chain, a multi-channel, multi-level national SBCC campaign that addresses the practice of multiple and concurrent sexual partnerships (MCP), C-Change Namibia and Nawa Life Trust developed this multiple and concurrent sexual partnerships picture code flip chart. Field workers and volunteers in Namibia are using it to create conversations for behaviour change that focus on the drivers of the HIV epidemic in Namibia. The MCP picture codes generate discussion on the practices of multiple and concurrent sexual partnerships, cross-generational sex, transactional sex, and couples communication. Included in this resource are details about how a field worker or volunteer can use picture codes to address MCP. Suggestions are offered about how to get started, what kinds of questions to ask during a session, how to be a good listener, how to get everyone to participate, and organising sessions.

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3. Alcohol and HIV Picture Codes Flip Chart

AlcoholHIVProduced by C-Change/Namibia as part of the "Stand Up" Alcohol and HIV campaign in January 2010, this picture codes flip chart is designed for field workers and volunteers to create conversations for behaviour change that focus on the drivers of the HIV epidemic. Contents of the flip chart can form part of a comprehensive HIV behaviour change curriculum or be used as a stand-alone material.

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4. C-Change Namibia's Approach to SBCC Capacity Strengthening: A Participatory Quality Improvement Process for SBCC Programs and Group Sessions on HIV Prevention and in Any Health Area

QIApproachC-Change Namibia has developed tools and uses a participatory approach to assist organisations with improving the quality of their social and behaviour change communication (SBCC) programming for HIV prevention and any health area. The tools include two checklists and a recommendation form for use by quality improvement (QI) teams. The checklists are based on minimum quality standards for SBCC programmes in three areas: planning and design, implementation of group sessions and other activities, and monitoring and evaluation (M&E). A QI team employs these checklists during office visits and observational and support visits to group sessions, then comes to consensus on agreed-upon actionable recommendations on strengthening the programme.

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5. Namibia's Prevention Planning Process: Successful Collaboration for a National Combination HIV Prevention Strategy

This June 2011 study from the AIDS Support and Technical Assistance Resources, Sector I, Task Order 1 (AIDSTAR-One) explores how Namibia has employed a combination HIV prevention strategy that has been designed to overcome some of the hurdles experienced by other nations. According to the authors, Namibia's prevention planning process demonstrates a combination prevention approach:

  • By using evidence to target prevention activities addressing social, economic, and cultural drivers of transmission.
  • By including a combination of risk reduction approaches (biomedical, behavioural, and structural).
  • By linking programme participants to diagnostic and treatment services.
  • By engaging appropriate leaders and decision makers.
  • By strengthening capacity to manage prevention programmes.

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PREVENTING HIV AMONG VULNERABLE GROUPS

6. Community Conversation Toolkit for HIV Prevention

BreakChainThe Community Conversation Toolkit for HIV Prevention, developed by the C Change project and funded by USAID, comprises six materials (community mobilisers' cards, role-play cards, storytelling finger puppets, promotional proverbs and best kept secrets throw boxes, promotional playing cards, and dialogue buttons) along with a facilitator's guide and is used to mobilise communities for HIV Prevention. Languages include: Kikaonde, English, Oshiwambo, Ndebele, Chichewa, Portuguese, Sesotho, Siswati, and Zulu; local language versions for Zimbabwe, Zambia, Malawi, and Namibia are in the works.

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7. Global Best Practices: Effective Approaches to Inform SBCC Programming and Reduce HIV Risk (from C-Change)

Developed by C-Change in May 2011, this report provides an overview of good and emerging SBCC responses to the HIV prevention needs of sex workers and men who have sex with men (MSM) in the United States, sub-Saharan Africa, India, the Caribbean, and Latin America. "The programs and approaches highlighted exemplify the vast global experience that can inform successful SBCC HIV prevention programs....The first step is to fill some critical gaps by:

  • Developing a national SBCC strategy in each country that addresses the prevention and support needs of sex workers and MSM and provides a cohesive framework for organizations serving these populations;
  • Strengthening the capacity of civil society and Ministry of Health partners implementing SBCC-related prevention programs for sex workers and MSM;
  • Comprehensively addressing the deep levels of stigma these groups' experience;
  • Undertaking advocacy toward the decriminalization of sex work and buggery - moving beyond addressing individual knowledge and behaviors to creating an enabling environment for change;
  • Engaging MSM and sex workers in the development of programming and messages;
  • Addressing the psychosocial needs of MSM and sex workers; and
  • Exploring how communication channels such as the Internet and other social media can play a role in programming for most-at-risk populations..."

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8. Faith-Based Organizations and HIV Prevention with Most-at-Risk Populations in Mexico

From the Case Study Series from the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1), this May 2011 case study describes the work of 3 Mexican faith-based organisations (FBOs) that are reaching out to most at risk populations (MARPs) who may have been overlooked by traditional HIV prevention outreach. "MARPs and other vulnerable populations often engage in behaviors that are at odds with traditional religious teachings. Instead of using religious doctrine as justification to avoid or to shun MARPs and other vulnerable populations, the three FBOs mentioned use their faith as a motivation and means to reach marginalized populations. Sexuality is approached from a holistic perspective, integrated with faith, and interwoven with messages on HIV prevention and care."

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9. Guidelines: Prevention and Treatment of HIV and Other Sexually Transmitted Infections among Men Who Have Sex with Men and Transgender People

From the World Health Organization (WHO), this June 2011 document presents good practice recommendations that focus on ensuring an enabling environment for the recognition and protection of the human rights of MSM and transgender people. Communication-related recommendations include:

  • Establish anti-discrimination and protective laws.
  • Make health services inclusive, based on the principles of medical ethics and the right to health.
  • Offer HIV testing and counselling to MSM and transgender people, as well as community-based HIV testing and counselling linked to care and treatment.
  • Implement individual- and community-level behavioural interventions for the prevention of HIV and STIs among MSM and transgender people.
  • Offer targeted internet-based information to decrease risky sexual behaviours and increase uptake of HIV testing and counselling.
  • Use social marketing strategies to increase the uptake of HIV/STI testing and counselling and HIV services.
  • Implement sex venue-based outreach strategies to decrease risky sexual behaviour and increase uptake of HIV testing and counselling.
  • Provide MSM and transgender people who engage in harmful alcohol or other substance use with access to evidence-based brief psychosocial interventions involving assessment, specific feedback, and advice.

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10. Don't Stop Now, Finish the Job!: Making HIV Prevention Funding Work

This April 2011 paper establishes the International HIV/AIDS Alliance What's Preventing Prevention? campaign. The paper calls on international donors to: (i) recommit to Universal Access by 2015 and strengthen country reporting; (ii) invest in rights-based, evidence-informed HIV prevention programmes for and with key populations - "including through the Global Fund (e.g. the 'Most-at risk populations (MARPs) channel') and similar mechanisms..."; and (iii) fund country-owned HIV programmes with meaningful involvement of key populations.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



FHI 360 has acquired the programmes, expertise, and assets of AED.



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks 20 - SBCC to Prevent HIV, Change Gender Norms, and Improve Women's Health

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Date: 
October 12, 2011

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 20 | October 12 2011

Subscribe to C-Picks
View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

SBCC to Prevent HIV, Change Gender Norms, and Improve Women's Health

C-Picks #20 highlights communication tools, strategies, and interventions that aim to change individual behaviours and the larger social context in order to prevent HIV, change gender norms, and improve reproductive and maternal health. Strengthening the capacity of local organisations to carry out SBCC is a critical component.

The tools include those developed by C-Change in Namibia, where the project developed A Participatory Quality Improvement Process for SBCC Programs in HIV Prevention and Any Health Area for use with local organisations that design, implement, and monitor health interventions; and C-Change's Community Conversation Toolkit for HIV Prevention (in Siswati) for use in Swaziland. This tool to mobilise communities for HIV prevention has been adapted to different cultural contexts and local languages across Southern Africa. This version and the other language versions of the toolkit are available on C-Hub ( #7948, #8007, #8008, #8009, #8010, #8012 and #8013). Other tools highlighted in this issue include the Gender Scales Compendium, developed by C-Change to assess gender-related attitudes and beliefs and evaluate the success of interventions incorporating gender approaches.




Trouble reading this edition? View it online - http://www.comminit.com/c-change-picks/c-picks-20.html

In This Issue

PARTICIPATORY HIV PREVENTION TOOLS

1. C-Change Namibia's Approach to SBCC Capacity Strengthening: A Participatory Quality Improvement Process for SBCC Programs and Group Sessions on HIV Prevention and in Any Health Area

2. Community Conversation Toolkit for HIV Prevention (in Siswati /Swaziland)

GENDER TRANSFORMATION: ASSESSMENT AND COMMUNICATION TOOLS

3. Compendium of Gender Scales

4. Engaging Boys and Men in Gender Transformation: A Spiritual Supplement for Facilitating the Men As Partners® Group Education Manual in Christian Settings

5. Engaging Boys and Men in Gender Transformation: The Group Education Manual

SBCC TO IMPROVE REPRODUCTIVE AND MATERNAL HEALTH

6. Challenge and Change: Integrating the Challenge of Gender Norms and Sexuality in a Maternal Health Program

7. Influence of Gender Measures on Maternal and Child Health in Africa

8. The Women, Girls, and Gender Equality Principle of the U.S. Global Health Initiative (GHI): Assessment of the GHI Plus Country Strategies

9. Synchronizing Gender Strategies: A Cooperative Model for Improving Reproductive Health and Transforming Gender Relations




PARTICIPATORY HIV PREVENTION TOOLS

1. C-Change Namibia's Approach to SBCC Capacity Strengthening: A Participatory Quality Improvement Process for SBCC Programs and Group Sessions on HIV Prevention and in Any Health Area

Compendium C-Change Namibia has developed tools and uses a participatory approach to assist organisations with improving the quality of their social and behaviour change communication (SBCC) programming for HIV prevention and any health area. The tools include two checklists and a recommendation form for use by quality improvement (QI) teams. The checklists are based on minimum quality standards for SBCC programmes in three areas: planning and design, implementation of group sessions and other activities, and monitoring and evaluation (M&E). A QI team employs these checklists during office visits and observational and support visits to group sessions, then comes to consensus on agreed-upon actionable recommendations on strengthening the programme. Visit C-Hub to download.

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2. Community Conversation Toolkit for HIV Prevention

Compendium The Community Conversation Toolkit for HIV Prevention (Swaziland version), developed by the C Change project and funded by USAID, comprises six materials (community mobilisers' cards, role-play cards, storytelling finger puppets, promotional proverbs and best kept secrets throw boxes, promotional playing cards, and dialogue buttons) along with a facilitator's guide and is used to mobilise communities for HIV Prevention. Translated into Siswati from a version originally developed in South Africa, it is launching October 2011.

Pretested with intended audiences and in close consultation with National Emergency Response Council on HIV/AIDS (NERCHA) and local implementing partners, the toolkit was adapted by: using local Siswati proverbs for the throwbox; revising artwork to depict the local Swazi context; adding components to the toolkit that address male circumcision and condom use; and integrating existing resources from local partners. Swaziland is the sixth country in Southern Africa to adapt the toolkit, which seeks to address key drivers of the epidemic (e.g., concurrency, cross-generational sex, gender-based violence, and alcohol abuse).


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GENDER TRANSFORMATION: ASSESSMENT AND COMMUNICATION TOOLS

3. Compendium of Gender Scales

Compendium Developed by C-Change under the United States Agency for International Development (USAID)'s direction, this is a tool to assess gender-related attitudes and beliefs and evaluate the success of interventions incorporating gender approaches. The Compendium comprises eight scales that measure beliefs, attitudes, and practices relating to issues such as couples communication, decision-making about sex, household and parental responsibilities, gender-based violence, and societal acceptance of inferior roles for women and girls.

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4. Engaging Boys and Men in Gender Transformation: A Spiritual Supplement for Facilitating the Men As Partners® Group Education Manual in Christian Settings

This July 2011 manual from EngenderHealth and LifeLine/ChildLine with funding support from the United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) was created to: 1) stimulate conversation and deeper reflection on topics from the Men As Partners® (MAP) Group Education Manual with Christian audiences, 2) promote gender transformation through biblical and spiritual discussion, 3) support facilitators in dealing with difficult questions, of a religious or spiritual nature, from training participants, and 4) give facilitators religious and spiritual justifications for gender equity and equality.

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5. Engaging Boys and Men in Gender Transformation: The Group Education Manual

From EngenderHealth's ACQUIRE project and Promundo, this is an educational manual for working with men to question non-equitable views about masculinity and develop more positive attitudes to prevent unhealthy behaviours that put them and their partners and families at risk. It can also be used to train facilitators who will implement workshop activities with groups of men. Published in January 2011, the manual highlights the importance of linking educational activities to action.

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SBCC TO IMPROVE REPRODUCTIVE AND MATERNAL HEALTH

6. Challenge and Change: Integrating the Challenge of Gender Norms and Sexuality in a Maternal Health Program

This April 2011 report from the non-governmental organisations (NGOs) CARE and the International Center for Research on Women (ICRW) documents some of the processes undertaken to integrate gender and sexuality factors into a maternal and neonatal health (MNH) project in Uttar Pradesh, India. The behaviour change communication (BCC) initiative used interpersonal communication (IPC) and community participation strategies in an effort to spark change. One recommendation that emerged from the training workshops with all project and partners staff: "find ways to increase communication between spouses to foster a more enabling environment for change....In addition to working directly with husbands to increase their knowledge and enhance their attitudes and behaviour with regard to health and gender issues, some MNH staff felt that the program needed more community-level components of social change interventions - to bring the debate about men's role in MNH care and gender relations to the whole community. They believed that addressing these issues at a community level as well as in smaller groups (e.g., through VHSCs [village health and sanitation committees], mothers' committees and home visits) would make the interventions more effective."

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7. Influence of Gender Measures on Maternal and Child Health in Africa

From MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), this August 2011 report explores the associations between gender measures and several maternal and child health (MCH) outcomes in Africa. It "focuses on areas of gender equality known to affect health outcomes for women and children which are available in the DHS data, specifically, women's autonomy within the context of household and financial decision making and social norms regarding attitudes towards wife beating and refusing sex...That gender equity measures were significant in some countries, even after controlling for education and wealth, suggests that programs and policy should facilitate empowerment in addition to focusing on educating girls and reducing poverty."

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8. The Women, Girls, and Gender Equality Principle of the U.S. Global Health Initiative (GHI): Assessment of the GHI Plus Country Strategies

This June 2011 report from the Kaiser Family Foundation (KFF) assesses how countries are responding to a United States (US) Global Health Initiative (GHI) principle that addresses women, girls, and gender equality. One of the principle's 10 key elements includes utilising multiple community-based programmatic approaches, such as behaviour change communication (BCC), community mobilisation, advocacy, and engagement of community leaders/role models to improve health for women and girls. The research found that: "Some of the country strategies went beyond viewing women and girls only as beneficiaries of health services, focusing on them as actors and decision-makers and/or on changing gender norms. These strategies addressed the broader gender issues that impact women's and girls' health..."

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9. Synchronizing Gender Strategies: A Cooperative Model for Improving Reproductive Health and Transforming Gender Relations

This concept paper, published in September 2010, explores gender integration approaches to sexual and reproductive health programmes and policies developed by the RESPOND project at EngenderHealth and the BRIDGE Project at the Population Reference Bureau (PRB) in consultation with the Interagency Gender Working Group (IGWG) of the United States Agency for International Development (USAID). The document raises the following question: "Can gender inequities and norms that harm health be best addressed by working with men and women in a coordinated or synchronized way?" It includes case studies of organisations from Peru, Ethiopia, South Africa, Senegal, Brazil, and India to illustrate 3 types of programmes as well as other organisations currently doing innovative work in this field. The study suggests that gender synchronised programmes view all actors in society in relation to each other and seek to identify or create shared values among women and men, within the range of roles they play (i.e., mothers-in-law, fathers, wives, brothers, caregivers, and so on) - values that promote human rights, mutual support for health, non-violence, equality, and gender justice. One example of how gender synchronisation may improve development and health outcomes: An intervention for women combining a microfinance programme with participatory training on understanding HIV infection, gender norms, domestic violence, and sexuality and treatment improved its results by electing and training female leaders to engage men to address male norms related to gender and HIV, holding events with village chiefs, police, schools, and soccer clubs.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



FHI 360 has acquired the programmes, expertise, and assets of AED.



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks 19 - Addressing HIV Vulnerability in Comprehensive Ways

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Date: 
August 8, 2011





C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 19 | August 8 2011

Subscribe to C-Picks
View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

Addressing HIV Vulnerability in Comprehensive Ways

C-Picks #19 highlights C-Change's work in HIV prevention among youth and young adults in Nigeria and the Democratic Republic of the Congo (DRC): a recent report on the HIV-related knowledge, attitudes, beliefs, and practices of young Nigerians in two states; and messages developed with C-Change's technical assistance in the DRC for radio and TV shows that are popular with young audiences.

The issue includes articles on tools and strategies that address vulnerability and HIV risk associated with excessive alcohol consumption and gender-based violence. One of these tools, an alcohol and HIV flip chart, was developed in Namibia with assistance from C-Change. C-Picks 19 also includes articles that detail combination prevention and structural approaches used to reduce HIV stigma and vulnerability. An AIDSTAR-One case study describes a number of integrated family planning and HIV prevention programmes that are leading the way in Kenya and Ethiopia.





Trouble reading this edition? View it online - http://www.comminit.com/c-change-picks/c-picks-19.html

In This Issue

ADDRESSING HIV VULNERABILITY AMONG YOUNG ADULTS AND YOUTH

1. HIV-Related Knowledge, Attitudes, Beliefs, and Practices of Young People in Cross River State and Kogi State, Nigeria

2. HIV Prevention Messages for Radio and TV Programs Popular with Youth in DRC

STRATEGIES THAT ADDRESS THE HIV RISK OF ALCOHOL CONSUMPTION AND GENDER-BASED VIOLENCE

3. Alcohol and HIV Picture Codes Developed by C-Change Namibia

4. Alcohol Consumption and HIV Risk: A Peer Education Strategy for Bar Patrons

5. Preventing Gender-Based Violence & HIV: Lessons from the Field

INTEGRATED SERVICES AND STRUCTURAL APPROACHES TO HIV PREVENTION

6. Integration of Family Planning and HIV Services: Programs in Ethiopia and Kenya Lead the Way

7. The Avahan-India AIDS Initiative: Promising Approaches to Combination HIV Prevention Programming in Concentrated Epidemics

8. Structural Interventions: An Overview of Structural Approaches to HIV Prevention

ADDRESSING STIGMA: LESSONS FROM AFRICA

9. Integrating Stigma Reduction into HIV Programming: Lessons from the Africa Regional Stigma Training Programme

10. Food Secure and HIV-Positive in Ethiopia (the Breedlove Project)

11. Stigma in the Balance: Ensuring the Roll-Out of ART Decreases Stigma




HIV PREVENTION FOR YOUNG ADULTS AND YOUTH

1. HIV-Related Knowledge, Attitudes, Beliefs, and Practices of Young People in Cross River State and Kogi State, Nigeria

HIV K,A,P C-Change issued a recent report on HIV-related knowledge, attitudes, beliefs, and practices of young people in two states in Nigeria, based on focus group discussions and in-depth interviews with more than 1,200 secondary and university students and out-of-school youth. Interviews and discussions centred on youth lifestyles and risky behaviours, information and misconceptions about HIV, media habits, and recall of youth-focused HIV prevention messages and programmes. The report notes risk factors that need to be addressed and makes recommendations on communicating with youth about HIV prevention.

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2. HIV Prevention Messages for Radio and TV Programs that Target Youth in DRC

DRC Students In the Democratic Republic of the Congo (DRC), C-Change is providing technical assistance in social and behaviour change communication (SBCC) to Search for Common Ground (SFCG), which produces informative and entertaining radio and TV programmes that address current issues and are popular with young people. C-Change assisted SFCG's local staff to develop messages that support HIV prevention, including by changing attitudes and behaviours and countering stigma and discrimination. Using the C-Modules, C-Change is also providing training to strengthen and sustain the capacity of SFCG's local staff to apply SBCC principles in their media work. Audio and video clips of the SFCG programmes, along with descriptive information, are available on C-Hub: 7966, 7967, 7968, and 7969.

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STRATEGIES THAT ADDRESS THE HIV RISK OF ALCOHOL CONSUMPTION AND GENDER-BASED VIOLENCE

3. Alcohol and HIV Picture Codes Developed by C-Change Namibia

Alcohol Flip ChartC-Change Namibia contributed to the development of a flip chart on alcohol and HIV, used by field workers and volunteers to create conversations on alcohol as a driver of HIV and promote behaviour change. The flip chart can be used as part of a comprehensive HIV behaviour change curriculum or as a stand-alone tool. Each page has a photo on the front and text on the back. After showing one of the photos to a small group or an individual, the facilitator asks open-ended questions and leads the conversation, referring to the text and summarised talking points. The flip chart and a fact sheet on the campaign can be downloaded from C-Hub.


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4. Alcohol Consumption and HIV Risk: A Peer Education Strategy for Bar Patrons

From October 2010, this case study explores the process and impact of the Collaborative HIV/STD [sexually transmitted disease] Prevention Trial, a 5-year research intervention that sought to study alcohol consumption and risky sex among male patrons of wine shops in the city of Chennai, in South India. The behaviour change communication (BCC) initiative involved identifying, recruiting, and training peer outreach workers called Community Popular Opinion Leaders (CPOLs), who communicated messages about safer sexual behaviour through informal, yet structured, one-on-one conversation with their peers, with the hope of preventing HIV. The case study includes details about what worked well in this project - for example, messaging focused on risk reduction rather than risk elimination, and peer-led delivery of personal messages ("I statements") to encourage change - as well as challenges that were encountered. Recommendations and future programming directions are presented. For more information about the Collaborative HIV/STD Prevention Trial, please click here.

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5. Preventing Gender-Based Violence & HIV: Lessons from the Field

This October 2010 brief describes the strategies of two organisations that have tackled the challenge of combining HIV and gender-based violence (GBV) prevention: Puntos de Encuentro in Nicaragua and Raising Voices in Uganda. An integrated strategy to address GBV in the context of HIV involves strategies such as advocacy and interpersonal communication (e.g., training providers to identify women living with violence and to respond with appropriate care and referrals). Lessons learned include:

  • To change attitudes, the issues of GBV and HIV must become real for people. In other words, to internalise the links between GBV and HIV, one must perceive and critically think about the benefits and consequences for him- or herself and the surrounding community, rather than think about them as distant societal problems.
  • Get people to focus on what they can do instead of what they cannot do - looking at the strength in people and the assets in the community, rather than focusing on the problem alone.
  • One source - be it a television show or workshop - is not enough to get people to take action. Both Puntos de Encuentro and Raising Voices support activists to spread messages about human rights in relation to sexual health, including GBV, in schools, in the media, in religious institutions, and in venues in the community on a long-term basis.

 

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INTEGRATED SERVICES AND STRUCTURAL APPROACHES TO HIV PREVENTION

6. Integration of Family Planning and HIV Services: Programs in Ethiopia and Kenya Lead the Way

This March 2011 case study from the United States Agency for International Development (USAID)'s AIDSTAR-One programme explores integration of family planning (FP) and HIV services as a promising strategy to prevent transmission of HIV - with a focus on how this strategy has been realised in Kenya and Ethiopia. Things that have worked well in terms of integration include: facilitated referrals (e.g., use of referral forms by community health workers), health worker training, the linkage of clinic- and community-based services, and government support. One core recommendation is to address male norms and behaviours - for example, by (in Kenya), holding "Men's Clinics" on weekends, where men are educated about HIV and other health issues and are given the option to be tested for HIV. "Though the integration models used in programs observed in Kenya and Ethiopia are different, what they have in common is a holistic understanding of an individual's health needs. This understanding is passed on to frontline workers who take the time to ask, listen, and act on a client's health needs, both expressed and observed."

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7. The Avahan-India AIDS Initiative: Promising Approaches to Combination HIV Prevention Programming in Concentrated Epidemics

This March 2011 case study describes the behavioural, biomedical, and structural components of the Avahan-India HIV prevention programme, launched by the Bill and Melinda Gates Foundation in 2003 as part of a plan to work with existing government interventions in 6 Indian states. Avahan "has successfully built a comprehensive prevention program that combines the most effective responses to the multiple and complex needs of most-at-risk populations (MARPs)", including female sex workers, men who have sex with men (MSM), transgender people, injecting drug users (IDUs), and truckers and their helpers. Interventions include: peer-led outreach to promote behaviour change, clinical services to treat sexually transmitted infections (STIs), condom social marketing and distribution of free condoms, distribution of clean needles and syringes, support for community mobilisation, and advocacy to reduce structural barriers to safer sexual practices. Over the entire project, more than 80% of male clients of female sex workers reported condom use at last sex with a sex worker; as of May 2007, that represented a 35% increase from a year earlier. The case study concludes with recommendations for implementers, such as securing good evidence for programming and addressing the social and cultural context that may contribute to or hinder a project's success.

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8. Structural Interventions: An Overview of Structural Approaches to HIV Prevention

This March 2011 resource provides information about, and links to, research and tools for those seeking to find what works in HIV prevention. The introductory section explains that structural approaches reduce an individual's HIV-related vulnerability by creating the conditions in which people can adopt safer behaviours. Strategies for categorising structural approaches detailed here include: (i) Social change: These approaches focus on factors affecting multiple groups (e.g., a region or country as a whole), such as legal reform, stigma reduction, and efforts to cultivate strong leadership on AIDS; (ii) Change within specific groups: These approaches address social structures that create vulnerability among specific populations, such as men who have sex with men, mine workers, young women, or economically poor women. Examples include efforts to organise and mobilise sex workers, and interventions to change harmful male norms; and (iii) Harm reduction or health-seeking behaviour change: These approaches work to make harm-reduction technologies available to those in need and to change rules, services, and attitudes about these technologies.

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ADDRESSING HIV STIGMA: LESSONS FROM AFRICA

9. Integrating Stigma Reduction into HIV Programming: Lessons from the Africa Regional Stigma Training Programme

This April 2011 document illustrates lessons learned from implementing the toolkit "Understanding and Challenging HIV Stigma across Africa". The most common approach has been through the incorporation of stigma exercises into training courses or workplace and community activities. However, there are also examples of how stigma reduction has been integrated into policies, throughout programmes, and how it has led to national government interventions to understand structural issues around stigma. The overall results show that creating opportunities for greater awareness and understanding of stigma is the first step to changing it; strategies to then scale up the change, through integration at different levels, can have real impact.

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10. Food Secure and HIV-Positive in Ethiopia (the Breedlove Project) - Ethiopia

The Breedlove Project integrates HIV programming (treatment and prevention of mother-to-child transmission (PMTCT) of HIV) with nutrition programming to address short-term and long-term needs of families and households in Ethiopia. The monthly coffee ceremony aspect of the project might take place in, for example, the antiretroviral therapy (ART) unit of a hospital in Addis Ababa. As women arrive for the discussion, they note that the reception area is transformed - condoms and pamphlets are swept off the table to make way for a colourful tablecloth, a bowl of flowers, and a pot of coffee. The group discusses issues such as stigma and the lies people tell to their own neighbours and family members to avoid the shame and discrimination of living with HIV in Ethiopian society.

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11. Stigma in the Balance: Ensuring the Roll-Out of ART Decreases Stigma

This policy briefing paper, published in April 2011 by Evidence for Action, draws on findings from qualitative research carried out against the backdrop of a longitudinal cohort study in a semi-rural area of North Tanzania. It explores the impact of ART on stigma and outlines recommendations for decreasing stigma during ART roll-out, such as: increasing visibility of people living with HIV to help increased "normalisation" of HIV and reduce self-stigma, training, reducing fear-related stigma, and involving all key stakeholders.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com


SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



FHI 360 has acquired the programmes, expertise, and assets of AED.




Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks




Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org


The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com

C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.


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C Picks 18 - Focus on Family Planning Communication Strategies and HIV Prevention Programmes Targeting Men

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Date: 
June 6, 2011

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 18 | June 6 2011

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View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

Focus on Family Planning Communication Strategies and HIV Prevention Programmes Targeting Men

C-Picks #18 highlights the implementation of national family planning/reproductive health (FP/RH) communication strategies. C-Change provided technical assistance in Malawi and Kenya to help the governments operationalise FP/RH communication strategies at national and district levels. In Malawi, C-Change provided technical support to the Ministry of Health's Health Education Unit, which led a participatory process with partners to develop the Guidelines for Family Planning Communication, and assisted its rollout to the district level. In Kenya, in collaboration with the Division of Reproductive Health of the Ministry of Public Health and Sanitation and partners, C-Change developed the Reproductive Health Communication Strategy Implementation Guide. Its purpose is to ensure coordination of SBCC in RH programming and to assist partners in operationalising the strategy throughout Kenya. USAID provided funding for these efforts.

The issue continues with examples of social and behaviour change communication (SBCC) initiatives and evaluations in the context of HIV prevention, men, and combating stigma. These include the Voluntary Medical Male Circumcision Communication Toolkit rolled out in Kenya by C-Change and partners; a report by C-Change on approaches to inform SBCC implementation and reduce HIV risk for sex workers and men who have sex with men (MSM) in Jamaica and The Bahamas; and six other initiatives and evaluations around this theme. The issue concludes with a description of two initiatives that integrate edutainment strategies into SBCC efforts for HIV prevention in Zambia and Africa-wide.



Trouble reading this edition? View it online - http://www.comminit.com/c-change-picks/c-picks-18.html

In This Issue

IMPLEMENTING PARTICIPATORY FP/RH SBCC STRATEGIES at the NATIONAL LEVEL

1. Malawi - Guidelines for Family Planning Communication

2. Kenya - Reproductive Health Communication Strategy Implementation Guide

GENDER TRANSFORMATION: ASSESSMENT AND COMMUNICATION TOOLS

3. Voluntary Medical Male Circumcision Communication Toolkit

4. Global Best Practices: Effective Approaches to Inform SBCC Programming and Reduce HIV Risk for Sex Workers and MSM in Jamaica and The Bahamas

5. Promoting New Models of Masculinity to Prevent HIV among Men Who Have Sex with Men in Nicaragua

6. You're the Man/Kenya

7. Communication Challenges in HIV Prevention: Multiple Concurrent Partnerships and Medical Male Circumcision

8. Homosexuality and Homophobia in Senegalese Media Content and Analysis

9. Protection: A Film About Men and Condoms in the Time of HIV and AIDS

10. Lessons from the Front Lines: Effective Community-Led Responses to HIV and AIDS among MSM and Transgender Populations

ENTERTAINING STRATEGIES TO PREVENT HIV

11. Club Risky Business: A Zambian Television Series Challenges Multiple and Concurrent Sexual Partnerships through the One Love Kwasila! Campaign

12. It Begins with You


IMPLEMENTING PARTICIPATORY FP/RH SBCC STRATEGIES at the NATIONAL LEVEL

1. Malawi - Guidelines for Family Planning Communication

Malawi – Guidelines for Family Planning Communication
C-Change provided technical support to development of Malawi's Guidelines for Family Planning Communication. The guidelines were developed in a participatory process by the Task Force on Family Planning Communication, led by Malawi's Health Education Unit. The document provides the framework for family planning communication programmes in the country and supports the objective of the National Reproductive Health Strategy: to promote through informed choice, safer reproductive health practices by men, women, and young people, including increased use of high-quality, accessible reproductive health services.



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2. Kenya - Reproductive Health Communication Strategy Implementation Guide

Kenya - Reproductive Health Communication Strategy Implementation Guide

The Reproductive Health Communication Strategy Implementation Guide provides the broad framework for communications that supports the implementation of Kenya's National Reproductive Health (RH) Strategy. This implementation guide seeks to facilitate the coordinated and systematic roll-out of the strategy at all levels and to stimulate dialogue. The guide also seeks to build and sustain institutional and multisectoral support towards the achievement of the Government of Kenya's RH/FP goals, through advocacy, behaviour change, and social mobilisation.

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BEHAVIOUR CHANGE: MEN and SEXUAL HEALTH

3. Voluntary Medical Male Circumcision Communication Toolkit

Voluntary Medical Male Circumcision Communication ToolkitDeveloped by C-Change and published in September 2010 as part of the Male Circumcision Task Force, this Toolkit provides a series of materials that build on Kenya's national communication strategy for voluntary medical male circumcision (VMMC) and guide its implementation in Kenya's Nyanza province. The guide follows the structure and sequence of C-Planning, a communication process used by C-Change. The kit includes, in PDF format: the guide, messages to various stakeholder leaders, a mobilisers' handbook, 3 posters, and a leaflet. C-Change emphasises that information be tailored to specific audiences. In addition, emphasis is placed on developing materials to address different information needs at different stages in the behaviour change process.

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4. Global Best Practices: Effective Approaches to Inform SBCC Programming and Reduce HIV Risk for Sex Workers and MSM in Jamaica and The Bahamas

Global Best Practices This report on Global Best Practices to inform social and behaviour change communication (SBCC) programming in Jamaica and the Bahamas provides an overview of good and emerging SBCC responses to the HIV prevention needs of sex workers and men who have sex with men (MSM) from programmes in the United States, sub-Saharan Africa, India, Caribbean, and Latin America. The information is intended to support the design of programmes in Jamaica and the Bahamas and to inform the global knowledge-base for the development of SBCC strategies addressing these populations. C-Change will apply the findings from this report towards the provision of SBCC technical assistance to Government and civil society partners to improve the quality and reach of their response with these vulnerable populations.

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5. Promoting New Models of Masculinity to Prevent HIV among Men Who Have Sex with Men in Nicaragua

From the Case Study Series from USAID's AIDSTAR-One, this March 2011 case study describes the work of Nicaragua's Centro para la Prevención y Educación del SIDA (CEPRESI). It explores the strategies, successes, and challenges associated with CEPRESI's efforts to change perceptions of masculinity among the general population of Nicaragua - where societal norms stigmatise same-sex sexual activity and favour conformity to strict gender roles - and to educate MSM on HIV prevention and treatment. To cite one example, CEPRESI implements outreach activities for MSM to promote sexual behavioural changes in community-based settings, social networks, and community spaces. What has worked well: addressing the social drivers of HIV among MSM, combining large- and micro-scale interventions, recruiting and training sensitive and representative staff, collecting and using data for programme management and advocacy, and disseminating promising practices in the region.

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6. You're the Man - Cambodia

Launched by Family Health International (FHI) in 2009, this competitive television (TV) reality show aims to respond to the lack of HIV prevention programming for young men in Cambodia. The initiative was designed to address the challenge young men face to live up to competing models of what it means to be a real man: a strong commitment to the male social group, including heavy drinking and commercial sex, but also the masculine concepts of responsibility to the family, to female partners, and to leadership.

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7. Communication Challenges in HIV Prevention: Multiple Concurrent Partnerships and Medical Male Circumcision

This briefing note, published by Panos' Global AIDS Programme, presents a summary of findings from a pilot research project in Uganda in 2009. The broad objectives of the research were to: examine how contemporary communication approaches on HIV prevention, specifically multiple concurrent partnerships (MCP) and medical male circumcision (MMC); address social and structural drivers; and stimulate debate on some of the key communication challenges around HIV prevention. The findings suggest that there is a need to complement any roll-out of programmes on MCP and MMC with social communication programming that addresses the structural and social drivers of HIV. Technical interventions which do not take into account these social dimensions of HIV may not be very effective.

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8. Homosexuality and Homophobia in Senegalese Media Content and Analysis

This study, coordinated by Panos Institute West Africa in collaboration with the SAHARA Programme (Social Aspects of HIV/AIDS & Health Research Alliance) looks at how the Senegalese media is handling issues of homosexuality and homophobia, specifically analysing representations of homosexuals and the manner in which they are constructed by the media, as well as the media's positive or negative role in "discrimination against these persons". The results of the study will be used to strengthen media professionalism and responsibility in reporting on homosexual issues in a way that does not discriminate or stigmatise. It also seeks to propose recommendations that will form the basis of further debate and possible advocacy actions.

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9. Protection: A Film About Men and Condoms in the Time of HIV and AIDS

Produced by Sonke Gender Justice and Fireworx Media, this October 2010 documentary explores the ways in which men and boys in South Africa, Kenya, and Sierra Leone relate to and experience condom use. Accompanied by a facilitator's guide, the film explores why correct and consistent condom use remains a challenge for many men across the continent, despite the fact that condoms are widely available. The guide also suggests different ways to utilise the film and lists questions that can help focus discussion after viewings.

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10. Lessons from the Front Lines: Effective Community-Led Responses to HIV and AIDS among MSM and Transgender Populations

This July 2010 report from amfAR, The Foundation for AIDS Research, in partnership with The Global Forum on MSM & HIV (MSMGF), profiles efforts by small, grassroots community-based organisations worldwide that are leading work to provide HIV prevention, education, care, support, and advocacy services to men who have sex with men (MSM) and transgender people. Outlined here are recommendations highlighting major issues - among them, stigma and discrimination, resource needs, and the inclusion of MSM and transgender groups in planning and decision making - that must be addressed to ensure an effective and sustained community-based response to HIV among MSM and transgender people.

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ENTERTAINING STRATEGIES TO PREVENT HIV

11. Club Risky Business: A Zambian Television Series Challenges Multiple and Concurrent Sexual Partnerships through the One Love Kwasila! Campaign

This December 2010 report, published by AIDSTAR-One, presents an interactive case study of the 10-episode television programme Club Risky Business, broadcast on Zambian television in 2009. The series examined multiple and concurrent sexual partnerships (MCP) through the engaging stories of 3 male friends and their partners in the age of HIV; each lead character reflected attitudes and behaviours that formative research revealed to be common among men in Zambia. Anecdotal evidence suggests that the TV programme, which which was accompanied by a 6-month multimedia campaign, achieved broad penetration among the intended audience. Feedback also suggests that the series broke the silence around MCP, with viewers across age, gender, and socio-economic status eager to talk about how MCP affects them personally.

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12. It Begins with You

Launched by the 41 member companies of the African Broadcast Media Partnership Against HIV/AIDS (ABMP), It Begins With You is a pan-African HIV-public education campaign. Under the theme of "Imagine the Possibility of an HIV-Free Generation", the multi-year campaign uses targeted radio and TV public service advertisements (PSAs) and other complementary programming to encourage all Africans to consider what they can do as individuals, families, communities, and nations to stop the spread of HIV/AIDS. The campaign aims to use an inspirational/motivational creative approach. With the primary focus on young people and young women in particular, subsequent phases of the campaign aim to concentrate more specifically on the principal behaviours and attitudes, as well as social and economic factors, that drive the spread of HIV among these groups, including: gender inequity, sexual coercion (forced sex), AIDS stigma, and cultural taboos. C-Change provided technical assistance to ABMP on social and behaviour change communication and preventing-the-mother-to-child-transmission of HIV (PMTCT).

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com


SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).


FHI 360 has acquired the programmes, expertise, and assets of AED.


Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com

C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C Picks 17 - SBCC and Family Planning and HIV Case Studies, Briefs, Guides, and Tools

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Date: 
April 4, 2011

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 17 | April 4 2011

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View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

SBCC and Family Planning and HIV Case Studies, Briefs, Guides, and Tools

C-Picks #17 opens with a focus on two C-Change family planning projects - one in Albania that used SBCC (including mass media and peer education) to increase awareness and uptake of modern contraceptives among young adults; and one in Kenya that used mass media, billboards, posters and materials distributed at local health facilities to promote child spacing and informed choice of modern contraceptives. Also featured in this issue is C-Change's updated SBCC Capacity Assessment Tool (SBCC-CAT), in two versions (for organisations and donor/networks) for use in workshop and meeting venues together with a facilitator, to determine competencies in design, implementation, and monitoring and evaluation (M&E) of health and development SBCC programmes across five areas: 1) SBCC Situation Analysis, 2) SBCC Strategy Development, 3) SBCC Materials Development, 4) SBCC Implementation, and 5) SBCC M&E.

This issue continues with an article examining the use of mobile technologies for family planning, and several case studies on the integration of family planning and HIV prevention programming. Three resources on messaging and tools to address social norm behaviours and gender equity issues follow, with a final focus on four resources which can be used to support community SBCC processes, including the Community Conversation Toolkit for HIV Prevention.




Trouble reading this edition? View it online - http://www.comminit.com/c-change-picks/c-picks-17.html

In This Issue

C-CHANGE - SBCC TOOLS AND FAMILY PLANNING CAMPAIGNS

1. Improving Access to and Use of Modern Contraceptive Methods - C-Change/Albania

2. Family Planning Media Campaign - C-Change/Kenya

3. SBCC Capacity Assessment Tool (SBCC-CAT) – C-Change

SBCC, FAMILY PLANNING, AND MOBILE TECHNOLOGIES

4. Family Planning Through the Mobile Phone in India

INTEGRATING FAMILY PLANNING AND HIV

5. Addressing Norms and Behaviours Through Integration in Ethiopia and Kenya

6. Community Discussions to Raise Awareness and Rally Advocacy in Malawi

7. Interpersonal Communication and Mass Media Messaging in Zimbabwe

SBCC, SOCIAL NORMS, AND GENDER EQUITY

8. Paying Attention to Sociocultural, Economic, and Political Contexts in Southern Africa

9. Creating or Finding Community Activists To Spread Messages Is Key

10. IEC Tools for Community Based Volunteers and Community Prevention Mobilisers

SBCC, SOCIAL NORMS, AND GENDER EQUITY

11. Community Conversation Toolkit for HIV Prevention

12. Peer Education in India

13. A Community Dialogue Guide on Relationships with a Focus on MCP

14. Facilitator's Guide for Training on HIV and AIDS Stigma and Discrimination Reduction




C-CHANGE - SBCC TOOLS AND FAMILY PLANNING CAMPAIGNSS

1. Albania Family Planning: Improving Access to and Use of Modern Contraceptive Methods

Compendium This report presents findings of an evaluation survey of C-Change social and behaviour change interventions in Albania to promote modern family planning methods. It assessed the impact of a peer education programme for young university students at four urban campuses in Albania, along with a concurrent mass media campaign. The study found that sexually active students exposed to the peer education programme were two times more likely to report that they used modern contraceptive methods as those not exposed to the programme. Exposure to both the peer education programme and the TV messages of the national media campaign increased this awareness fourfold compared to those not exposed to either intervention. Campaign materials and supporting documents are available on C-Hub at www.c-hubonline.org/7747/

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2. Family Planning Media Campaign - Kenya

Plan for Yourself a Good Life

Kenya's Division of Reproductive Health in the Ministry of Health, with technical assistance from C-Change, launched the mass media campaign Plan for Yourself a Good Life in late 2010 in the country's western, northeastern, and coastal provinces. Radio spots, posters, and billboards target men and women, ages 25-35, in rural and peri-urban areas with information on modern contraceptives and the importance of child spacing for the health of the child and mother. Campaign materials and supporting documents are available on C-Hub at www.c-hubonline.org/7892/

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3. SBCC Capacity Assessment Tool (SBCC-CAT) from C-Change

Good LifeThe SBCC CAT is available in two versions (for organisations and for donors/networks) to improve the design, implementation, and M&E of health and development SBCC programmes. This Tool comprises a three-stage participatory process and ends with a discussion around the findings and the development of a capacity strengthening plan. The Tool helps groups to identify the strengths and weaknesses of current programmes, and define activities to strengthen and refocus programmes to improve the overall quality of their SBCC efforts. Each version includes a Facilitator's Guide.

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SBCC, FAMILY PLANNING, AND MOBILE TECHNOLOGIES

4. Family Planning Through the Mobile Phone in India

This November 2010 MobileActive.org article reports on an SMS (text message)-based delivery project of the Standard Days Method® (SDM) of family planning developed by the Institute for Reproductive Health (IRH) at Georgetown University, Washington, DC, United States. Because of the high use of traditional methods for family planning, and the ubiquity of mobile phones reported in research in India, IRH developed a mobile platform for delivery of SDM called CycleTel™. The CycleTel system is designed to send users a message to let her know which days she can get pregnant. There may also be menu-based service built into the programme, where women can choose from a set of options to receive more information via SMS about alternative family planning methods, STI/HIV prevention, counseling and testing information, condom use and connect to local health clinics. Additionally, a helpline number is available for one-on-one consultation over the phone.

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INTEGRATING FAMILY PLANNING AND HIV

5. Addressing Norms and Behaviours Through Integration in Ethiopia and Kenya

This March 2011 case study from USAID's AIDSTAR-One programme explores integration of family planning and HIV services as a promising strategy to prevent transmission of HIV, particularly from mother to child. This case study explores different models of integration and how they have been realised in Kenya and Ethiopia, 2 areas of high fertility and HIV prevalence. Specific activities and strategies as well as their outcomes and results, within both countries, are articulated in this study. Recommendations and conclusions, such as focus on addressing male gender norms and behaviours, are noted.

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6. Community Discussions to Raise Awareness and Rally Advocacy in Malawi

Completed in September of 2010, "Expanding Reproductive Rights Knowledge among HIV-positive Women and Girls - Tackling the Problem of Unsafe Abortion in Malawi", a final project report, summarises the development and implementation of a project carried out from February through June 2009 by the International Community of Women Living with HIV/AIDS (ICW) Malawi and Ipas in an effort to de-stigmatise unwanted pregnancy and abortion among women living with HIV in Malawi and to expand ICW Malawi's partnerships with other organisations in order to undertake reproductive rights advocacy. In brief, this report addresses the projects 3 main objectives, which were divided into several activities:

  • Contribute to awareness-raising around, and de-stigmatisation of, the topics of unwanted pregnancy, HIV and reproductive rights, and unsafe abortion
  • Gather information regarding experiences of HIV-positive women with abortion that could be used in advocacy with civil society, legislators and the media to promote the reproductive rights of women living with HIV/AIDS
  • Establish closer links with organisations and groups that are willing to advocate and support work on sexual and reproductive rights in Malawi.

For more information about the Expanding Reproductive Rights Knowledge among HIV-positive Women and Girls project in Malawi, please click here.

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7. Interpersonal Communication and Mass Media Messaging in Zimbabwe

This April 2010 Populations Services International (PSI)/Zimbabwe brief, "Integration of Family Planning and HIV Services in Zimbabwe Hormonal Implants and Dual Protection Messages," examines a family planning/HIV integration programme that used counselling and mass media messaging to prevent primary infection of HIV and unintended pregnancies in young women, as well as vertical and horizontal HIV transmission in infected women and discordant couples. Developed by PSI/Zimbabwe under the Strategic Alliances with International NGOs (SALIN) project, the programme activities aimed at increasing both awareness and adoption of dual protection, which is the concurrent use of condoms and other contraceptive methods to prevent unintended pregnancies as well as HIV and sexually transmitted infections, among these groups: young women (age 15 to 29), infected women, and discordant couples. Conclusions of the project: counselling combined with direct, onsite access to family planning methods as well as female and male condoms or counselling combined with strong linkages to family planning service providers can increase dual protection use among women and couples. The dual protection communications campaigns could be adapted for use by other platforms working on HIV and family planning.

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SBCC, SOCIAL NORMS, AND GENDER EQUITY

8. Paying Attention to Sociocultural, Economic, and Political Contexts in Southern Africa

According to this January 2010 SAfAIDS position paper, "The Southern African Quadrant Jeopardy: Interlinkages Between Culture, GBV, HIV and Women's Rights," the drivers of the HIV epidemic in southern Africa lie not only in gender inequalities, but also in the unique intricacies of the sociocultural, economic, and political contexts of the countries in the region, which form a sharp backdrop against which the increased vulnerability of women to HIV infection must be viewed. Southern African women's lower socio-economic, political, and cultural status inhibits them from making informed sexual and reproductive health choices to prevent HIV infection. Male attitudes and behaviours, intergenerational sex involving young girls and older men, harmful cultural practices that predispose women to HIV, and gender-based violence (GBV) are pervasive in the region and are upheld by beliefs, patriarchy, and lack of accountability to achievement of gender equality commitments.

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9. Creating or Finding Community Activists To Spread Messages Is Key

"Preventing Gender-Based Violence & HIV: Lessons from the Field,” an October 2010 AIDSTAR-One brief, describes the strategies of two organisations that have tackled the challenge of combining HIV and gender-based violence (GBV) prevention: Puntos de Encuentro in Nicaragua and Raising Voices in Uganda. As detailed here, an integrated strategy to address GBV in the context of HIV involves approaches such as advocacy and interpersonal communication. The brief addresses the question of how to get people to act on their increased knowledge and gender-equitable attitudes in the following way: “Both Puntos de Encuentro and Raising Voices emphasize that one source - be it a television show in the case of the former, or a SASA! workshop in the latter - is not enough to get people to take action. Both programs support activists to spread messages about human rights in relation to sexual health - including GBV - in schools, in the media, in religious institutions, and venues in the community on a long-term basis."

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10. IEC Tools for Community Based Volunteers and Community Prevention Mobilisers

Published by Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS), the “HIV and GBV Prevention Package for Community Based Volunteers (CBVs) and Community Prevention Mobilisers” is designed for community members working to prevent HIV and gender-based violence, and caring and supporting those affected. The package includes a series of drama and storytelling guides, and communication tools such as a flip chart and support and action cards.

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11. Community Conversation Toolkit for HIV Prevention

Community Conversation ToolkitC-Change developed the Community Conversation Toolkit, a set of six materials (with a Facilitator's Guide) on HIV prevention for adult audiences with lower literacy skills, to assist communities in the southern Africa region to initiate thoughtful discussions around key drivers of HIV. The materials are designed to help audiences "make meaning" for themselves about information on key drivers of HIV (multiple concurrent partnerships, alcohol, intergenerational sex, and violence). There are six interactive formats (including cubes, role-play cards, finger puppets, and dialogue buttons), grouped around a simple community mobilisation process that illustrates new PEPFAR quality criteria. Materials are available for download on C-Hub in English, Zulu, Sotho, Oshiwambo, Chichewa, and local Zambian and Zimbabwean languages.

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12. Peer Education in India

This October 2010 case study, from AIDSTAR-One and the Y.R. Gaitonde Center for AIDS Research and Education (Y.R.G. CARE), explores the process and impact of the Collaborative HIV/STD Prevention Trial, a 5-year research intervention that sought to study alcohol consumption and risky sex among male patrons of wine shops in Chennai, South India. This BCC initiative involved identifying, recruiting, and training peer outreach workers called Community Popular Opinion Leaders (CPOLs), who communicated messages about safer sexual behaviour through informal, yet structured, one-on-one conversation with their peers. As reported in "Alcohol Consumption and HIV Risk: A Peer Education Strategy for Bar Patrons", there were increases in knowledge and self-reported risk reduction behaviours among patrons of wine shops targeted by the intervention. However, similar increases in knowledge and self-reported risk reduction behaviours were reported by patrons of bars that were not actively targeted or included in the intervention. A closer examination of this finding revealed that wine shop customers often patronise more than one wine shop, making it likely that CPOLs were also delivering messages in wine shops that were not involved in the intervention.

For more information on the Collaborative HIV/STD Prevention Trial in India, please click here.

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13. A Community Dialogue Guide on Relationships with a Focus on MCP

From C-Change, "Relationships: Intimacy Without Risk - Facilitators Guide to MCP Community Dialogue Guide" emerges from the Relationships: Intimacy without Risk Community Dialogue programme in Lesotho, whose goal is to reduce the practice of multiple concurrent partnerships (MCP). It provides guidance for holding a series of conversations during which participants reflect on how they can improve their relationships and sexual lives without taking on extra lovers. In groups, dialogue sessions are spread over at least 11 weeks; the concept is that time is needed for people to think about what they are learning and to enable them to go through a process of change in their values, attitudes, and behaviour.

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14. Facilitator's Guide for Training on HIV and AIDS Stigma and Discrimination Reduction

Published by the Christian Council of Ghana (CCG) and World Association for Christian Communication (WACC) in May 2010, this guide is designed to build the capacity of community members to enable them to lead a campaign on stigma reduction in their communities. The guide lays out a systematic strategy for workshop discussions on issues such as moral judgments, stigmatising religious practices, and coping with stigma. It also includes illustrations on forms of stigma and discrimination adapted to an African social reality.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



FHI 360 has acquired the programmes, expertise, and assets of AED.



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks 16 - Tools and Media Campaigns Promoting Behaviour Change from C-Change

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Date: 
February 7, 2011

C-Picks
Social and Behaviour Change Communication (SBCC)
Issue 16 | February 7 2011

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View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

SBCC to Prevent HIV, Change Gender Norms, and Improve Women's Health

C-Picks #16 features materials developed by C-Change and partners to address social norms and individual behaviours around HIV prevention. First is a tool (#1) developed for use in the southern Africa region to assist communities with low literacy skills to discuss the key drivers of HIV. Next is a tool (#2) developed in Lesotho that helps communities discuss and reflect on HIV and the practice of multiple concurrent partnerships (MCP). The next three summaries concern mass media campaigns that received technical assistance from C-Change. Plan for Yourself a Good life (#3) is a current family planning mass media campaign in Kenya to increase use of modern contraceptives. Next (#4) is It Begins with YOU, an Africa-wide mass media campaign to eliminate pediatric HIV. The third (#5) highlights the Shuga TV series, which confronted the reality of HIV in the daily lives of young Kenyans. Visit the C-Change website for more information and C-Hub to view and download the communication materials.

A series of reports focused on addressing MCP in specific Africa settings follows, with strategies such as multi-level media campaigns, marketing, and interpersonal communication, as well as recommendations related to male friendship norms and changing attitudes and behaviours through the church. Then, we highlight two case studies - one from Togo and one from India - exploring communication messages and outreach for HIV prevention among men who have sex with men (MSM). The issue closes with two articles focused on marginalised young women and strategies for changing gender norms in order to reach them with reproductive health and HIV prevention behaviour change communication.




Trouble reading this edition? View it online - http://www.comminit.com/c-change-picks/c-picks-16.html

In This Issue

C-CHANGE - SBCC TOOLS AND CAMPAIGNS

1. Community Conversation Toolkit for HIV Prevention

2. Facilitator's Guide to MCP Community Dialogues - Lesotho

3. Family Planning Media Campaign - Kenya

4. ABMP-It Begins with You- Eliminating Pediatric HIV

CHANGING SOCIAL NORMS AND BEHAVIOURS AROUND MCP - AFRICA

5. Evaluating "Project Ignite" including Shuga - MCP Social Norms and Behaviour Change in Kenya and Zambia

6. Examining a National Multi-level Communication Programme to Reduce MCP in Botswana

7. Developing a Marketing Plan to Address MCP Behaviour in Zimbabwe

8. Addressing MCP among Individuals on HAART in South Africa

9. Extra-marital Sexual Partnerships and Male Friendships in Relation to MCP in Rural Malawi

10. Confronting Norms Around MCP in the Church

HIV PREVENTION ADDRESSING MSM

11. Improving Access to HIV Prevention Messages and Services among MSM in Togo

12. Empowering Communities of MSM to Prevent HIV in India

CHANGING GENDER NORMS - IMPROVING YOUNG WOMEN'S LIVES

13. Delaying Marriage in Yemen

14. Reaching Out-of-School and Marginalised Girls in Urban Ethiopia




C-CHANGE - SBCC TOOLS AND CAMPAIGNS

1. Community Conversation Toolkit for HIV Prevention/a>

Community Conversation Toolkit C-Change developed the Community Conversation Toolkit, a set of six materials (with a Facilitator's Guide) on HIV prevention for adult audiences with lower literacy skills, to assist communities in the southern Africa region to initiate thoughtful discussions around key drivers of HIV. The materials are designed to help audiences "make meaning" for themselves about information on key drivers of HIV (multiple concurrent partnerships, alcohol, intergenerational sex, and violence). There are six interactive formats (including cubes, role-play cards, finger puppets, and dialogue buttons), grouped around a simple community mobilisation process that illustrates new PEPFAR quality criteria. The English version is available for download on C-Hub; Zulu and Sotho versions will be available by the end of January. C-Change partner Soul City and their network partners are leading the adaptation of the toolkit in Zambia, Zimbabwe, Namibia, and Malawi. These local language country versions will be available on C-Hub in March 2011.

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2. Relationships: Intimacy without Risk - Facilitators Guide to MCP Community Dialogue

Faciliator's Guide - LesothoFrom C-Change, this manual emerges from the Relationships: Intimacy without Risk Community Dialogue programme in Lesotho, whose goal is to reduce the practice of MCP. The manual provides guidance for holding a series of conversations during which participants reflect on how they can improve their relationships and sexual lives without taking on extra lovers. In groups (ideally including 10 to 12 members), dialogue sessions are spread over at least 11 weeks; the concept is that time is needed for people to think about what they are learning and to enable them to go through a process of change in their values, attitudes, and behaviour. The manual and accompanying materials, including talk show transcripts and public service announcements, are available on C-Hub at www.c-hubonline.org/7784/


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3. Family Planning Media Campaign - Kenya

Plan for Yourself a Good Life Kenya's Division of Reproductive Health in the Ministry of Health, with technical assistance from C-Change, launched the mass media campaign Plan for Yourself a Good Life in late 2010 in the country's western, northeastern, and coastal provinces. Radio spots, posters, and billboards target men and women, ages 25-35, in rural and peri-urban areas with information on modern contraceptives and the importance of child spacing for the health of the child and mother. Campaign materials and supporting documents are available on C-Hub at www.c-hubonline.org/7892/


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4. ABMP-It Begins with You (Africa-wide Media Campaign to Eliminate Pediatric HIV)

ABMP-It Begins With You With technical assistance from C-Change, the African Broadcast Media Partnership (ABMP) is producing the campaign It Begins with YOU, which advocates for elimination of pediatric HIV. The radio and TV programming promotes the importance of prevention of mother-to-child transmission (PMTCT) services for pregnant and nursing mothers. C-Change provided information about PMTCT and assisted development of production guides for longer programming. Campaign materials are available on C-Hub at www.c-hubonline.org/7896/


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CHANGING SOCIAL NORMS AND BEHAVIOURS AROUND MCP – AFRICA

5. Evaluating "Project Ignite" including Shuga - MCP Social Norms and Behaviour Change in Kenya and Zambia

Project Ignite - Shuga "The Project Ignite Evaluation: Tribes in Trinidad & Tobago and Shuga in Kenya and Zambia", an external evaluation published in July 2010, examines 2 of 3 country campaigns of MTV's over-arching Staying Alive Ignite campaign – "Shuga" in Kenya and Zambia, and "Tribes" in Trinidad and Tobago - which used television drama, social networking platforms, and interpersonal communication to put forward key messages around transmission, prevention, condom use, HIV testing, MCP, and stigma and discrimination relating to HIV/AIDS. C-Change provided technical assistance to MTV's Staying Alive Foundation to produce "Shuga" in Kenya. The three-part, fast-moving drama was part of a multi-component campaign designed to reach young people on issues related to HIV/AIDS. Filmed in Nairobi, the series addresses sexual networks, MCP, substance abuse, and living with HIV. In addition, the campaign included an online component, radio programming, training for local broadcasters, and a Training of Trainers and educational toolkit for peer education in communities vulnerable to HIV. Several recommendations for future research and campaigns are offered here.


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6. Examining a National Multi-level Communication Programme to Reduce MCP in Botswana

Published in October 2010 by AIDSTAR-One, this case study looks at Botswana's O Icheke - Break the Chain campaign which is designed to change attitudes and behaviour around multiple concurrent partnerships. According to the study, O Icheke is seen as key to achieving Botswana's long-term goal of zero new HIV infections by 2016. The three-year campaign uses the national mass media to stimulate public discussion about MCP. At the same time, interventions at the district/community level - which are linked to the national mass media by the same branding, messages, and tools - are designed to encourage communities to change norms and individuals to change behaviour. Community-level activities include one-on-one sessions, group discussions, dramas, testimonials by people living with HIV, community and church events, youth clubs, and schools and poetry/music groups. This study looks at the rationale behind the campaign, how it was developed, and provides a brief evaluation of the programme's first year. It also includes recommendations and information around future programming.

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7. Developing a Marketing Plan to Address MCP Behaviour in Zimbabwe

Published by Population Services International (PSI) in May 2010, “Concurrent Sexual Partnerships in Zimbabwe: Using DELTA to Develop a Marketing Plan for a Complex Behavior” outlines the multiple step process PSI/Zimbabwe used to apply the findings of formative research to design a national marketing strategy to address concurrent partnerships. According to the case study, developing the messages was dependent on a clear understanding of the primary audience(s) and adequate positioning of the desired behaviour - reduction in concurrent sexual partnerships among the sexually active population. The case study explains that the DELTA process has been widely applied to develop marketing plans for PSI products and services but only recently applied to developing marketing strategies for behaviour change communication interventions. In doing so, DELTA is increasingly recognised as a planning tool for all types of social marketing interventions.

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8. Addressing MCP among Individuals on HAART in South Africa

This December 2009 working paper from the Centre for Social Science Research (CSSR) shares findings of a study to measure the prevalence of MCP and condom use among individuals on highly active antiretroviral therapy (HAART) in the township of Khayelitsha in Cape Town. Comparisons are made between individuals on HAART and the general population from the same geographic area. According to "Concurrent Sexual Partnerships Among Individuals on HAART in South Africa: An Opportunity for HIV Prevention", the prevalence of reported concurrency was relatively high both among a sample of HAART patients and in the general population while reported consistent condom use was significantly higher among HAART patients compared to the general population. Given the large numbers of people living with HIV (PLHIV), particularly in southern Africa, there is a need for specific efforts to promote partner and concurrency reduction among the general population and specifically among PLHIV and those on HAART. While increasing the risk perception of concurrency is important in the short term, research needs to evaluate structural factors, such as economic and gender inequalities, which play a role in engaging in concurrent sexual partnerships.

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9. Extra-marital Sexual Partnerships and Male Friendships in Relation to MCP in Rural Malawi

This January 2010 paper, published by the Max Planck Democratic Research Institute, investigates the roles of two types of male friendships - best friends and friends with whom men talk about AIDS - in determining whether men have extra-marital sexual partnerships (EMSPs). The author argues that EMSPs are a major route of HIV/AIDS transmission in sub-Saharan Africa, and that men's extra-marital sexual behaviour in rural Malawi is closely correlated with the behaviour of their best friends. According to the paper, this study, along with previous findings, raises the possibility of developing effective interventions designed to change men's non-marital sexual behaviours by harnessing men's social networks, particularly their male friendships. Specifically, individuals within the social network could be targeted for behaviour change communication in order to better utilise men's social networks to disseminate messages about the risks of concurrent sexual partnerships.

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10. Confronting Norms around MCP in the Church

This report, published by Catholic Relief Services in May 2010, assesses the effects of The Faithful House (TFH) curricula, focused on fidelity, on TFH trainers' attitudes and practices. Facilitator trainees underwent a week of training in TFH in Rwanda, Central Uganda, and Northern Uganda. Using the metaphor of a house, couples are progressively led through different rooms that include, among others: a foundation in God; four pillars of love, respect, faithfulness, and communication; walls representing their values; and windows of forgiveness. Designed to better understand the attitudes and behaviours of church attendees related to MCP and identify attitudes and behavioural intentions most and least consistently impacted by TFH curriculum, the study concludes that there is a need to train community and church leaders about what to do when confronted with MCP. Community leaders also need to be called upon to model good behaviour, church leaders and TFH trainers need to receive more training, and avenues to address MCP through church structure need to be strengthened.

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HIV PREVENTION ADDRESSING MSM

11. Improving Access to HIV Prevention Messages and Services among MSM in Togo

This April 2010 brief explores a peer-education-based programme launched by Population Services International (PSI) in 2007 in an effort to reach men who have sex with men (MSM) in Lomé, Togo, with HIV prevention messages and products, referrals to appropriate HIV counselling and testing services, psychosocial counselling, and diagnosis and treatment of sexually transmitted infections. PSI recruited and trained 17 young men to serve as peer educators and reach MSM with HIV prevention messages and products; each month, they reach more than 300 men and distribute over 2,000 condoms and 70 tubes of water-based lubricant. Peer education activities are complemented by the sponsorship of social activities, such as monthly movie nights, which serve as opportunities to further promote HIV prevention messages and products. The brief concludes with a number of lessons learned thus far.

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12. Empowering Communities of MSM to Prevent HIV in India

Written under the auspices of USAID's AIDSTAR-One programme in January 2010, "Case Study: The Humsafar Trust, Mumbai, India: Empowering Communities of Men Who Have Sex with Men to Prevent HIV" examines the work of India's Humsafar trust, which works to create a safe haven and provide support for Mumbai's community of men who have sex with men (MSM) and transgender people. Much of Humsafar's programmatic work has focused on HIV prevention, particularly street outreach and condom promotion activities. This involves bringing prevention messages and materials to cruising sites such as parks, public toilets, cinemas, truck stops, and beaches. In designing its outreach materials, Humsafar has found it necessary to be careful how it represents sexual behaviour. "...MSM who take part in Humsafar's prevention programming often report that before they received MSM-specific education, they thought condom use was only necessary during vaginal sex....The absence of discussion about anal sex in the general HIV prevention discourse puts not only MSM at risk but also women who might consider anal sex as an option to protect their virginity or avoid conception." Other challenges and lessons are outlined within this report.

For more information on Humsafar Trust, please click here.

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CHANGING GENDER NORMS - IMPROVING YOUNG WOMEN'S LIVES

13. Delaying Marriage in Yemen

This June 2010 brief describes how the Extending Service Delivery (ESD) Project, in partnership with the Basic Health Services (BHS) Project in Yemen and the Yemeni Women's Union (YWU), implemented the "Safe Age of Marriage" programme as part of Yemen's national effort to reduce maternal and neonatal mortalities. The pilot programme drew on voluntary community educators to communicate messages about ending marriage before the age of 18 and improving the poor health and social outcomes of marginalised young girls by changing entrenched social/gender norms and by stressing the importance of girls' education. The endline survey indicated that there was an 18% increase in awareness about the benefits of delaying marriage and a 16% increase in agreement that there is a relationship between early marriage, early pregnancy, and childbearing.

For more information on Safe Age of Marriage Programme, please click here.

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14. Reaching Out-of-School and Marginalised Girls in Urban Ethiopia

This August 2009 baseline survey, published by Population Council, consists of interviews with over 1,000 out-of-school girls living in low income and slum areas of 3 cities in Ethiopia. The survey seeks to broaden understanding of the experience of the poorest and most marginalised girls, focusing on individual as well as structural and social factors that may increase girls' vulnerability to HIV and other negative health outcomes. The study highlighted that out-of-school girls are not only vulnerable, but also hard to reach. Mechanisms to reach this population may include going door-to-door to identify the most marginalised girls and negotiating with gatekeepers, such as guardians or employers, for their participation in a programme. Explicit messaging is also needed on non-consensual and transactional sex. At the same time, messages must also address the risk of HIV transmission within marriage, and to promote the condom as an appropriate family planning and disease prevention method within marriage. Programmes should also address social and contextual factors that exacerbate girls' risk of negative reproductive health outcomes, including HIV infection.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



FHI 360 has acquired the programmes, expertise, and assets of AED.



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change) is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@fhi360.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks - Communication, Tools, and Technologies for Social Norms and Behaviour Change

No votes yet
Date: 
December 6, 2010


C-Picks

Social and Behaviour Change Communication (SBCC)

Issue 15 | December 6 2010


Subscribe to C-Picks
View C-Picks Archives
More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

Focus on Communication, Tools, and Technologies for Social Norm and Behaviour Change

C-Picks #15 highlights three tools/toolkits from C-Change — the Gender Scales Compendium, the Voluntary Medical Male Circumcision (VMMC) Communication Toolkit, and the Family Planning Dialogue Guide (formerly the "Family Planning Conversation Tool"). It continues with recent research focused on changing masculinity social norms through SBCC and an article on family planning and behaviour change for PLHIV. Examples of the strategic use of mHealth and social marketing for behaviour change follow. The issue closes with two resources that focus on transforming behaviour through private and community conversations.

C-HubCommunication materials developed by C-Change are available for download from C-Hub (www.c-hubonline.org), its online resource of communication materials for development. C-Hub provides a free and open online system where users can view, access, and share examples of communication materials, showcasing the processes of developing effective SBCC campaigns and materials.

C-ModulesC-Modules: A Learning Package for Social and Behavior Change Communication has been revised based on feedback from practitioners. Additional information on theories and models that inform SBCC is also included along with a nuanced explanation of the tipping point for change. The modules are available for download at www.c-changeprogram.org/focus-area/capacity-strengthening/sbcc-modules.




In this Issue


TOOLS FROM C-CHANGE

1. Gender Scales Compendium

2. Voluntary Medical Male Circumcision (VMMC) Communication Toolkit

3. Family Planning Dialogue Guide


GENDER EQUALITY, BEHAVIOUR CHANGE, AND MASCULINITY

4. SBCC, Gender Equality, and Masculinity - 12 Country Cases

5. Changing Behaviour by Changing Images of Manhood in Tanzania


COMMUNITY-BASED PROGRAMMES FOR FAMILY PLANNING AND HIV PREVENTION

6. Support Groups Address Behaviour Change for Family Planning with PLHIV in Ghana

7. Community- and Peer-based Communication for Reproductive Health in Mozambique


CHANGING FAMILY PLANNING BEHAVIOURS USING MHEALTH AND LOW-LIT TOOLS

8. Changing Family Planning via Mobile Phones in India

9. Social Marketing around Family Planning Appropiate for Rural, Low-Literacy Audiences in Niger


USING DIALOGUE TO PROVOKE BEHAVIOUR AND SOCIAL CHANGE ON SEXUALITY AND HIV/AIDS

10. Changing the Dialogue Around Young Sexuality in Guatemala, Madagascar, and Rwanda

11. Conversations on the Bible and HIV




TOOLS FROM C-CHANGE

1. Gender Scales Compendium Gender Scale Compendium

Developed by C-Change and USAID, with input from a relevant group of researchers, the Gender Scales Compendium is a tool to assess gender-related attitudes and beliefs and evaluate the success of interventions incorporating gender approaches. The compendium comprises eight scales that measure beliefs, attitudes, and practices relating to issues such as couples communication, decision-making about sex, household and parental responsibilities, gender-based violence, and societal acceptance of inferior roles for women and girls. The compendium is available at www.c-changeprogram.org/content/gender-scales-compendium/index.html

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2. Voluntary Medical Male Circumcision (VMMC) Communication Toolkit

In Kenya, C-Change and local partners developed this toolkit for Nyanza Province, which has an HIV prevalence rate of 15% and the lowest rate of male circumcision in the country. This set of innovative communication materials emphasises safe healing and the importance of continued HIV prevention practices. The toolkit includes billboards, posters, video, flip charts for health providers, radio spots, fact sheets for community, faith and business leaders, dialogue cards, and a handbook for community mobilisers. The toolkit can be downloaded at www.c-hubonline.org/7815/

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3. Family Planning Dialogue Guide

This C-Change guide, published in June 2010 and available in English and French, is designed to help community health workers ("relais") in the Democratic Republic of the Congo (DRC) as they talk to small and large groups of men and women about family planning. Issues covered in the booklet include spacing of pregnancies for the health of the mother and her children, visiting the health clinic for family planning counselling and antenatal care, and adopting use of modern contraceptives. The Ministry of Health recently reviewed and approved the Family Planning Dialogue Guide and determined that it will be used nationally. The guide is available for download at www.c-changeprogram.org/resources/family-planning-dialogue-guide-community-relays-drc in French or English.

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GENDER EQUALITY, BEHAVIOUR CHANGE, AND MASCULINITY

4. SBCC, Gender Equality, and Masculinity - 12 Country Cases

This October 2010 research report from the International Planned Parenthood Federation (IPPF) describes and analyses 12 programmes and interventions from around the world that have sought to alter the sexual attitudes and behaviours of men. "Men Are Changing: Case Study Evidence on Work with Men and Boys to Promote Gender Equality and Positive Masculinities" includes examinations of: the use of face-to-face trainings; the production of printed materials and video clips; in-person discussion groups; drama performances; radio programmes; street parades; and text messages. A number of findings, lessons learned, and best practices are identified in this report. Two lessons learned were of particular interest:

  • Interventions should 'go where men are at' instead of bringing men into unfamiliar locations.
  • Recognise that many men are struggling to come to terms with social and cultural change that undermines previously-held certainties about male power, authority and roles, and are actively seeking new identities in relation to other men and women and children.

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5. Changing Behaviour by Changing Images of Manhood in Tanzania

This is an August 2010 case study of an integrated male engagement workplace programme called Healthy Images of Manhood (HIM), which was launched by the Extending Service Delivery (ESD) initiative in Tanzania early 2008. HIM was developed as a workplace health education intervention addressing gender, HIV, and family planning, with a focus on building effective counselling and communication skills among those who disseminate information, such as peer or community educators. It aims to strengthen local capacity and build a critical mass of male champions to act as change agents and model healthier sexual reproductive health behaviours, including: seeking health care services; being supportive, caring, and involved partners/husbands and fathers; and adopting healthy and non-violent means to respond to conflict. "Healthy Images of Manhood: A Male Engagement Approach for Workplaces and Community Programs Integrating Gender, Family Planning and HIV/AIDS - A Case Study" outlines a number of HIM-related behaviour change outcomes, as well as challenges faced, lessons learned, and recommendations for future iterations. ESD is finalising a package of HIM tools, including a gender assessment tool, a Peer Educator handbook, and a guide for corporate managers and project coordinators. A Facilitator's Guide, published in February 2010, can be accessed by clicking here.

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COMMUNITY-BASED PROGRAMMES FOR FAMILY PLANNING AND HIV PREVENTION

6. Support Groups Address Behaviour Change for Family Planning with PLHIV in Ghana

This resource presents a mid-2009 evaluation of the Family Planning for Healthy Living project in Ghana implemented by the ACQUIRE Project partnership with Quality Health Partners and Opportunities Industrialisation Centers International (OICI). The project focused on peer education via support groups for PLHIV, involving a number of interventions, including family planning provider training, peer educator training, the development of job aids and behaviour change communication materials, and regional meetings of peer educators and family planning providers. The assessment presented in "Addressing the Family Planning Needs of People Living with HIV in Ghana: A Community-Facility Partnership Approach" provides key lessons learned, including the need to support peer educators through adequate training and supervision; ensuring trained provider coverage of HIV support groups and facilities; fostering peer educator-provider partnerships for referrals; identifying champions to advocate for family planning and promoting scale-up; and addressing barriers to family planning such as stigma, transport costs, and myths/misperceptions.

For more information on the Family Planning for Healthy Living Project and its communication strategies, please click here.

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7. Community- and Peer-based Communication for Reproductive Health in Mozambique

This December 2009 case study describes a multisectoral adolescent sexual and reproductive health programme implemented by the Government of Mozambique. The main goals of Geração Biz ("busy generation") are to influence knowledge, practices, attitudes, and behaviours related to contraception, pregnancy, sexuality, and seeking reproductive and sexual health care.

The central components of Geração Biz are:

  • Branded, youth-friendly and gender-sensitive health clinics.
  • School-based peer education interventions, including the use of counselling, drama, films, group debates, and youth discussion centres.
  • Community-based interventions, including counselling centres, special events, and community radio programmes.
  • HIV/AIDS support group.
An assessment conducted between 2003 and 2005 showed that use of contraceptive methods during the first sexual experience increased from 35.7% to 60.2%. Consistent condom use even when "in love" increased from 70% to 83%. Among respondents, 38% had undergone voluntary counselling and testing in 2005, compared to 11% in 2003. Of those who were tested, those who reported a positive test dropped from 57% in 2003 to 18.6% in 2005.

For more information about the Geração Biz programme, click here.

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CHANGING FAMILY PLANNING BEHAVIOURS USING MHEALTH AND LOW-LIT TOOLS

8. Changing Family Planning via Mobile Phones in India

This slideshow from the Institute for Reproductive Health (IRH) at Georgetown University was presented at the International Conference on Family Planning (ICFP) in November 2009 in Kampala, Uganda. It explores an (m)Health solution that supplies a modern family planning method directly to a user's mobile phone. As part of the Fertility Awareness-based Methods (FAM) Project, IRH developed a mobile application called CycleTel™ that supplies the Standard Days Method® (SDM) directly to a user's cell phone. After a woman provides the date her menstrual period starts (each cycle) she can be advised of her fertility status on a daily basis via text messaging. Additional messages support correct use of the SDM, monitor her cycle lengths to identify whether they are in the 26-32 day range, and offer information on other family planning options and reproductive health issues. Study results indicate that CycleTel would fit well within typical mobile phone use and SMS habits in India, and that women have significant interest in applying SMS to use the SDM and receive related reproductive health information.

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9. Social Marketing around Family Planning Appropiate for Rural, Low-Literacy Audiences in Niger

This July 2009 German HIV Practice Collection study, "Social Marketing for Health and Family Planning: Building on Tradition and Popular Culture in Niger," examines the social marketing methods used by the Association Nigerienne de Marketing Social (Animas-Sutura) to not only sell products, but change behaviour in Niger. According to Animas-Sutura, challenges to behaviour change messaging in Niger include a population that is primarily rural, has no electricity, and has low literacy levels. Communication strategies chosen for their behaviour change approach include the following:

  • Using traditional symbols and pop culture figures (such as popular sports heroes) in branding and promotion of products.
  • Developing songs featuring popular entertainers to be played both on television and the radio.
  • Television marketing spots, including the songs, to reach urban populations.
  • Radio - to reach those with access to radio in rural areas.
    • Marketing spots, including the songs.
    • A series of 15 five-minute radio mini-dramas in the 3 main languages of Niger about: risky sexual activity that can result in unwanted pregnancy or disease, when to use condoms, how to get your partner to agree, early marriage, forced marriage, and the spacing of births.
    • Weekly radio debates.
  • Organising gatherings of young people's fadas (informal groups of friends) which are guided by trained animators who are, in turn, guided by discussion sheets.
  • Organising discussions in school classrooms.

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USING DIALOGUE TO PROVOKE BEHAVIOUR AND SOCIAL CHANGE ON SEXUALITY AND HIV/AIDS

10. Changing the Dialogue Around Young Sexuality in Guatemala, Madagascar, and Rwanda

Focusing on the Fertility Awareness-based Methods (FAM) Project, this IRH presentation, from the Family Planning conference in Kampala, Uganda in November 2009, describes strategies and results of formative research conducted as part of My Changing Body (MCB), a course for very young adolescents being tested in Guatemala, Madagascar, and Rwanda. Originally developed with Family Health International, MCB was recently revised to more explicitly integrate gender and sexuality concepts, as well as include parents so they can better support their children. "Evaluating Programs Reaching Very Young Adolescents: Experiences and Lessons from My Changing Body, A Body Literacy and Fertility Awareness Course" looks at MCB’s ability to facilitate reflection and self-awareness within and among peers and with parents to develop healthy, more gender-equitable attitudes and skills. Games and other action-oriented strategies were designed around real-life issues of young people. Homework activities sought to promote child-parent dialogue.

The researchers concluded that 6 sessions can provoke significant changes in some areas. One main challenge is how to make discussions relevant and practical. It is clear, from this research, that programmes designed for older adolescents do not necessarily have content relevant to very young adolescents and there is a need for formative, culturally-specific research to develop programme content.

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11. Conversations on the Bible and HIV

This handbook, written by twelve church leaders from a wide ecumenical background in four African countries and published by Strategies for Hope Trust in early 2010, consists of 20 Bible studies on topics related to HIV and AIDS. "Call to Me: How the Bible Speaks in the Age of AIDS" was produced to enable churches and community groups to discuss difficult, sensitive issues related to the AIDS epidemic, and to decide on ways of dealing with these. Each Bible study consists of seven clearly defined steps, leading to a final session in which the participants suggest and discuss ways in which particular issues and problems can be addressed.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine that highlights social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health).



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change), implemented by AED, is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Picks - Focus on HIV, Male Circumcision, and Multiple Concurrent Partnerships

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Date: 
October 18, 2010
C-Picks

Social and Behaviour Change Communication (SBCC)

Issue 14 | October 18 2010


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More about C-Picks
A collaboration between C-Change, supported by the United States Agency for International Development (USAID), and The Communication Initiative.

Focus on HIV, Male Circumcision, and Multiple Concurrent Partnerships

C-Picks #14 begins with a spotlight on C-Hub, C-Change's online resource of communication materials for development. It follows with information and updates on HIV prevention and social and behaviour change communication (SBCC) focused on: male circumcision (MC) programmes in Kenya and Southern and Eastern Africa; multiple concurrent partnerships (MCP) activities in Namibia and South Africa; high-risk groups in Bangladesh and Central America; and youth populations in sub-Saharan Africa, Guyana, and Haiti. The issue concludes with a review of three educational HIV/AIDS resources.

The Government of Kenya (GOK) through the support of the Ministry of Public Health and Sanitation (MOPHS), the National AIDS and STIs Control Programme (NASCOP) and Department of Health Promotion, and partners C-Change, CDC, FHI, PSI, and UNICEF as well as implementing partners (NRHS, IRDO, FACES, and the CMMB) has launched a Voluntary Medical Male Circumcision (VMMC) programme in Kenya. As part of the initiative, the National and Provincial Communication Sub-Committees on VMMC developed the VMMC Communication Toolkit to create and sustain demand for male circumcision and reinforce that, while MC reduces risk for men, it does not prevent HIV.

C-Change presented the initial VMMC Communication Toolkit at the UNAIDS-PEPFAR Regional Meeting in Durban, South Africa in September 2010. Materials in the MC Toolkit include: a communication guide that builds upon the national strategy; billboards; posters; video vignettes; flip charts for health providers; radio spots; fact sheets for community, faith and business leaders; dialogue cards; and a handbook for community mobilisers.

The Toolkit is available for download at http://www.c-hubonline.org/7815/?cp=14. Additional information about the C-Change programme in Kenya is available on the website.

In Namibia, C-Change and partners launched the "Break the Chain" MCP campaign to meet urgent requests from civil society, private, and public sector organisations for effective tools to address MCP, a key driver of HIV in Namibia. The campaign materials are http://www.c-hubonline.org/7842/?cp=14.

 



Trouble reading this edition? View it online - http://www.comminit.com/en/c-picks-14.html?cp=14

In this Issue


ONLINE RESOURCE OF COMMUNICATION MATERIALS from C-Change


1. C-Hub: Communication Materials for Development


HIV/AIDS


Male Circumcision

2. Voluntary Medical Male Circumcision (VMMC) Communication Toolkit

3. Experiences in the Scale-up of Male Circumcision in the Eastern and Southern African Region

4. Clearinghouse on Male Circumcision for HIV Prevention

5. Print Media Reporting of Male Circumcision for Preventing HIV Infection in sub-Saharan Africa


Addressing MCP

6. A Project to Break the Chain of MCP in Namibia

7. Break the Chain MCP Picture Codes

8. OneLove South Africa Interim Evaluation


Addressing High Risk/Excluded Groups

9. HIV/AIDS Interventions: What Can Application of a Social Exclusion Framework Tell Us?

10. Addressing HIV in At-Risk Populations in Central America and Mexico

11. Partnership Defined Quality: A Methodology for Improving VCT Services


Addressing Youth

12. Review of HIV Prevention Among Young People in Sub-Saharan Africa

13. Recommendations on HIV Prevention Among Young People in Sub-Saharan Africa

14. A Proven Multi-Country Peer Education Program and Community Mobilization Strategy for Youth HIV Prevention


Tools

15. "Positive Prevention" for PLWHA

16. Guidelines and Activities for a Unified Approach to Sexuality, Gender, HIV, and Human Rights Education

17. Classroom Activities for HIV and AIDS Education




ONLINE C-Change RESOURCE OF COMMUNICATION MATERIALS

1. C-Hub: Communication Materials for Development

C-Change has launched C-Hub, an online resource of communication materials for development. C-Hub showcases the products and the processes of effective health campaigns. Each record in the C-Hub comprises a set of electronic files - video, audio, and print materials (e.g., posters, outdoor displays, pamphlets, flip charts, and radio & TV programmes/spots) and project descriptions, strategies, research, testing, and evaluation reports. Visit C-Hub to view and download communication materials and contact C-Hub if you would like help with uploading your project's materials.

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HIV/AIDS


Male Circumcision


2. Voluntary Medical Male Circumcision (VMMC) Communication Toolkit

The Government of Kenya (GOK) through the support of the National AIDS and STIs Control Programme (NASCOP) and Department of Health Promotion, as well as partners including C-Change, CDC, FHI, PSI, and UNICEF has launched a Voluntary Medical Male Circumcision (VMMC) programme in Kenya. As part of this initiative, the National Communication Sub-Committee on VMMC developed this toolkit to create demand for MC and reinforce that, while MC reduces risk for men, it does not prevent HIV. The Toolkit targets affected audiences in Nyanza province, which has Kenya's highest HIV prevalence rate at 15% and the lowest percentage of circumcised men [Ministry of Health, 2008]. Materials in the MC Toolkit include: a communication guide that builds upon the national strategy; billboards; posters; video vignettes; flip charts for health providers; radio spots; fact sheets for community, faith and business leaders; dialogue cards; and a handbook for community mobilisers.

The Voluntary Medical Male Circumcision Communication Toolkit is available for download.

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3. Experiences in the Scale-up of Male Circumcision in the Eastern and Southern African Region

This report from the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) of a sub-regional consultation held in Windhoek, Namibia, in July 2009, summarises progress, lessons learned, and future priorities from nine countries working to scale-up male circumcision for HIV prevention. All countries represented made progress towards establishing the necessary conditions to increase the availability of male circumcision services for HIV prevention. Countries have also faced challenges and constraints. Key constraints include: shortage of human resources for programming and service delivery; difficulties in accessing funds; challenges creating appropriate and effective communication messages - for example, that male circumcision is not a "magic bullet"; and delays in getting buy-in from 'gatekeepers' such as politicians and traditional leaders, which has been a time consuming process. Community engagement to influence behavioural change was also recognised as a challenge, as was addressing implications for women in rolling out male circumcision. For example, there may be a reduction in women's ability to negotiate condom use.

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4. Clearinghouse on Male Circumcision for HIV Prevention

This website, developed by Family Health International (FHI), is designed to generate and share evidence-based information about the role of male circumcision in HIV prevention. In its archives on policies and programmes, research, advocacy, training, and publications, it contains: a database of scientific abstracts and full-text articles; an inventory of research activities on male circumcision; tools and guidelines for provider training and programme scale-up; evidence-based protocols and guidelines; a compendium of better and best practices; summaries of advocacy issues and civil society engagement; an opportunity to sign up for an RSS feed on news related to male circumcision; a global mechanism for exchanging and integrating information on male circumcision programmes and associated services.

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5. Print Media Reporting of Male Circumcision for Preventing HIV Infection in sub-Saharan Africa

This August 2009 report, from the University of Texas Medical School at Houston, presents the findings of a review examining the types, content, and accuracy of print media reports on male circumcision for preventing HIV infection among men in sub-Saharan Africa. The review involved a trilingual (English, French, and Portuguese) search between March 2007 and June 2008. In total, 412 articles were identified, of which 219 were unique and 193 were repeats. The researchers judged the accuracy of the report and determined the context, public perceptions, misconceptions, and areas of missing information in the print media. The study found that most articles presented circumcision for HIV prevention in a positive light. However, those that portrayed it negatively had an overall repeat rate 2.9 times higher than positive articles, suggesting an inclination to publish anti-circumcision articles or articles with a controversial viewpoint. The report also states that reports on male circumcision are few in the part of the world where its adoption could most markedly help curb the HIV epidemic.

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Addressing MCP


6. A Project to Break the Chain of MCP in Namibia

Launched December 2009, Break the Chain is a USAID-funded and C-Change-supported national multi-channel SBCC campaign that addresses the practice of multiple and concurrent sexual partnerships (MCP) in Namibia. The initiative, which is being implemented by a wide range of civil society and Government of Namibia partners, has an emphasis not only on those who actively have MCP, but also on those who are passively connected. There is also targeted messaging for audiences more likely to practice MCP as a result of mobility (long-distance relationships), due to traditional reasons/beliefs (e.g., polygamy), and/or within the context of same-sex relationships (men who have sex with men [MSM]), and for people living with HIV (PLWH). The campaign was named first runner-up in the category "Multi-Channel Communication Strategy" for excellence in HIV and AIDS communication by AfriComNet in Johannesburg, South Africa, in August 2010. In a series of focus group discussions conducted three months into the campaign across Namibia, respondents describe the campaign as "new" and "different" and said that it made them re-evaluate their personal risk of HIV.

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7. Break the Chain MCP Picture Codes

As part of Break the Chain, C-Change Namibia and Nawa Life Trust developed this multiple and concurrent sexual partnerships picture code flip chart. Field workers and volunteers in Namibia are using it to create conversations for behaviour change that focus on the drivers of the HIV epidemic. The MCP picture codes generate discussion on the practices of multiple and concurrent sexual partnerships, cross-generational sex, transactional sex, and couples communication. Included in this resource are details about how a field worker or volunteer can use picture codes to address MCP. Suggestions are offered about how to get started, what kinds of questions to ask during a session, how to be a good listener, how to get everyone to participate, and organising sessions.

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8. OneLove South Africa Interim Evaluation

This fact sheet offers some key statistics, observations, and insights drawn from both a quantitative and qualitative evaluation of the OneLove campaign in South Africa. The campaign was launched in January 2009 in South Africa as part of a Southern African regional campaign, and was integrated into the Soul City 9 multimedia programme. The main focus of the OneLove campaign is on the reduction of multiple and concurrent partnerships (MCP), identified as one of the key drivers of HIV infection in the region. In terms of impact, the campaign was responsible for a 6% (1,644,600 people) increase in knowledge around partner reduction or faithfulness to one partner. Behaviour change associated with OneLove was observed in condom use and intergenerational and transactional sexual relations.

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Addressing High Risk/Excluded Groups


9. HIV/AIDS Interventions: What Can Application of a Social Exclusion Framework Tell Us?

Published in the Journal of Health, Population, and Nutrition in August 2009 and based on research by Johns Hopkins Bloomberg School of Public Health, this paper argues that the underlying exclusion of high-risk groups from HIV/AIDS interventions must be addressed if significant progress is to be attained in preventing an HIV epidemic in Bangladesh. Using a social exclusion framework, the paper identifies social, economic, and legal forces that heighten the vulnerability to HIV/AIDS of excluded groups, including sex workers, injection drug users (IDUs), men who have sex with men (MSM), and the transgender population (hijras/hijra population). The paper concludes with areas for research and policy action so that the social exclusion of high-risk groups can be reduced, their rights protected, and an HIV epidemic averted.

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10. Addressing HIV in At-Risk Populations in Central America and Mexico

This 2009 evaluation from the Institute for Reproductive Health (IRH) describes and assesses a 4-year project (2006-2009) designed to reduce the incidence of HIV in Mexico and 5 Central American countries - El Salvador, Guatemala, Nicaragua, Panama, and Belize. Groups within these countries who are most at-risk of HIV infection - female sex workers (FSWs) and men who have sex with men (MSM) - reportedly experience distinctive barriers to health services due to stigma and discrimination on the part of health providers and other gatekeepers. To address this problem, Population Services International's (PSI) Pan American Social Marketing Organization (PASMO) partnered with IRH in implementing USAID's Program for HIV/AIDS Prevention which sought to improve access, quality, and use of services for voluntary counselling and testing (VCT) and screening for sexually transmitted infections (STIs) among at-risk populations; and use behaviour change communication to promote healthier behaviours. Detailed outcomes, lessons learned, and recommendations are noted.

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11. Partnership Defined Quality: A Methodology for Improving VCT Services

Partnership Defined Quality (PDQ), a methodology developed by Save the Children, is intended to improve the quality of and access to health services through better community involvement. This January 2010 brief details the Institute for Reproductive Health (IRH)'s use of the PDQ methodology to improve voluntary counselling and testing (VCT) services in Guatemala, Nicaragua, and El Salvador within the context of the above-mentioned USAID HIV/AIDS Prevention Program (see #10 above). The PDQ process brings together clients and health workers to jointly address fears, misperceptions, and other challenges and to develop a shared vision of quality VCT services. The goal is to have participants engage in sincere and respectful dialogue about quality concerns and to create a shared definition of quality. Some of the lessons learned include:

  • Building relationships between health providers and the communities they serve is a critical first step in the quality improvement process.
  • Good facilitation skills and a high degree of cultural sensitivity throughout the PDQ process are necessary.
  • The PDQ methodology was an effective tool for addressing negative perceptions and practices of providers and vulnerable groups and to begin the process of sensitising all stakeholders to widespread stigma and discrimination.
  • The PDQ process facilitated open dialogue and consensus building between different perspectives.

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Addressing Youth


12. Review of HIV Prevention Among Young People in Sub-Saharan Africa

This report, published in February 2010 by the London School of Hygiene and Tropical Medicine (LSHTM), examines the use of a methodology known as the "Steady, Ready, Go!" approach, wherein different types of HIV interventions for young people in different settings are systematically reviewed alongside each other and graded for their effectiveness. This review (covering from 1990-2008) on the effectiveness of interventions in sub-Saharan Africa to reduce risky sexual behaviours and pregnancy, HIV, and other STIs among youth found that, despite 19 years of research, there is still insufficient evidence to recommend widescale implementation of the majority of the types of interventions that have been considered. The evaluators assert that "a one-size-fits-all intervention is unlikely to be the most effective approach, and careful evaluation of local risk factors and context is necessary to determine the optimal intervention. There is a growing consensus that to achieve HIV prevention in young people it is necessary to provide a range of tools and address a number of barriers, and to accomplish this it is necessary to implement interventions in different settings simultaneously..."

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13. Recommendations on HIV Prevention Among Young People in Sub-Saharan Africa

This document, published in September 2009 also by the London School of Hygiene and Tropical Medicine (LSHTM), reports on a technical workshop organised by LSHTM and the Mwanza Research Centre of the Tanzanian National Institute for Medical Research. Held in 2009 in Tanzania, the objective of the workshop was to provide guidance and support for evidence-informed interventions to prevent HIV among young people in Sub-Saharan Africa. The report suggests that interventions to prevent new infections among young people must be designed both to reduce their risk of acquiring HIV, and also reduce the risk of transmitting the virus to others, which may require different approaches and designing interventions for different groups. The report also includes relevant findings from the updated systematic review of behavioural interventions in young people, called "Steady, Ready, Go!" (see #12 above). Recommendations are included for programme implementers, policymakers, researchers, and donors.

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14. A Proven Multi-Country Peer Education Program and Community Mobilization Strategy for Youth HIV Prevention

This document is an annual report on one year of the "Scaling Up Together We Can" programme, funded by PEPFAR and USAID and implemented through the American Red Cross by the Guyana, Haitian, and Tanzania Red Cross Societies. Scaling Up Together We Can is a 6-year effort to reach more than 1,060,000 youth ages 10 to 24 through interpersonal and participative approaches to relaying HIV prevention messages, community-based "edutainment" events, and mass media-based outreach in Guyana, Haiti, and Tanzania. Peer education, community and social mobilisation, and capacity building for the 3 national Red Cross societies are the primary strategies used to promote positive behaviour change among youth. This report details specific behaviour change strategies used, accomplishments in each country, and major issues and constraints met during implementation.

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Tools


15. "Positive Prevention" for PLWHA

This booklet, published by Southern Africa HIV and AIDS Information Dissemination Service (SAFAIDS) includes sections that discuss steps towards "positive" prevention for people living with HIV and AIDS (PLWHA), including coming to terms with an HIV-positive status, dispelling myths related to HIV, adopting a lifestyle of positive prevention, and playing an active role in HIV prevention efforts in communities. It is designed for those who want to learn how they can take active steps to protect themselves, their partners, and their children from further transmission.

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16. Guidelines and Activities for a Unified Approach to Sexuality, Gender, HIV, and Human Rights Education

This Population Council resource is meant to help readers develop sexuality and HIV education curricula with an emphasis on gender and rights. It is intended to enable educators to teach young people about topics such as: gender norms; communication and decision making; sexual consent and coercion; fairness and human rights (including sexual rights); power and relationships; preventing HIV, sexually transmitted infections (STIs), and unintended pregnancy; puberty; and social change. The first volume, Guidelines, includes seven content units, 22 fact sheets, “points for reflection” to foster critical thinking, and a module on advocacy. The second volume, Activities, includes 54 sample activities, a chapter on effective teaching methods, and an additional resources section.

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17. Classroom Activities for HIV and AIDS Education

This toolkit, developed by Education International, the Education Development Center, and WHO, is designed to help teachers address themes relating to HIV and AIDS with their students. Age-appropriate activities and lesson plan templates are provided for teaching students the skills they need to protect themselves from HIV and support those in their schools and communities who are living with HIV. The book introduces the teaching approach and methods, explains the use of the activities, and provides 7 to 10 activities in each of the following age groups: under age 10, ages 10-14, and ages 15+. Photocopy master sheets are included.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com



SBCC E-magazine

C-Picks, supported by C-Change and implemented by The Communication Initiative, is an e-magazine on social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health) and the environment and democracy and governance sectors.



Subscribe to C-Picks Unsubscribe from C-Picks View C-Picks Archives More about C-Picks

Communication for Change (C-Change), implemented by AED, is a USAID-funded project to improve the effectiveness and sustainability of social and behaviour change communication (SBCC) as an integral part of development efforts in health, environment, and civil society. C-Change works with global, regional, and local partners to apply communication approaches supported by evidence-based strategies, state-of-the-art capacity strengthening, and cutting-edge research. C-Change also works to strengthen the capacity of local organisations to incorporate SBCC in the planning, implementation, and monitoring of their programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website. To contact The CI, please email info@comminit.com


C-CHANGE USAID The CI


This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Change Picks - Focus on Reproductive Health, Maternal Health, and Malaria

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Date: 
June 7, 2010

C-Change Picks #13 - Focus on Reproductive Health, Maternal Health, and Malaria
Information about Social and Behaviour Change Communication, sponsored by C-Change
June 2010

 

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme

 

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C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative on social and behaviour change communication (SBCC) case studies, reports, analyses, and resources in the health sector (HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health) and the environment sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #13 opens with a highlight on SBCC strategies for addressing women's reproductive health, including improving access to family planning among young married couples, delaying first births, healthy spacing between births, and using the LAM method. Evaluations of four maternal health-focused SBCC projects, from the Middle East to East Timor, follow. A section on malaria spotlights IEC tools recently developed by C-Change for a malaria prevention campaign in Ethiopia, a comic book and social mobilisation campaign in India, and two reports on other SBCC strategies for addressing malaria prevention in Ethiopia and globally. The issue concludes with three upcoming events.

 

C-Change recently assisted the Government of Kenya in its efforts to revitalise family planning with a launch of the national reproductive health strategy and related guideline documents. C Change is providing technical assistance to implementing partners in the design and implementation of communication interventions in family planning programmes, with the overarching goal of assisting individuals to make informed decisions and determine their own reproductive intentions based on what is best for their families.

 

With funding from the U.S. President's Malaria Initiative (PMI), C-Change is working with the regional Oromia government in Ethiopia to educate and assist families to carry out actions to prevent and treat malaria. This includes providing training to government health staff that in turn assist families and communities to improve their malaria prevention knowledge using C Change developed materials. Working together, a health worker helps a family to monitor progress in carrying out specific actions to prevent malaria under the Model Families Program and use the Malaria Protection Scorecard to verify compliance. Visit the C-Change website for additional information about C-Change programmes and activities.

 

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Please visit the C-Change Picks website for more resources and thinking recently highlighted by the C-Change programme.

 

You will find the current edition of the C-Change Picks e-magazine online.

 

For the archived issues of the C-Change Picks e-magazine, please click here.

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

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The C-Change Capacity Strengthening Online Resource Center (CSORC) is now live and linked from the C-Change Picks website.

 

The CSORC is dedicated to providing the resources and opportunities needed to strengthen capacity in the area of SBCC. It offers resources and practical tools - including links to C-Change's C-Modules and other training tools.

 

Please visit the CSORC. To subscribe to The ORC, the SBCC capacity strengthening e-magazine, send an email to cchangeorc@comminit.com

 

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In this Issue of C-Change Picks...

 

FAMILY PLANNING AND COUPLES

 


1. A Couples' Reproductive Health Communication Model from India

2. Linking Marriage, Family Planning, and Adaptation to Climate Change in Ethiopia
3. Mobilizing Married Youth in Nepal to Improve Reproductive Health
4. Lactational Amenorrhea Method Family Planning Tools and Resources

 

MATERNAL HEALTH

 

5. White Ribbon Alliances in Asia and the Middle East Make it Happen for Maternal Health and Family Planning
6. Postpartum Care Survey Results from Sub-Saharan Africa
7. Evaluations of Two USAID-supported Maternal, Newborn and Child Health Programmes in Pakistan
8. Improving Maternal and Newborn Health in Timor Leste

 

MALARIA

 

9. Tools Developed for a Malaria Prevention Campaign in Ethiopia
10. A Primer for PMI Communication and Social Mobilisation
11. Malaria Awareness Comic Book-based Campaign in India
12. Strategically Involving Communities in the Fight Against Malaria in Ethiopia
13. Nets + Hang Up Campaign: The Winning Formula to Beat Malaria

 

EVENTS

 

14. Women Deliver 2010
15. Global Health Council's Annual Conference - Dateline 2010
16. Global Maternal Health Conference 2010

 

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FAMILY PLANNING AND COUPLES

 

1. A Couples' Reproductive Health Communication Model from India

 

Using data from PRACHAR, a project in Bihar, India, this January 2010 paper, "A Reproductive Health Communication Model That Helps Improve Young Women's Reproductive Life and Reduce Population Growth," from Pathfinder International, shows that culturally- and community-focused interventions geared to adolescents and youth can help to: increase age of marriage and first birth, increase contraceptive use among young couples, provide vulnerable populations with better access to reproductive health (RH) services, and reduce population growth. Sample PRACHAR activities include: newlywed couples are given "infotainment" parties; young married women are visited by female workers who provide information on the benefits of delaying childbearing and spacing of pregnancies; and meetings are held with young married males, parents and in-laws, and influential community members. The impact of PRACHAR interventions was assessed at both Phase 1 (2002-2005) and Phase 2 (2005-08), with a summary of the findings included here.

 

2. Linking Marriage, Family Planning, and Adaptation to Climate Change in Ethiopia

 

This October 2009 document, "Linking Population, Fertility and Family Planning with Adaptation to Climate Change in Ethiopia," from Population Action International, details a study exploring how communities in Ethiopia react to and cope with climate variation, which groups are considered most vulnerable, what resources communities need to adapt to climate changes, and the role of family planning and reproductive health in increasing resilience to climate change impacts. Researchers found that, while awareness of family planning is high, 34% of currently married women want to postpone childbearing for 2 or more years or stop entirely, but they are not currently using contraception. In the Southern Nations, Nationalities and People's region, a rural community member remarked that "...if a family has limited children, he will have enough land for his kids and hence we can protect the forests....In earlier years, we had a lot of fallow lands, but now, as a result of population growth, we don't have adequate fallow land. Therefore, limiting the number of children will help us to cope with the change in climate."

 

3. Mobilizing Married Youth in Nepal to Improve Reproductive Health

 

This report evaluates the 2-year Reproductive Health for Married Adolescent Couples Project (RHMACP), implemented in Nepal in 2005 by the ACQUIRE Project in association with CARE Nepal and with funding from USAID. The project utilised an ecological model to improve health outcomes for married adolescents in the 2 target districts (Parsa and Dhanusha). In close collaboration with District Public Health Offices, the RHMACP established a peer education network to disseminate reproductive health information to married couples; supported local health facilities to provide youth-friendly services; and fostered an enabling environment among parents, in-laws, and influential community members to increase married adolescents' access to, and use of, health services. "The ecological model successfully accommodated an expanded project focus that embraced peer initiatives in community development, local governance, and citizens' rights - all of which strongly supported the core project goal of effective access to quality reproductive health services for all married adolescents."

For more information about the RHMACP project, please click here.

 

4. Lactational Amenorrhea Method Family Planning Tools and Resources

 

a) Counseling Guide for Teaching Women How to Use LAM and Informational Client Card: LAM Lactational Amenorrhea Method: A Family Planning Method for Breastfeeding Women

 

This Counseling Guide is designed to help family planning counsellors explain when and how to use the Lactational Amenorrhea Method (LAM) of birth control. The Informational Client Card is a smaller format describing the same information and using the same illustrations as the Counselling Guide, but addresses women who have given birth and are breastfeeding their infants.

 

b) Repositioning the Lactational Amenorrhea Method: Benefits for Women, Children and Programs

 

This document intends to give guidance to providers about how LAM can be repositioned in their programmes so that they can better address the needs of postpartum women. The document first describes the benefits of the method, citing World Health Organization (WHO) recognition of its importance, and then recommends use of strategic steps for repositioning LAM as an introductory family planning method.

 

Also see the Consensus Statement on Rationale for Operationalizing LAM Criteria.

 

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MATERNAL HEALTH

 

5. White Ribbon Alliances in Asia and the Middle East Make it Happen for Maternal Health and Family Planning

 

This July 2009 publication, entitled "Time to Deliver on Maternal Health and Family Planning Best Practices: White Ribbon Alliances in Asia and the Middle East Make it Happen," examines White Ribbon Alliances (WRAs), which have been established across Asia and the Middle East as advocates for evidence-based strategies to reduce maternal mortality. This brief highlights the achievements of alliances from Bangladesh, India (Orissa), Indonesia, Pakistan, and Yemen. The 5 case studies demonstrate the alliances' strategies for strengthening commitment to and active promotion of maternal and child health, as well as for designing country-specific action plans to scale up evidenced-based FP/MNCH best practices, including best practices in SBCC.

 

6. Postpartum Care Survey Results from Sub-Saharan Africa

 

Based on a model developed in 2005 by the Extending Service Delivery Project and CATALYST for the Asia and Near East region, the postpartum case survey from the ACCESS Program on family planning (FP), ACCESS-FP, was created to identify, document, and share information on the status of postpartum care (PPC) services implemented by USAID cooperating agencies. This report describes the purpose and scope of the survey, and presents results from 37 sub-Saharan African projects surveyed. SBCC best practices, lessons learned, recommendations, and potential barriers are all identified here.

 

7. Evaluations of Two USAID-supported Maternal, Newborn and Child Health Programmes in Pakistan

 

This is a 2008 evaluation of both the Pakistan Initiative for Mothers and Newborns (PAIMAN) maternal and newborn project, led by John Snow Inc. (JSI), and the Improved Child Health Project (ICHP) implemented by Save the Children. Conducted in June-July 2008 through the Global Health Technical Assistance Project, these evaluations assessed whether the projects were achieving intended results, reviewed their organisational structures and technical approaches, and formulated recommendations for future directions. During field visits to selected project sites, the team interviewed a broad range of stakeholders, including health managers, service providers, trainees, and community members. Findings related to SBCC within each project are included in this report.

 

For more information about the PAIMAN project, click here.
For more information about the ICHP project, click here.

 

8. Improving Maternal and Newborn Health in Timor Leste

 

This evaluation report explores the initial 4-year cycle of the Child Survival and Health Grants Program (CSHGP), which was carried out by Health Alliance International (HAI) in 7 Districts in the Democratic Republic of Timor-Leste. Launched in September 2004, the intervention combined community-level health promotion activities and health system strengthening. The strategies focused on training, behaviour change, materials development, and community outreach. Best practices, lessons learned, and recommendations are indicated in this report.

 

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MALARIA

 

9. Tools Developed for a Malaria Prevention Campaign in Ethiopia

 

These 3 graphic tools, designed by C-Change for the Malaria Prevention Campaign in Ethiopia, focus on small, "doable actions" that families can carry out to protect themselves against malaria. The tools include: 1) Malaria Protection Scorecard; 2) Essential Malaria Actions Flipchart; and 3) Malaria Prevention Sticker.

 

10. A Primer for PMI Communication and Social Mobilisation

 

This short-form document presents summary guidelines to assist in the development, implementation, and monitoring and evaluation (M&E) of programmes to influence behaviours and mobilise communities to create long-term behaviour change around the President’s Malaria Initiative (PMI) interventions: correct and consistent use of insecticide-treated nets (ITNs); acceptance of indoor residual spraying (IRS); and adherence to treatment and prevention therapies, particularly during pregnancy. The guidelines are structured as a planning framework. They explain how to: establish goals and objectives, review existing data and conduct a rapid assessment, develop a strategy with a budgeted plan of activities, and monitor and evaluate the process.

 

Also see the PMI Communication and Social Mobilization Guidelines.

 

11. Malaria Awareness Comic Book-based Campaign in India

 

An India-based content and design service provider, Chillibreeeze, has produced a comic book called "A Tale of Two Magic Potions" to spread awareness about hazards of malaria. The comic book is designed to engage Indian children, who can then go on to educate their families about the disease. An associated campaign implemented through school curricula, a contest, and participatory online social networking tools such as Facebook are broadening distribution and supporting social norms change.

 

For more information about "A Tale of Two Magic Potions", please click here.

 

12. Involving Communities in the Fight Against Malaria in Ethiopia

 

Published by the African Medical and Research Foundation (AMREF) in 2009, this case study shares the experience of the organisation's Malaria Prevention and Control Programme in the Afar region of Ethiopia, which comprises mostly pastoralist communities. The main activities of the programme included training health care service providers, equipping health centres, training mother coordinators, distributing insecticide treated nets (ITNs), and sensitising local leaders on malaria prevention and control. According to AMREF, as a result of this programme, the skills of over 200 health care service providers on diagnosis and treatment improved. There was a 34% increase in knowledge about transmission of malaria, 62.5% increase in ITN possession, and 48% increase in treatment seeking behaviour at the community level. The case study suggests that the programme demonstrated a reasonable and replicable model of malaria prevention and control by strengthening and linking the different segments of health systems in pastoralist communities.

 

13. Nets + Hang Up Campaign: The Winning Formula to Beat Malaria

 

Published in mid-2009, this International Federation of Red Cross and Red Crescent Societies (IFRC) World Malaria Day report discusses the organisation's experiences with distributing insecticide treated nets accompanied by "hang up" campaigns to ensure the nets are used. According to the report, there is growing scientific evidence to demonstrate that combining mosquito net distribution with follow-on "hang up" campaigns carried out by trained local volunteers significantly reduces incidence of malaria, particularly among those living in remote areas, refugees, and people affected by stigma and discrimination.

 

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EVENTS

 

14. Women Deliver 2010 (June 7-10 2010) Washington, DC, United States

 

15. Global Health Council's Annual Conference - Dateline 2010: Global Health Goals & Metrics (June 14-18 2010) Washington, DC, United States

 

16. Global Maternal Health Conference 2010 (August 3 – September 1 2010) India Habitat Centre, New Delhi, India

 

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~

 

Communication for Change (C-Change),implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

~

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

~

 

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C-Change Picks - Focus on MCP and Gender Issues

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Date: 
April 12, 2010

C-Change Picks #12 - Focus on MCP and Gender Issues
Information about Social and Behaviour Change Communication, sponsored by C-Change
April 12 2010

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

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C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication (SBCC) in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

C-Change Picks 12 focuses on multiple concurrent partnerships (MCP), a major driver of HIV in Africa, and on gender issues in the context of HIV. It closes with a focus on faith-based responses to HIV prevention programmes that address MCP and gender-based violence.

C-Change completed the first of a multi-part capacity strengthening monitoring and evaluation training in Namibia in March 2010. The training strengthens the capacity of local partners and agencies to monitor outcomes and results of their SBCC programmes. Role playing and hands-on practice allowed participants to apply the skills they were learning, which included interview techniques, how to administer a questionnaire designed to measure outcomes, and how to use a corresponding database to store collected data. Participants will return for further C-Change training in June. See the C-Change website for additional information on C-Change’s capacity strengthening work around SBCC.

C-Change recently finalised and launched the C-Modules: A Learning Package for Social and Behavior Change Communication for facilitated, face-to-face workshops on SBCC. The C-Modules focus on essential SBCC competencies for each of the five key stages of developing an effective SBCC programme. The package includes a series of six modules with accompanying facilitator guides for communication practitioners working in development. This package is designed for staff of development programmes in small and medium-sized organisations with varying degrees of experience in planning or implementing SBCC programmes.

 

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The C-Change Capacity Strengthening Online Resource Center (CSORC) is now live and linked from the C-Change Picks website.

 

The CSORC is dedicated to providing the resources and opportunities needed to strengthen capacity in the important area of SBCC. It offers resources and practical tools - including links to the C-Modules mentioned above as well as other C-Change SBCC training tools.

Please visit the CSORC - click here!

 

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Please visit the C-Change Picks website for more resources and thinking recently highlighted by the C-Change programme.

You will find the current edition of the C-Change Picks e-magazine online.

For the archived issues of the C-Change Picks e-magazine, please click here.

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

~

In this Issue...

GENDER ISSUES AND HIV

1. Masculinity, Rape, and HIV in South Africa
2. Multiple Concurrent Partnerships and Gender Power Dynamics

MCP AS A DRIVER OF HIV

3. Assessing Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho

4. The Language of MCP, Sex, and HIV and AIDS in Lesotho
5. Lessons from a Hard-Hitting Mass Media MCP Campaign in Swaziland
6. The Role of Sexual Dissatisfaction in MCP in South Africa
7. National MCP Communication Plan - Botswana
8. Understanding Why MCP
9. Southern African Policy Guidance for MCP Programming
10. Defining, Measuring, and Identifying a Future Research Agenda for MCP

SOME FAITH-BASED RESPONSES

11. Religious Leaders Mobilize a Faith-based Response to HIV in Kenya
12. MCP Attitudes and Perceptions of Community Leaders of Faith

13. The Role of Religious Communities in Addressing Gender-Based Violence and HIV

UPCOMING EVENTS

14. HIV/Culture Confluence: Changing the River's Flow
15. XVIII International AIDS Conference (AIDS 2010)

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GENDER ISSUES AND HIV

1. Masculinity, Rape, and HIV in South Africa

 

Published by the Gender and Health Research Unit of the Medical Research Council (MRC) in June 2009, "Understanding Men's Health and Use of Violence: Interface of Rape and HIV in South Africa" is based on research in South Africa that sought to: clarify the prevalence of rape perpetration in a random sample of community-based adult men; understand factors associated with rape perpetration; and describe intersections between rape, physical intimate partner violence, and HIV. The authors note that high levels of rape are rooted in negative conceptions of masculinity. They argue that the problem cannot be addressed solely through criminal prosecution, but requires a broader approach that addresses these conceptions of manhood.

2. Multiple Concurrent Partnerships and Gender Power Dynamics

This poster presentation, exhibited at the 2009 meeting of the International AIDS Society in Cape Town, South Africa, examines MCP in South Africa's Eastern Cape Province. The presentation suggests that the practice of having multiple concurrent partnerships is culturally sanctioned in many parts of South Africa and is often inextricably linked to gender power differentials. Power imbalances in sexual relationships can hinder healthy couple communication and negotiation for safer sex, and may facilitate gender-based violence, which in turn can increase women's vulnerability to HIV. The presentation concludes by recommending that programmes seeking to reduce the prevalence of MCP in the country must also address issues of gender inequality and gender-based violence within relationships and should be designed for both men and women.

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MCP AS A DRIVER OF HIV

3. Assessing Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho

Published by C-Change in July 2009, "A Baseline Survey of Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho" presents the findings from a survey conducted by C-Change in March 2009 in order to collect population-based data related to the MCP knowledge, attitudes, and practices of Basotho men and to consider appropriate communication channels for HIV prevention messages. The report suggests that in designing media campaigns, messages do not need to concentrate on the protective benefits of condoms or the dangers of MCP, per se, recommending more nuanced messages that discuss the need to use condoms with steady partners, the high risk when MCP and intergenerational sex are combined, and the need to balance having fun with the risks associated with MCP. In addition, the study recommends increasing awareness of where men can obtain condoms, as well as encouraging the practice of carrying condoms, as this may be a cause of the relatively inconsistent condom use.

4. The Language of MCP, Sex, and HIV and AIDS in Lesotho

Also published by C-Change in July 2009, "The Language of Multiple Concurrent Partners, Sex, and HIV and AIDS in Lesotho: Opportunities for Dialogue Promotion Research Report" analyses formative research carried out by C-Change to understand how culturally-embedded communication about HIV and AIDS and sexual behaviour contributes to sustaining the practice of MCP in Lesotho. According to the report, the findings from qualitative research along with a review of existing research is informing message development for a short-term communication campaign in Lesotho focusing on HIV prevention through the promotion of dialogue about MCP. The report suggests that opportunities for intervening in language, promoting dialogue, and community mobilisation should pay attention to the fact that dialogue about sex and MCP using open and direct language runs counter to indigenous concepts of respect and social status and risks provoking a backlash.

5. Lessons from a Hard-Hitting Mass Media MCP Campaign in Swaziland

This September 2009 AIDSTAR-One case study, "Secret Lovers Kill: A National Mass Media Campaign to Address Multiple and Concurrent Partnerships," is about a national media campaign in Swaziland which focuses on HIV prevention, with a specific focus on MCP. Launched by the government's National Emergency Response Council on HIV/AIDS (NERCHA) in 2006 with controversial and blunt messages about the practice of "secret lovers", the campaign sparked passionate national debate in the media and in communities about the practice of makhwapheni. According to survey data, the number of men reporting two or more partners dropped by 50% immediately after the campaign began. However, the campaign was suspended due to objections raised about the stigmatising effect of what was termed fear-based advertising. This case study shows that if direct and hard-hitting campaigns are being designed, attention must be given to ensuring that groups within the community are not stigmatised as a result of unintended messages.

6. The Role of Sexual Dissatisfaction in MCP in South Africa

"The Role of Sexual Dissatisfaction in Driving Multiple Concurrent Partnerships," presented by Soul City Institute for Health and Development at the 4th South African AIDS Conference in 2009, looks at the role of sexual dissatisfaction and lack of partner communication in driving MCP in South Africa. The overall aim of the research was to gain insight into the audience's understanding, attitudes, and practices around sexual relationships in the context of HIV prevention. The author argues that sexual dissatisfaction and partner communication around sex must be addressed as part of a strategy to decrease MCP.

7. National MCP Communication Plan - Botswana

"Republic of Botswana: National Campaign Plan - Multiple Concurrent Partnerships", published in March 2009 by the National AIDS Coordinating Agency Botswana (NACA), outlines a multi-year behaviour change campaign, with a focus on MCP as a key driver of HIV transmission. One insight from the research that underpins this plan is that MCP is not a single phenomenon but a complex and multi-faceted one driven by a combination of factors, both traditional and modern. According to this plan, treating MCP as a uniform, monolithic behaviour obscures the variety of motivations that prompt individuals to have partners in addition to their primary ones, and the functions that these additional relationships fulfil. A typology that characterises the different forms that MCP takes is presented in the plan and this understanding of the complexity of the phenomenon underpins the behaviour change approaches taken in the campaign.

8. Understanding Why MCP

In "Why Multiple Sexual Partners?" published in August 2009 in The Lancet, James D. Shelton examines behavioural components of MCP. As stated by Sheldon: "Understanding why people have multiple partnerships is key to efforts to change behaviour, with the realisation that behaviours range from polygamy itself, to longer term quasi-polygamy (sometimes described as having a 'small house'), to sporadic sexual encounters." Shelton provides a brief review of one campaign to address MCP in Botswana: "O Icheke - Break the Chain - campaign," led by the NACA with help from Population Services International and other partners. He concludes by suggesting that behaviour change projects on MCP, along with the promotion of male circumcision and use of condoms, especially for high-risk sex, appear to be the most promising way forward for preventing hyper-epidemic HIV transmission.

9. Southern African Policy Guidance for MCP Programming

A 2-day meeting on "Addressing MCP in Southern Africa: Developing Guidance for Bold Actions" which was co-hosted by the AIDS Prevention Research Project (APRP) at Harvard University, the World Bank, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), brought together various organisations working in the southern Africa region with the aim of establishing a common vision and agenda to guide interventions and strategies addressing MCP. Key principles for future MCP programming are outlined here, including that programming "must be based on sound evidence regarding the epidemic and the existing responses and unmet needs. It needs to be a coherent strategy and to operate at different levels, but with the specific solutions and messages to be community-driven. Both social transformative and individual behaviour change approaches are required, and there must be consistency and complementarity between them and in the approaches taken by the various stakeholders."

10. Defining, Measuring, and Identifying a Future Research Agenda for MCP

"Consultation on Concurrent Sexual Partnerships: Recommendations from a meeting of the UNAIDS Reference Group on Estimates, Modelling and Projections held in Nairobi, Kenya, April 20-21st 2009" outlines recommendations that emerged from a meeting that brought together experts who worked to: reach consensus on a standard definition of "concurrent sexual partnerships", recommend methods for measuring concurrency in a population, and set out a future research agenda around the study of concurrent sexual partnerships and its association with HIV transmission. The report closes with a detailed description of a future research agenda which includes methodological, epidemiological, and "innovative" research designs.

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SOME FAITH-BASED RESPONSES

11. Religious Leaders Mobilize a Faith-based Response to HIV in Kenya

This September 2009 brief, prepared by USAID's Health Policy Initiative, shares strategies and lessons learned from the Health Policy Initiative's work to help support the Kenya Network of Religious Leaders Living with or Personally Affected by HIV/AIDS (KENERELA+). This group seeks to equip, empower, and engage religious leaders living with or personally affected by HIV and AIDS to live positively and openly as agents of hope and change. “Finding Courage in Faith: Religious Leaders Challenge Stigma and Mobilize a Faith-based Response to HIV in Kenya” states that one of the keys to KENERELA+'s success has been the cultivation and support of strong individual champions. In addition, KENERELA+ says that successful implementation and delivery at the grassroots level is more effective than centralised action.

12. MCP Attitudes and Perceptions of Community Leaders of Faith

Published by the Pan African Christian AIDS Network (PACANet) in January 2009, this report shares findings from a survey that sought to access churchgoers' perceptions about MCP and the church's response to these relationships, with a view that church leaders must understand the attitudes and perceptions surrounding these relationships in order to develop effective interventions. "Multiple Concurrent Partnerships and the Church: Assessing the Attitudes and Perceptions of Community Leaders of Faith," which collected data across denominations, found that members of evangelical churches in Africa were less likely to perceive MCP as a problem within their congregations. Additionally, most tended to explain MCP by drawing on gender stereotypes, saying that women participated in such partnerships for economic reasons while men's "natural and social impulses" drove them to seek multiple partners.

13. The Role of Religious Communities in Addressing Gender-Based Violence and HIV

This August 2009 report summarises a USAID Health Policy Initiative project which was designed and implemented in Africa by Futures Group International and Religions for Peace. Recognising the importance of collaborating to prevent and reduce gender-based violence (GBV) and HIV among women and girls, the initiative partners worked to improve the capacity of religious leaders and faith-based organisations to respond to GBV and its links to HIV. This report details the project’s process and identifies lessons learned.

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UPCOMING EVENTS

14. HIV/Culture Confluence: Changing the River's Flow – April 12-13 – South Africa

15. XVIII International AIDS Conference (AIDS 2010) – July 18-23 – Austria

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~

Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website .

 

~

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

~

Sent to you from The Communication Initiative...where communication and media are central to social and economic development...

The CI Partners: ANDI, BBC World Service Trust, Bernard van Leer Foundation, Calandria, CFSC Consortium, CIDA, DFID, FAO, Fundación Nuevo Periodismo Iberoamericano, Ford Foundation, Healthlink Worldwide, Inter-American Development Bank, International Institute for Communication and Development, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, PAHO, The Panos Institute, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, Swiss Agency for Development and Cooperation, UNAIDS, UNDP, UNICEF, USAID, WHO, W.K. Kellogg Foundation.
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C-Change Picks - Focus on Family Planning

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Date: 
February 8, 2010

C-Change Picks #11 - Focus on Family Planning
Information about Social and Behaviour Change Communication, sponsored by C-Change
February 8 2010

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication (SBCC) in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #11 focuses on SBCC strategies for promoting family planning (FP). This includes a concentration on integrating FP services with other health services, linking FP awareness activities with income generating activities, training reproductive health providers (particularly those at the village level), and identifying approaches that are appropriate for addressing youth. This issue closes with four resources that can be used to support the training of health service providers in family planning awareness and promotion.

 

To revitalise family planning programmes and garner high-level political and budgetary support for family planning, C-Change organised a conference in the Democratic Republic of Congo (DRC) in December 2009. DRC's Ministry of Health, other ministries, USAID, and the United Nations Population Fund (UNFPA), along with donor agencies and stakeholders, met for two days to address the situation related to FP services in the country, including the high unmet need for family planning methods (only 7% of women use a modern contraceptive method [DHS 2007]) and the high rates of maternal and child deaths. This conference led to recommendations and a plan of action for the DRC government and donors to address these critical needs. See the C-Change website for more information.

 

 

 

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

 

In this Issue...

FAMILY PLANNING (FP) THROUGH HEALTHY FAMILY INITIATIVES

1. Fostering Linkages between Family Planning and Maternal/Child Health Services
2. Creating Healthy Families in Nepal

FP THROUGH LIVELIHOOD PROGRAMMES

3. Supporting Economic Independence and Family Planning In Mali
4. Integrating Reproductive Health Into Livelihood Programs In India

FP THROUGH HEALTH PROVIDER TRAINING

5. Forging Partnerships between Communities and Service Providers in Guatemala
6. Family Planning Promotion Training for Village Health Committees in Guinea
7. Creating Standard Delivery Practices to Increase Access to Family Planning in Guatemala

FP THROUGH REACHING YOUTH

8. Reaching Out to Teen Mothers in Malawi
9. Preventing Student Pregnancy in Guinea's Forest Region
10. Reaching Youth Through Community Strategies

TRAINING RESOURCES

11. Postpartum Family Planning for Healthy Pregnancy Outcomes: A Training Manual
12. Constructive Men's Engagement in Reproductive Health: A Training-of-Trainers Manual
13. Basics of Community-Based Family Planning: Facilitator and Participant Guides
14. Programming for Training: A Resource Package

 

FP THROUGH HEALTHY FAMILY INITIATIVES

 

1. Fostering Linkages between Family Planning and Maternal/Child Health Services

 

"Helping Egyptian Women Achieve Optimal Birth Spacing Intervals through Fostering Linkages between Family Planning and Maternal/Child Health Services" explores a research intervention implemented by the USAID-funded FRONTIERS programme. The effort is designed to support Egyptian women in achieving healthier birth intervals through measurement of the acceptability and effectiveness of two birth spacing message models:

  • Model I (health services model) - birth spacing messages were communicated through services by health workers to women during prenatal and postpartum periods.
  • Model II (community awareness model) - Model I was supplemented by an awareness-raising component that reached out to men through training community "influentials" to communicate messages.

 

Providing birth spacing messages to low parity women during antenatal and postpartum care, and also to husbands through community awareness activities, was found to be feasible and acceptable. Both models proved effective in changing women's knowledge and attitudes towards birth spacing and in enhancing use of contraception at 10-11 months postpartum, by 48% among Model I mothers and 43% among Model II mothers, compared with 31% among control group mothers. Furthermore, over the postpartum period, women in the two intervention groups used contraception more consistently than women in the control group - median duration of protection against pregnancy was 6.8 months for Model I mothers, 4.5 months for Model II mothers, and 2.9 months for control group mothers. Finally, both intervention models were associated with an increased utilisation of services, especially FP services, by women who only had one child (36% increase in Model I clinics, 47% increase in Model II clinics, and 3.2% in control clinics).

 

"It is interesting to note that although contraceptive use reported among women in group II was not higher than in group I, service statistics showed a substantial increase in the proportion of FP clients with one child in Model II clinics. This could be attributed to a gradual gain in momentum of Model II interventions and awareness-raising activities, reaching a larger audience over time and impacting contraceptive use among other (and more) low parity women in the community."

 

This report concludes with a number of policy recommendations.

 

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2. Creating Healthy Families in Nepal

 

Published by the CORE Group in March 2009, "Creating Healthy Families in Nepal: Sustaining Family Planning Practices Among Marginalized Groups" documents the sustainable activities and interventions of an initiative that aimed to help women and couples from disadvantaged groups in Nepal realise their reproductive intentions through: a) increased knowledge of and interest in family planning services through participatory learning and action/radio listening groups (PLA/RLG); b) improved quality of family planning (FP) services facilitated by community involvement in defining, implementing, and monitoring the quality improvement process; c) increased community access to FP services through voluntary surgical contraception (VSC) outreach; and d) improved social and policy environment for FP and reproductive health (RH) services and behaviour through capacity building and the Non-governmental Organisation (NGO) Institutional Capacity Tool.

 

This case study details a number of specific impacts of the project. A few key ones include:

  • After completion of the project, some PLA members remained functional as members of mothers groups and some of them organised themselves into income generation groups called "saving/credit groups"; as part of these latter groups, some women share the RH/FP messages with the other women in the village.
  • NGO partners catalysed community participation in all aspects of the project, encouraging family dialogue about family planning through radio listening groups, peer dialogue through literacy groups, and dialogue with health facility staff through Quality Improvement Teams.
  • Use of health facilities has increased. The register from the Haripur Sub Health Post indicated that on an average, 30 patients come to the clinic every day for different services and treatment. In May-June 2008, a total of 800 patients were seen by the clinic. Out of 800 clients, 32 women received injectable FP (Depo) services and 31 pregnant women received antenatal care services from the health facility.
  • VSC services provided in the Muslim communities increased in the year following the end of the project. Comprehensive FP and VSC services are well accepted and continue to be available year-round, not only in the winter months. There continue to be requests for expanded VSC services from District Public Health Offices to serve as a complement to their own services.

 

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FP THROUGH LIVELIHOODS PROGRAMMES

 

3. Supporting Economic Independence and Family Planning In Mali

 

From the paper series Voices from the Village: Improving Lives through CARE's Sexual and Reproductive Health Programs, this May 2009 report, "Keneya Ciwara: Supporting Family Planning In Mali," describes an initiative to increase the availability and demand for quality health services at the community level while improving essential health practices in the household, including an element linking FP and income generation for women. The second phase of the Keneya Ciwara programme began in October 2008 and will last 3 years, eventually covering every health district in the country.

 

Keneya Ciwara revolves around a system of volunteer outreach workers ("relais") who seek to raise awareness about family planning and other health issues among community members who lack access to local health centres.

 

The other crucial component of the programme is Musow Ka Jigiya Ton (MJTs, or Women's Savings Clubs). Each MJT selects members who are trained by the programme to be community health agents. These agents then provide basic health information and peer counselling; for example, they talk with other women about how to better communicate with their husbands about family planning. Each health agent is given an initial stock of contraceptive products that she can sell to generate income, which she then contributes to a communal fund. This money can finance the purchase of more family planning products and also fund women's visits to the community health centre, where they can procure other contraceptives. Members can also borrow money from the fund to start their own small enterprises. As of May 2007, there were about 560 women participating in 20 MJTs across 7 villages in the Kendie health district. In the first phase of the programme, they were able to mobilise more than US$18,000 in credit and carry out 188 awareness-raising sessions on health and family planning, which involved nearly 4,000 local women.

 

According to this study, women's groups can help significantly increase rates of family planning. "The groups offer women economic independence from men, allowing them to support one another in the face of opposition from their husbands....An important next step in the program is thus to emphasize, particularly to men, that there are economic advantages to using family planning. Women's groups can help open up dialogue on this subject by giving women the support and negotiating skills to improve spousal communication."

 

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4. Integrating Reproductive Health Into Livelihood Programs In India

 

This report details the implementation and evaluation of a project carried out in 2008 and 2009 to develop and test a sexual and reproductive health (SRH) curriculum for vocational students aged 15-24 from economically poor families in urban and rural areas of India. As part of the year long Samriddhi Project, a curriculum and teaching aids were developed and then used to build the skills of youth educators to teach SRH and family planning (FP) topics. The Samriddhi curriculum was integrated into existing vocational training programmes for youth. The goal was to equip low-income and at-risk youth in Andhra Pradesh and Delhi with accurate, age-appropriate information on how to maintain their reproductive health and prevent risky behaviours that lead to poor health outcomes including sexually transmitted infections (STIs), unplanned pregnancies, and unsafe abortions.

 

Key findings related to youth knowledge:

  • In post-tests, 90% of male youth and 85% of female youth correctly discussed the changes that occur in their bodies during puberty.
  • In the pre-test, only 39% of male youth correctly responded to the question, "How do girls get pregnant?" This percentage rose to 95% in the post-test.
  • After the course, more than 90% of youth correctly identified pregnancy prevention methods.

 

Key findings related to youth attitudes and perceptions:

  • Most youth indicated they were comfortable attending the SRH sessions that were integrated into existing vocational training programmes.
  • 65% of male youth indicated that, after this training, they would not be embarrassed to ask for condoms in a pharmacy.
  • 70% of male youth reported feeling more aware of gender issues and bias.

 

For more information about the Samriddhi Project in India, click here.

 

 

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FP THROUGH HEALTH PROVIDER TRAINING

 

5. Forging Partnerships between Communities and Service Providers in Guatemala

 

This December 2009 report explores the 4-year Maya Salud (Mayan Health) project, which sought to bridge the gap between those who wanted information, counselling, and services in sexual and reproductive health (SRH) in their communities and those charged with providing these services but who often lacked the knowledge, skills, and resources to do so effectively.

 

"Improving Family Planning by Creating Community-Service Provider Partnerships in Guatemala" details Maya Salud's use of the Partnership Defined Quality (PDQ) methodology, which engages community members in improving and monitoring the quality of their health services through partnerships with the health system. In the course of a 4-phase process, each of the 88 participating communities established its own Quality Improvement Team (QIT) composed of a subset of community members and health workers. Through dialogue and analysis, the QITs explored the root causes of inadequate quality of services and identified appropriate, feasible solutions for reaching the desired level of quality. The resulting Quality Improvement Plans delineated actions to fill gaps in knowledge, skills, or attitudes. One such action involved building demand by creating peer networks called Amigas/Amigos (friends) in participating communities. Amigas and Amigos learned the basics of FP, including modern methods, peer counselling, and referral (and sometimes accompaniment) to health facilities. In addition, steps were taken to ensure comfortable, confidential FP services, and to bring these services to particularly isolated areas through mobile health clinics.

 

Save the Children's final evaluation of Maya Salud (2009) measured a number of indicators and contrasted them to the project's baseline (2006), revealing that PDQ had improved access to and use of FP, and that users appreciated service quality. For example, the percentage of couples who discussed FP over a 3-year period rose from 44% to 46% in Nebaj, from 39% to 56% in Cotzal, and from 36% to 50% in Chajul. In 2009, 56% of women indicated that they had discussed birth spacing and desired family size with their partner in the previous year, whereas only 37% of women reporting having done so at baseline. Knowledge shifts were reported; for instance, 72% of women of reproductive age surveyed could name 3 or more FP methods in 2009, up from 52% in 2006. 21% of women of reproductive age received a home visit by a health care provider who spoke with them about FP in 2009, up from 5% in 2006. And 51% of such women received FP information during their last visit to their local health post in 2009, up from 13% in 2006. Practices also shifted: the number of new FP users rose from 2,087 (in 2006) to 5,638 (in 2008) - a 270% change; the percentage of married/united women using a modern FP method was 28.3% at baseline (2006), and 33.5% at endline (2009).

 

A number of strategic lessons learned are detailed in this report, including, in brief: invest first in trust; tailor your communications and schedules to your context; engage QITs in monitoring and evaluation (M&E); and promote learning and engagement among national stakeholders.

 

For more information about the Maya Salud (Mayan Health) project in Guatemala, click here.

 

 

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6. Family Planning Promotion Training for Village Health Committees in Guinea

 

This March 2009 report, "Village Health Committees Drive Family Planning Uptake: Communities Play Lead Role in Increased Acceptability, Availability," describes the role of the Village Health Committees (VHCs) of rural Guinea and their partnership in increasing contraceptive availability and acceptance as a means to child survival through a project which included training community-based distributors (CBDs) in each participating village and adding family planning promotion to the job description of every VHC member.

 

The VHCs' primary purpose was threefold: (1) to forge a link of ownership and responsibility between the community and the health system; (2) to increase the community’s demand for and use of quality health services including family planning; and (3) to increase the health system’s ability to provide such services in a way acceptable and accessible to the local population. The VHCs were composed of seven to nine members, each a permanent resident of his or her village and respected by the community as a whole, typically district chiefs, Imams, village elders, representatives of traditional health workers, and a traditional communicator (griot).

 

Key findings from project evaluations show that the contraceptive prevalence rate increased substantially among women with children under 2 years. The use of modern family planning methods by mothers not wanting another child in the next 2 years rose. Almost three-quarters (73%) of women in Mandiana and Kouroussa spaced their last two pregnancies by at least 24 months. In all villages, Imams - many of whom were once opponents of family planning - talked about birth spacing via breastfeeding and oral/injectable contraceptives in their mosques. In some cases, the children or siblings of Imams became CBDs. CBDs - 225 women and 225 men - were trained in family planning policies and promotions, sales, referrals, sexually transmitted infections and HIV/AIDS, and improving relations with health facility workers. Villages without health facilities benefited from the family planning component as much as those with health facilities because of the presence of VHCs and their CBDs. Villages with access to family planning services almost doubled over 5 years. In addition, the VHC in Mandiana district successfully piloted a reintroduction of the intrauterine device (IUD).

 

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7. Creating Standard Delivery Practices to Increase Access to Family Planning in Guatemala

 

"Increasing Access to Family Planning Among Indigenous Groups in Guatemala" describes an initiative to promote equitable access to family planning and reproductive health services among indigenous women in Guatemala through development of a set of locally appropriate service delivery practices.

 

From April 2006 to April 2008, USAID’s Health Policy Initiative undertook a participatory research endeavour with the aim of reducing barriers to access and use of FP/RH services among disadvantaged groups. The project reviewed existing research and policies to identify the factors affecting access to FP/RH services, and then conducted interviews with service providers, indigenous women, and community educators and traditional midwives in 3 departments of Guatemala. During stakeholder workshops at the national and community levels, project staff developed a set of service delivery practices that could improve access to services. These practices were then incorporated into operational guidelines that were pilot-tested in 5 districts in Quiché. Next, the Health Policy Initiative helped the Departmental Office of Health in Quiché develop a list of 10 locally appropriate service delivery practices. Following the collection of baseline information on the status of the 10 priority service delivery practices, the Quiché team trained service providers in the new guidelines through a series of one-day workshops. The team then monitored implementation of the guidelines in the 5 pilot districts.

 

The project interviewed programme implementers to capture lessons learned and best practices. They found that, in developing a targeted programme, local health programme managers should consider the following practices:

  • When identifying barriers: Involve the intended population in identifying barriers to service access; interview users and non-users of health services and providers, using local language when appropriate, to understand why the intended population is not using services; and incorporate all major service providers in the study.
  • When planning interventions: Involve the intended population in the design, development, and implementation of programmes; include all stakeholders, including local leaders, in programme implementation; strengthen the relationship between the area, district, and basic health units through the development of technical guidelines for FP services to ensure quality and uniformity of services throughout the system; work with community members to disseminate information that clarifies misconceptions about FP; train all health centre personnel, including non-medical staff, on FP issues; and strengthen the commitment of district health officials to FP.
  • When engaging in advocacy: Involve representative NGOs in advocacy efforts at the local level to build support and consensus from the community and to promote early involvement of the intended population; advocate at all levels - central, district, and community - to build political will and momentum for interventions; promote a continuous process of advocacy, policy dialogue, data sharing, and information gathering and dissemination; and involve the right stakeholders - representative NGOs, major service providers, Ministry of Health officials, and district- and community-level health officials - to strengthen commitment to equitable access to FP/RH services.

 

 

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FP THROUGH REACHING YOUTH

 

8. Reaching Out to Teen Mothers in Malawi

 

This August 2009 case study examines a communication initiative implemented by Save the Children to improve the health of Malawian women aged 10 to 24 and their children in the southern Mangochi district through increased voluntary use of family planning services. In 2006, Save the Children launched the 27-month project "Reaching Out to Teen Mothers in Malawi". Save the Children built upon several interventions from a previous project, "Nchanda ni Nchanda," and reached out to 35,000 youth, promoting delayed marriage, delayed sexual debut, and use of modern contraceptives, specifically reaching out to teen mothers.

 

Teen Mothers Clubs (TMCs) provided a total of 2,035 young women with a venue in which to discuss their common concerns - openly and without stigma - and to get support from fellow teen mothers and friends. In in-depth interviews with teen mothers at the end of the project, many reported improved knowledge about FP and greater ability to successfully negotiate contraceptive use with their partners. They also said that the male motivators helped their husbands become more supportive of FP.

 

Save the Children’s situation analysis had revealed that parents, community leaders, teachers, and chiefs believed that access to and knowledge of FP would increase youth promiscuity. So, the project continuously involved these individuals - whom it calls "gatekeepers" to mark their important role in youths' lives - in its activities. In one such activity, a team of 4 gatekeepers, plus 2 in-school teen mothers and one teacher, raised awareness among community members and schoolgirls about the benefits of FP, the dangers of teen pregnancies, etc.

 

The project also invited initiation counsellors - the women and men who guide children's initiation into adulthood - to participate in the project. Overall, 150 such counsellors attended a workshop where FP messages were developed and incorporated, along with HIV prevention practices, into messages passed on to initiates. The counsellors discussed the importance of FP, as well as the dangers and merits of certain traditional practices, such as those that lead to early pregnancy and young motherhood, thereby possibly compromising the health of young girls.

 

For more information about the Reaching Out to Teen Mothers Initiative in Malawi, click here.

 

 

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9. Preventing Student Pregnancy in Guinea's Forest Region

 

Produced by USAID's Flexible Fund (Flex Fund) in August 2009, this evaluation examines a school-based family planning intervention carried out in Yomou Prefecture within Guinea's forest region by Plan International and the Association Guinéenne pour le Bien-Etre Familiale. By equipping secondary school teachers and peer educators with the information to increase teens' knowledge and use of FP, organisers hoped to reduce unwanted pregnancy and allow teen girls to complete their secondary education.

 

The rationale for the project and its strategies are detailed within the document. In brief, strategies included in-school FP curricula, training of teachers as peer educators and community-based services agents (CBAs) for behaviour change FP messaging and support, FP posters, FP leaflets, and public awareness FP messaging.

 

As this evaluation indicates, the number and proportion of teenage students who experienced pregnancy in Yomou dropped from nearly 9% to just under 3%, and remained in that lower range for the two most recent school years. Project records show that the number of people of any age who adopted a modern FP method increased in Yomou from about 700 to more than 7,800 users.

 

The evaluation finds that Plan International's participatory processes, including community consultation with religious leaders, elected officials, village elders, and parents, allowed adults and teens to openly discuss and agree on the importance of the problem of unwanted pregnancies in schools. The intervention's success may also be attributed to the synergy between the school-based information and communication activities and the availability of FP methods via the CBSAs. The role of school-based peer educators was found to be especially important. Plan International notes that the intervention's success was also helped in part because its objectives mirrored those of the Guinean government, which had recently outlined the importance of sexual and reproductive health education in schools.

 

For more information about the Forest Region Sustainable Community-Based Reproductive and Sexual Health Project in Guinea, click here.

 

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10. Reaching Youth Through Community Strategies

 

Published in July 2009, this USAID Technical Update discusses steps for designing community-based youth family planning programmes, strategies to reach youth, and advantages of linking with larger community mobilisation efforts. Strategies for reaching youth through community members referenced in this resource include:

 

  • Involve youth themselves. Because youth experience different barriers to access and choice, their perspectives need to be included in programme interventions, e.g., as peer educators.
  • Ensure that youth participation is authentic and meaningful. Work through existing youth-oriented organisations, centres, or infrastructures that are accepted by the community.
  • Involve both genders. For example, a model developed in Brazil meets weekly with groups of young men to discuss gender, sexuality, and reproductive health; evaluations of the model have shown positive impact.
  • Involve parents. Programmes trying to reach youth should include supporting parents in their roles as caretakers.
  • Involve religious leaders. Young people look to religious leaders for guidance on decision making. Organisations should work with religious leaders to examine their role in sharing accurate information that will help youth make healthy decisions and to identify appropriate ways to discuss sexual and reproductive health.
  • Involve health care providers. Privacy, confidentiality, and provider attitudes towards serving young people are important dimensions of understanding young people’s experiences with health care providers.
  • Community mobilisation, a capacity-building process through which individuals, groups, or organisations plan, carry out, and evaluate activities on a participatory and sustained basis, may be useful to help those involved reach youth.

 

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TRAINING RESOURCES

 

11. Postpartum Family Planning for Healthy Pregnancy Outcomes: A Training Manual

 

Produced by the USAID-funded Extending Service Delivery (ESD) Project, this manual is intended to promote positive health outcomes for mothers, newborns, and infants by improving health workers' skills in fostering healthy timing and spacing of pregnancy (HTSP). It provides practical information and guidance on how to conduct a two-day training for primary health facility-based health workers in providing postpartum family planning information, education, and counselling, and in increasing postpartum women's access to all FP methods and services. The manual is designed for health trainers, nurses, health supervisors, and community health workers who already have basic understanding of and experience with FP/RH.

 

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12. Constructive Men's Engagement in Reproductive Health: A Training-of-Trainers Manual

 

This publication features the curriculum developed as part of a USAID Health Policy Initiative, Task Order 1 project focused on building an enabling policy and institutional environment for constructive men's engagement (CME) in reproductive health in Mali. This document contains the manual used in pilot workshops with community peer educators. It is designed to enable community health educators to incorporate activities related to CME in RH in their daily work. This includes promoting dialogue among men and women to increase couple communication and shared decisionmaking related to FP/RH. As such, it can be adapted in other settings, based on local needs.

 

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13. Basics of Community-Based Family Planning: Facilitator and Participant Guides

 

Developed by the Child Survival Technical Support Plus (CSTS+) Project, funded by USAID and published in April 2009, this curriculum is intended for the implementation of a two-week workshop designed to bring together middle- to senior-level managers and specialists working in the areas of programme design, monitoring, and evaluation (PDME) of community-based family planning programmes or interested in integrating community-based FP programming into their current projects. This curriculum explains the key elements of a quality community-based FP programme and technical and programmatic concepts of FP service. It explains a six-step process for developing a project design using a results framework and a monitoring and evaluation plan that is linked to the project design.

 

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14. Programming for Training: A Resource Package for Trainers, Program Managers, and Supervisors of Reproductive Health and Family Planning Programs

 

This resource package provides an overall approach to programming for training health care providers in family planning and reproductive health. It draws on the training experience of the ACQUIRE Project, as well as that of EngenderHealth and other organisations providing training in FP/RH for improving service delivery. Funded by USAID, the document includes the ACQUIRE training model and discusses the three primary training subsystems: pre-service education, in-service training, and continuing education, as well as "commonly used" and "useful" training methods for FP/RH, including group-based training, structured on-the-job training, self-paced training, technology-assisted training, distance learning, blended learning, and whole-site training.

 

 

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage SBCC planning, programming, and monitoring and evaluation, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email: cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please visit The CI website.

 

 

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Change Picks - Focus on Gender Norms

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Date: 
November 9, 2009

C-Change Picks #10 - Focus on Gender Norms
Information about Social and Behaviour Change Communication, sponsored by C-Change
November 11 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

 

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication (SBCC) in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - and in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #10 focuses on gender norms and highlights programme efforts that address gender norms to improve health outcomes by addressing gender norms. Included in this issue are programmatic examples and evaluations of integration of gender strategies into programming from several HIV prevention projects and a couple of family planning projects.

 

C-Change has just published two new resources focused on gender norms and family planning. "Gender Norms and Family Planning Decision-making in Tanzania: A Qualitative Study" based on research carried out in Tanzania, examines the role of gender norms in decision making among young married women and men on issues of family planning and contraceptive use. "Incorporating Male Gender Norms into Family Planning and Reproductive Health Programs: Program Guidance Brief," provides evidence-based recommendations to guide family planning programmers in the design, implementation, and evaluation of family planning programmes that have a male gender norms component. Both reports are summarised and available below.

 

 

 

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

 

 

 

In this Issue...

 

 

GENDER NORMS AND HEALTH PROGRAMMING

1. Incorporating Male Gender Norms into Family Planning and Reproductive Health Programs: Program Guidance Brief
2. Gender Norms and Family Planning in Tanzania
3. Addressing Gender-Based Violence through Health Programming
4. Research Related to Gender Norms and Family Planning in Jamaica and Uganda

GENDER AND HIV IN AFRICA

5. Integrating Multiple Gender Strategies to Improve HIV and AIDS Interventions
6. Developing Men as a Means of HIV/AIDS Prevention in sub-Saharan Africa
7. Integrating HIV Prevention and Gender Norms and Rights in Kenya and Indonesia
8. Gender Norms and HIV Risk in Kenya
9. Letting Girls Call the Shots in Madagascar
10. Changing Behaviours on Gender Norms to Prevent HIV in Malawi
11. Building the Capacity of South African Leaders Involve Men and Boys in Achieving Gender Equality and Responding to HIV/AIDS
12. Gender, HIV, and the Church

RESOURCES FOR THE FIELD

13. Using Interactive Drama for Sexual and Reproductive Health
14. Effective Sexuality Education through Use of Youth Language

 

 

 

 

GENDER NORMS AND HEALTH PROGRAMMING

 

 

1. Incorporating Male Gender Norms into Family Planning and Reproductive Health Programs

 

Drawn from a March 2009 C-Change Expert's Meeting, this brief is intended to provide family planning and reproductive health programme planners and implementers with suggestions for how to incorporate activities that address male gender norms. It builds on the recommendations of the 2007 World Health Organization (WHO) report on evaluated health interventions that engage men and boys.

 

Male gender norms - defined as "socially constructed expectations about how men and boys should behave" - are factors influencing a range of family planning and reproductive health behaviours. These include informed use of family planning methods, condom use for disease prevention, and actions to prevent violence against women. Evidence suggests that gender-transformative interventions deliberately trying to examine, question, and change male gender norms are more effective in improving outcomes than those that merely acknowledge or mention gender roles. The following are strategies reviewed in the study:

 

  1. Encouraging equitable communication, joint decision-making, and shared responsibility for family planning through couple counselling.
  2. Encouraging men to critically reflect on gender norms and their impact on family planning behaviours and outcomes through participatory group education or other participatory community activities.
  3. Addressing notions of gender in family planning through community channels of communication such as participatory theatre or community dialogue.
  4. Portraying gender-equitable role models through mass media.
  5. Promoting the norm that 'real men' are no longer obstacles to family planning through role models, such as model couples.
  6. Engaging men's involvement in the health and well-being of the family through fatherhood programmes.

 

 

Those interventions that accommodated male gender norms, such as approaching men as gatekeepers and encouraging them to endorse contraceptive use, have not, according to the study, challenged the inequitable power dynamic between couples that often favour men and can limit women's decision-making abilities.

 

Based on reviewed programmes, this brief identifies evidence-based recommendations to guide family planning/reproductive health programmers as they design, implement, and evaluate programmes with a male gender norms component.

 

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2. Gender Norms and Family Planning Decision-making in Tanzania: A Qualitative Study

This paper examines a qualitative study undertaken by researchers from C-Change in order to explore the role of gender norms in reproductive decision-making and contraceptive use among young married men and women in Tanzania. The purpose of the research was to understand the role of gender norms in supporting high fertility, unplanned pregnancies, and unhealthy timing and spacing of births in Tanzania - with the ultimate goal of incorporating this understanding into social and behaviour change communication (SBCC) in specific social contexts.

 

According to the paper, gender norms - such as men's dominance in decision-making - often support high fertility, influencing the timing of marriage and childbearing, and aspirations regarding family size and sex composition. Family planning programs and services have often selectively accommodated rather than challenged prevailing gender norms by targeting family planning toward women, reinforcing the idea that reproduction and family welfare are women's responsibilities.

 

The findings showed near universal agreement among women and men users and non-users of contraceptives about the norms related to men's and women's roles in the family and society. In short, men were characterised as being the head of the household, the provider for the family, able to have sex and satisfy a woman, able to have children, and able to participate in society. A woman in Tanzanian society was characterised as the supporter of the husband, a caretaker of the family, and a bearer of children. It was considered disrespectful for a woman to disagree with and disobey her husband.

 

This paper details findings and concludes that "...despite ample evidence of gender inequality and gender norms that were potential barriers to the use of contraception, fears and misconceptions about side effects appeared to be more powerful deterrents to contraceptive use than non-egalitarian gender norms...." Family planning "messages and interventions should engage both men and women and encourage equitable decision-making. Men should be encouraged both to seek information about modern contraceptive methods from reliable sources and to encourage their wives or partners to do so. In addition, the capacity of clinics and other sources of contraception to provide accurate information might need to be strengthened."

 

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3. Addressing Gender-Based Violence through Health Programming

 

According to this September 2008 document from USAID entitled "Addressing Gender-Based Violence Through USAID's Health Programs: A Guide for Health Sector Program Officers", research demonstrates that gender-based violence has implications for almost every aspect of health policy and programming, from primary care to reproductive health programmes, because it not only results in injury and death of its victims, but also it can contribute to the spread of HIV. Reducing violence and coercion is among five high-priority gender strategies of the President’s Emergency Plan for AIDS Relief (PEPFAR).

 

Findings show that violence against women may increase in communities where women break from traditional norms. Crime and armed conflict are causally linked to gender violence. The document suggests that: "From a public health perspective, community-level risk factors may be the most helpful for identifying promising ways to reduce violence against women. Focusing too much on individual risk factors may obscure the fact that violence against women tends to occur throughout society and across all demographic and socio-economic groups and appears to be heavily influenced by community norms and responses."

 

Examples of factors associated with high levels of violence against women at the community level include:

  • Traditional gender norms that support male superiority and entitlement
  • Gender norms that tolerate or even justify violence against women
  • Weak community sanctions against perpetrators
  • Poverty
  • High levels of crime and conflict in society more generally

 

This document presents strategies - by programme type - suggesting what programmes should and should not do. For example, Communication for Social and Behaviour Change (CSBC) programmes should support long-term efforts to link communication activities with other types of GBV activities, such as combining mass media communication strategies to include helping their audiences find services in the community and build support for policy change. They should integrate GBV messages into existing public health communication programmes, ensuring that images and messages are empowering and that they do not reinforce stereotypes, such as women as "victims" and men as "aggressors." They can also support programmes that use many different types of media channels and formats, including "edutainment", and focus not only on men and women, adolescents and adults, but also on teachers, the police, and the justice system.

 

 

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4. Research Related to Gender Norms and Family Planning in Jamaica and Uganda

 

Published in 2008 from the Youth Research Working Paper Series of Family Health International (FHI), "Early Sexual Debut, Sexual Violence, and Sexual Risk-Taking among Pregnant Adolescents and Their Peers in Jamaica and Uganda" focuses on early sexual début and experiences of sexual coercion/violence as they are related to each other and to unintended adolescent pregnancy.

 

A selection of the key findings from this research include the following:

  • In Uganda, most of the pregnant girls married early and childbearing was an expected consequence of being married at an early age.
  • Sexual violence was a common experience for girls in both countries. Verbal harassment was common. Many girls described having been coerced to have sex at one time or another by their boyfriends or someone they had a relationship with; sometimes this meant actual force or threat of force and sometimes this meant feeling verbally pressured.
  • Jamaican girls were more likely to describe resistance to sexual violence than the girls in Uganda, who were more likely to keep sexual violence a secret. Results from the study in Jamaica found an association between pregnancy and early sexual debut but not between pregnancy and sexual violence. Though this lack of statistical association was a surprise, the prevalence of sexual violence among both pregnant and never pregnant girls indicates that it is an issue that cannot be ignored in programmes for and with adolescent girls.

 

Based on the study's findings, the following are strategies and goals for programmes to reduce unintended pregnancy:

  • build adolescents' self-esteem and future orientation
  • address norms that encourage early marriage and enforce marriage-age laws
  • discourage older partners
  • encourage stronger connections with parents and community groups
  • teach girls and boys about contraception and make it accessible
  • teach the community about the benefits of delayed childbearing among married and unmarried adolescents
  • teach boys to respect that girls have the right to refuse sex
  • teach refusal skills to girls
  • provide girls with good reasons to delay sexual début
  • reach girls and boys at young ages (before age 14).

 

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GENDER AND HIV IN AFRICA

 

 

5. Integrating Multiple Gender Strategies to Improve HIV and AIDS Interventions

 

Published in May 2009 by USAID, this compendium of HIV/AIDS programmes in sub-Saharan Africa is designed to illustrate the many programmatic approaches to integrating multiple gender strategies to mitigate women's and men's vulnerability to infection. Its premise is that gender strongly influences how HIV spreads and how people respond to the epidemic and that using multiple approaches in HIV/AIDS programming is more effective than single strategies. Featured programmes address at least two of the following gender strategies: reducing violence and sexual coercion; addressing male norms and behaviours; increasing women’s legal protection; and increasing women’s access to income and productive resources.

 

The compendium describes each of the 31 selected programmes, and synthesises trends and findings to provide initial insights on using multiple gender strategies in HIV programming, including how strategies are employed together, where gaps exist, and what lessons and experiences are common across programmes.

 

The findings include:

  • Community involvement is vital to programmes that address multiple gender strategies because these approaches often require changing interconnected and sensitive gender norms. National policy and government involvement also are important to sustaining and scaling up combined approaches.
  • Of the four gender strategies:
    - Reducing gender-based violence was the most common.
    - Increasing women's legal protection was the least common.
    - Programmes often addressed male norms and behaviours in combination with gender-based violence efforts, successfully engaging men with innovative approaches.
    - Strategies to increase women's income were combined with other strategies to sustain women's capacity to address a range of issues in their lives, including violence and HIV.
  • Most programmes lack rigorous data collection and evaluation, often because implementers do not have sufficient resources or technical capacity.
  • Few featured programmes collect findings related to gender outcomes.

 

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6. Developing Men as a Means of HIV/AIDS Prevention in sub-Saharan Africa

 

Published in January 2008 in the journal Political Perspectives, "As a Man This is How You Should Behave! A Critical Look into Methods of 'Developing Men' as a Means of HIV/AIDS Prevention in sub-Saharan Africa" looks at two HIV/AIDS prevention programmes in Uganda that both focus on changing men's attitudes and behaviour. According to the author, both programmes, Operation Gideon and the "Be a Man" campaign, tend to reinforce the same "truth" about Ugandan men, namely that they are the ones in control of their families or society. However, the author states that because the programmes use different methods and techniques, their effects are very different.

 

The "Be a Man" campaign combines health awareness techniques with specific gender perspectives to enable Ugandan men to reflect on how certain dominant notions of masculinity in Uganda make them behave in ways which are unhealthy to themselves and others. It aims to change male gender norms rather than changing men.

 

Operation Gideon primarily relies on strengthening Christian techniques of self-government to enable men in Mbuya to resist the dangers of the Ugandan culture's negative influences. Operation Gideon organises facilitated discussion groups in different drinking establishments.

 

The key concern in Operation Gideon is not so much to redefine the cultural and social expectations of men, as it is to change how men in Mbuya relate to these expectations. Facilitators attempt to enable men to resist "negative" cultural influences through messages combining AIDS prevention and Christian morality.

 

The author argues that within their various strategies and methods, neither programme actually attempts to change the balance of power between men and women - men's role as decision-maker and head of the household is not questioned - rather the programme simply encourages men to use the power they have differently.

 

The conclusion is that there is a need to further study the consequences and effects of HIV/AIDS prevention initiatives in sub-Saharan Africa that are specifically geared toward men, paying attention to how these overall ideas are translated on the ground into specific practices.

 

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7. Integrating HIV Prevention and Gender Norms and Rights in Kenya and Indonesia

 

The initial sections of "Gender Development Project Review Report: Kenya and Indonesia" from Stop AIDS Now! (SAN!) in November 2008 explore the design and development of the Gender Development Project (GDP), which seeks to add value to the HIV/AIDS and gender policies of SAN! partners - community-based and non-governmental organisations (NGOs) - by identifying promising local-level strategies and interventions for HIV prevention that integrate promotion of egalitarian gender-based attitudes, behaviours, and norms, and women's rights. In keeping with other SAN! development projects, the GDP takes place in two countries, one with a generalised epidemic and another with a nascent or concentrated epidemic. This particular two-country choice is designed to allow for comparisons and to provide opportunities for actors in the AIDS response in the low-prevalence country to learn from the experiences of their counterparts in the high-prevalence country.

 

Some of the key lessons from the review are the following:

  • Use of tangentially relevant entry points for dialogue with communities helps lead into discussions on HIV/AIDS. Such entry points currently used by counterparts include such issues as economic empowerment, education, and religion. The use of such entry points also help get men and boys become involved in discussions.
  • It is important to involve men and boys from the start of an activity. This helps create greater acceptance of the activity, and to ensure their overall greater participation as well as that of women and girls.
  • It is important to integrate activities that address the economic well-being of beneficiaries. The struggle for day-to-day survival still hampers the involvement of women (and men) in awareness raising activities around HIV/AIDS. This point is especially relevant in relation to women living with HIV.
  • It is helpful to create or link beneficiaries living with HIV to existing people living with HIV/AIDS (PLWHA) support groups. This helps increase the confidence and knowledge of beneficiaries to take action to live positively and better manage their lives with HIV.
  • The involvement of community leaders such as teachers, cultural custodians, and government officials in projects is key to the greater impact and sustainability of the changes the GDP is seeking to achieve. Such leaders have the influence to promote and/or implement change and the legitimacy and respect of communities to influence their thinking and behaviour.

 

For more information on the Gender Development Project (GDP), please click here.

 

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8. Gender Norms and HIV Risk in Kenya

 

The Silent Partner: HIV in Marriage is a 12-minute documentary that was filmed and produced in Kenya by Population Action International (PAI). The film explores some of the complex realities of married women, and how the challenges of HIV prevention in this group defy simple solutions. According to the producers, the film urges a broader, integrated approach to preventing HIV, which includes confronting damaging social norms that put all people - men and women alike – at risk. It is designed to raise awareness of the risk of HIV transmission within marriage and illustrate the particular challenges facing married women. It also shows that traditional approaches to HIV prevention do not meet the needs of married women, because practicing abstinence is unrealistic, wives cannot control the faithfulness of their husbands, and because they find it difficult to negotiate condom use.

 

This film is intended to be used as an advocacy tool to inform, provoke discussion, and mobilise political and financial support for evidence-based HIV prevention, sexual and reproductive health and rights programmes, and broader social and economic policies to improve the lives of women and their families. The film is accompanied by fact sheets that can be downloaded from the website and used at organised screenings.

 

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9. Letting Girls Call the Shots in Madagascar

 

Red Card is a component of a health communication campaign led by C-Change in Madagascar that was designed to prevent the spread of HIV/AIDS and to curb associated risky behaviours by "letting girls call the shots" and sparking conversation between parents and adolescents. The campaign appropriated the signal soccer referees use to kick aggressive players out of a game; paper Red Cards were distributed to 1.5 million young women across Madagascar. These girls use the Red Cards as ice breakers to start conversations on sensitive topics and to stop risky and inappropriate behaviours at school, parties, their homes, and on dates.

 

To kick off the initiative, 4 television spots were broadcast showing teenage girls in common, but difficult, situations. For example, one spot features a boyfriend who won't listen to a girl's polite, but insistent, refusals to drink alcohol at a party. Not knowing what else to say, she draws a Red Card from her pocket, shakes her head with confident disapproval, says, "I told you three times I just want a soda; why won't you listen to me?" and leaves.

 

As the initial series of spots was airing, dozens of two-hour training sessions were held in schools and clubs and with sports teams so that girls could practice using Red Cards. Trainers asked the girls to explain Red Card to their parents once they got home. The intention was that this conversation might open the door to discussing sexual harassment, alcohol use, and other risky behaviours.

 

During the project's second phase, trainings took place throughout the country, directly reaching 30,000 teenage girls and sparking an exponential increase in the number of phone calls made to the national HIV/AIDS hotline - most of them asking for packs of 100 Red Cards. In addition, more than 2,000 Red Card clubs were formed, providing an opportunity for girls to talk about their experiences using the tool. In the words of organisers, "Red Cards...clearly give young women a way to be heard, even if they can't find the right words."

 

Note: currently all USAID funding for programmes in Madagascar, including those implemented through C-Change, has been suspended.

 

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10. Changing Behaviours on Gender Norms to Prevent HIV in Malawi

 

This report from 2008 details an evaluation of the Enhanced HIV/AIDS Prevention and Improved Family Health Program (EHAP-IFH), which was launched in Malawi in July 2005 by Population Services International (PSI)/Malawi in an effort to contribute to the overall USAID Malawi Strategic Objective (SO) 8: Improved Health Status of Malawians. Malawians face many barriers to access to health services: At least 14% of the total population of 12-13 million Malawians is estimated to be HIV-positive, with 90,000 infected every year. Young women aged 15 to 24 are nearly 4 times more likely to be infected than young men. One in every 8 children dies before age 5, and malaria is endemic in all parts of the country.

 

There are a number of programmatic elements, including various behaviour change communication (BCC) and social marketing interventions, detailed here. Those that specifically address gender norms include:

  • As enhancement to the YA! Mix radio programme, YA! Listener Club Open Days are held occasionally in order to sensitise community members, reinforce messages, and address problems such as adverse societal pressures. This is part of an effort to embed the YA! approach and activities within traditional structures, to engage gatekeepers without whose permission such activities could not occur, and to move forward on BC issues.
  • The pilot Faith Communities Program (FCP) works primarily through training of traditional and religious gatekeepers. A dedicated manual aids in leadership training. The FCP manuals have a detailed and culturally aware focus on gender issues such as incest and gender-based and sexual violence, their links to both HIV transmission and human rights, and the need for the community to address such matters equitably.

 

Key recommendations from this evaluation related to gender include:

  • Future PSI/Malawi behaviour change and behaviour maintenance (BC/BM) interventions should further strengthen girls' capacity to communicate and negotiate.
  • Gender should be more systematically mainstreamed throughout PSI/Malawi programmes and activities.
  • Gender analysis should be incorporated into all qualitative and quantitative research activities and inform all BC/BM message development.

 

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11. Building the Capacity of South African Leaders Involve Men and Boys in Achieving Gender Equality and Responding to HIV/AIDS

 

"Sonke Gender Justice Network's Report to the Ford Foundation" evaluates the One Man Can (OMC) campaign, which the South African NGO Sonke Gender Justice (Sonke) launched in November 2006 to promote attitudinal change among men in their interactions with women. The report, published in August 2008, describes the range of activities carried out by Sonke with Ford Foundation support during the period July 1 2007 to June 30 2008.

 

As detailed in this report, the OMC campaign encourages men to become actively involved in advocating for gender equality, preventing gender-based violence (GBV), and responding to HIV and AIDS. The organisation holds trainings with other community-based organisations and groups that focus on gender norms and traditional roles and are intended to catalyse change. For example, Sonke held a 4-day workshop to train 15 AIDS Consortium participants in the OMC approach and methods. When asked before the training whether men have the right to choose when to have sex with their partner, 67% of the participants agreed; post-training, none of them agreed. When asked beforehand if they felt that people with sexually transmitted infections (STIs) are at a higher risk for contracting HIV, 100% of the participants disagreed; post-training, 60% agreed that this statement was actually true. As a culmination of the training, a memorandum was presented to the South African Police Services (SAPS) station in Hillbrow urging efficient implementation of the Domestic Violence Act and offering OMC training to SAPS staff. The memorandum and walk to the SAPS offices was designed to forge a link between the OMC training and the importance of community mobilisation.

 

Having been trained by Sonke, another organisation, Munna Ndinnyi, has conducted community activities focusing on voluntary counselling and testing (VCT) and teen pregnancy, and has hosted HIV talks at Tshilidzini Hospital. The group has developed posters challenging stereotypes and the cultural beliefs regarding gender issues and HIV/AIDS. Munna Ndinnyi has conducted training workshops, working with traditional leaders through the relationship they have with the male circumcision schools. Two hundred students were reached with messages about gender and HIV and AIDS through school debates. Munna Ndinnyi staff trained Thsilidzini Hospital staff on the OMC initiative and formed 2 community action teams which have developed early drafts of posters they will finalise and disseminate widely.

 

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12. Gender, HIV, and the Church

 

Describing a two-year pilot project to engage local churches in Zimbabwe and Burkina Faso, this March 2009 Tearfund case study looks at the church's ability to work with communities to address culturally sensitive issues such as gender and HIV, by focusing on the relationships between men and women.

 

Research in both countries found that many attitudes and behaviours prevalent among Christians were based on underlying traditional cultural values rather than biblical values, and that in many cases the church was not challenging harmful traditional views about gender; indeed, it was often reinforcing them through selective use of Bible passages.

 

Over the 2-year pilot project, the churches involved held a variety of interventions including workshops for couples to develop relationship and parenting skills; camps for young people focusing on life skills, goal setting, and making positive choices; teaching in churches; and training for church leaders. A significant part of the project involved addressing key Bible passages often used to justify gender inequalities.

 

According to Tearfund, the programme did have a significant impact on the communities involved. During a review of the project, focus group participants were asked to discuss the most significant change in their communities. People reported increased HIV testing, reduction in multiple or concurrent partners, and increased discussion within relationships about love and sexuality. Some also reported increased condom use, and young people said they no longer saw HIV as a death sentence. However, the case study notes that tackling deep-rooted traditions is a long-term process, as some women still felt as though they had no choice in negotiating sex with their partners.

 

The report concludes that working with local churches is key to addressing gender inequality, and that by taking a biblical and relationships-based approach to gender, pastors and congregations can openly discuss and debate cultural traditions and norms that have previously restricted both men and women from reaching their full potential in life.

 

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RESOURCES FOR THE FIELD

 

 

13. Using Interactive Drama for Sexual and Reproductive Health

 

"Feel! Think! Act! A Guide to Interactive Drama for Sexual and Reproductive Health With Young People", a toolkit published by the International HIV/AIDS Alliance Secretariat in March 2008, looks at how interactive drama can be used in work with young people to encourage them to think about and take action to improve their sexual and reproductive health (SRH). It is based on the experience of the International HIV/AIDS Alliance, its partners, and drama practitioners working in Zimbabwe, Malawi, and Zambia.

 

The toolkit is designed to:

  • encourage practitioners in drama and in SRH to share their knowledge and skills, and work together to improve lives through interactive drama;
  • increase the use of drama as a creative and participatory process to address SRH issues as opposed to using a one-way message delivery tool;
  • equip practitioners with the knowledge, skills, and attitudes that they need to use interactive drama effectively in SRH programmes and other areas; and
  • enable practitioners to use drama in a positive way, which reduces stigma and discrimination towards vulnerable groups.

 

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14. Effective Sexuality Education through Use of Youth Language

 

This article explains that language shapes the way people think about life and, therefore, influences actions. It proposes that analysing the metaphors young people use while talking about sex can provide valuable insights into the ways in which youth understand sex, sexual behaviour, and sexual relationships. These insights may have untapped potential for enhancing the effectiveness of sexuality education interventions.

 

"Talking About Sex: Using Youth Language in Sexuality Education" discusses how interventions to raise knowledge and awareness and to influence attitudes and behaviour need to be well-designed and accessible for young people. The authors suggest that an important way of tailoring interventions to the sociocultural context is through incorporating young people's own language into curricula and teaching approaches.

 

Research conducted by the African Population and Health Research Center (APHRC) found that young people conceptualise sex in three main ways. Young people’s expressions focused largely on the mechanics of sexual actions and the utility of sexual organs, the gratifying nature of sex, and the passionate aspects of sexual activity. Recurrent metaphors could serve as a starting point for tailoring educational messages; for example, discussing phrases related to having sex - such as, "putting Colgate toothpaste on a toothbrush" or "opening a girl" - or related to multiple sexual partnerships - such as, "It is good to have a spare tire; if one gets flat, you just fix the other", or "Girls say, you don’t need to have one cloth outfit only".

 

The report concludes that given the importance of sexuality education, there is value in continued development of innovative ways of addressing these challenges. A reflective discussion of metaphors not only provides an opportunity for instructors to understand the concepts and constructs in the sexual worlds of young people in their own right, but it could also help teachers and trainers to identify and address their own biases and assumptions.

 

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a social and behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and evaluate programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email: cchange@aed.org.

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please visit The CI website.

 

 

 

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

 

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C-Change Picks - Focus on HIV Prevention

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Date: 
September 8, 2009

C-Change Picks #9 - Focus on HIV Prevention
Information about Social and Behaviour Change Communication, sponsored by C-Change
September 8 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - and in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #9 focuses on social and behaviour change communication (SBCC) strategies for HIV prevention. A mix of approaches to HIV prevention programming are highlighted within this issue, through research reports, case studies, and evaluations. The approaches include combination programming; integrating services; mass media strategies; interpersonal communication methods; and capacity building.

 

C-Change is working in Namibia to strengthen the capacity of partners and local NGOs to apply SBCC programming to their work in the prevention of HIV transmission. C Change developed a tool to assess an organisation's SBCC capacity in three core areas: planning and design, programme implementation, and monitoring, evaluation and research. (Click here to download the tool).

 

Using the tool, C-Change/Namibia has identified gaps among the organisations it has assessed that include: lack of programme focus on behavioural outcomes; lack of behavioural analysis of target audiences; lack of appropriate information, education, and communication (IEC) materials related to drivers of the HIV epidemic; inadequate training materials; and tools not updated to reflect current information about the drivers of HIV. As a result, C-Change has developed and implemented a systematic, stepped approach to strengthening organisations' capacities in the basics of SBCC and HIV prevention programming that meet standards of quality for SBCC, are evidence-driven, and are focused on the drivers of the epidemic. For more information, visit the C-Change website - click here.

 

 

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

 

 

In this Issue...

 

 

SPOTLIGHT ON SBCC TOOL

 

1. Social and Behaviour Change Communication (SBCC) Capacity Assessment Tool

 

FOCUS ON HIV PREVENTION

 

PROMISING PROGRAMMING FUSIONS

 

2. Promising Approaches to Combination HIV Prevention Programming
3. Evaluation of a Programme to Reach Transport Workers and CSWs in Ethiopia/Djibouti
4. Findings on South African HIV Prevalence, Incidence, Behaviour, and Communication

 

PROMISING CAPACITY BUILDING APPROACHES

 

5. HIV Prevention and Mitigation through Entrepreneurship in DRC
6. Expanding the Capacity of the Broadcast Media in Africa

 

INTEGRATING SERVICES: HIV/AIDS and FAMILY PLANNING

 

7. Integrating HIV Prevention and Counselling and Testing for HIV within Family Planning Services in South Africa
8. Integrating Counselling and Testing for HIV within Family Planning Services in Kenya

 

ASSESSING MASS MEDIA APPROACHES
9. Impact of a Regional Mass Media HIV Prevention Programme in Southern Africa
10. Impact of a Mass Media HIV Prevention Programme in Nicaragua
11. Evaluating the Trusted Partner Campaign in Four Sub-Saharan African Countries

 

REFLECTING ON INTERPERSONAL APPROACHES

 

12. Community Conversations to Address Harmful Traditional Practices and Reduce Stigma in Ethiopia
13. Thailand Turns to Education and Dialogue for Youth
14. Boosting Prevention through Interactive Games and Conversation

 

 

SPOTLIGHT ON SBCC TOOL

 

1. Social and Behaviour Change Communication (SBCC) Capacity Assessment Tool

 

This tool and an accompanying worksheet have been developed by C-Change for use in workshop and meeting venues in which an organisation and a facilitator work to determine an organisation's competencies in three areas:

  • SBCC planning
  • SBCC programme implementation
  • SBCC research, monitoring, and evaluation

The intention is that by using this Tool, programme planners can identify the strengths and weaknesses of current programmes, and define activities to strengthen and refocus programmes to improve the overall quality of their SBCC efforts.

 

This Tool can be adapted for use across a wide variety of health areas, including: HIV and AIDS; malaria; family planning; and maternal, sexual, and reproductive health. Users are encouraged to adapt sections of the Tool or use the particular components that best address their needs in assessing capacities of organisations implementing SBCC programmes.

 

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FOCUS ON HIV PREVENTION

 

PROMISING PROGRAMMING FUSIONS

 

2. Approaches to Combination HIV Prevention Programming

 

Presented at the June 2009 HIV/AIDS Implementers' Meeting held in Namibia, "A Systematic Analysis of Three Promising Approaches to Combination HIV Prevention Programming" explores "combination HIV prevention", which includes a mix of strategies and risk reduction approaches that use current epidemiological and programmatic evidence to address different audiences with simultaneous behavioural, biomedical, social, normative, and structural interventions.

 

The AIDS Support and Technical Assistance Resources Project, Sector 1, Task Order 1 (AIDSTAR-One)'s Good and Promising Programmatic Practice (G3P) database was used to identify 25 promising combination programmes, 3 of which were selected to feature in this study: the AIDS, Population and Health Integrated Assistance Program (APHIA-II) Project (implemented in Kenya by Family Health International (FHI); the Avahan-India AIDS Initiative; and Alliance-Ukraine.

 

For each of the 3 interventions, a case study involving 2 weeks of field observation and a review of programme documents was conducted. Programmes were assessed along 3 dimensions, including the simultaneous implementation of: several risk-reduction options (behavioural, biomedical, and structural); activities to increase appropriate leadership and political support; and activities to increase community involvement.

 

Core components of combination prevention identified in this presentation are:

  1. Know your epidemic - Track the epidemic, drivers, and underlying risk factors, changing the composition of the response - and the activities that compose it as the epidemic (or what we learn about it) changes.
  2. A mix of activities that produces a maximum effect in a given setting - Add new activities, introducing innovative approaches to solve "old" problems and bringing in new areas of programming to tackle underlying factors that increase vulnerability.
  3. A core commitment to strengthening civil society and the local response - The programme should engender confidence, skills, and commitment to community and pride in accomplishments among peers, staff, and participants.
  4. Policy engagement and advocacy at all levels.

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3. Evaluation of a Programme to Reach Transport Workers and CSWs in Ethiopia/Djibouti

 

 

USAID Ethiopia and Save the Children USA (SC/USA) together launched the High Risk Corridor Initiative (HRCI) in 2001 in both Ethiopia and Djibouti as a prevention programme to address the high HIV transmission rates among transport workers and commercial sex workers (CSWs) in 21 towns along a busy transportation corridor originating in Addis Ababa that has two separate routes to the border with Djibouti. Over its course, the HRCI programme expanded to link prevention efforts with strategies for care and support for PLWHA, and to broaden its prevention programme to additional intended audiences, especially in- and out-of-school youth who engage in high-risk activities.

 

As detailed in "Final Evaluation: USAID/Ethiopia High-risk Corridor Initiative", HRCI incorporated information dissemination (HIV/AIDS information centres), peer education activities, school- and community-based prevention outreach for young people, VCT service strengthening, community home-based care for PLWHA, and interactive drama. Core strategies detailed and evaluated in the document include: increase of prevention practices and demand for services; utilisation of the oral tradition that is embedded in Ethiopian coffee ceremonies; increase availability of and access to prevention and treatment services; provision of care and support services, including food support; and enhancement of livelihoods.

 

Recommendations for future planning include:

  1. explore partnerships with larger private industries in Ethiopia (e.g., in the pharmaceutical industry) to mobilise more resources for responding to HIV.
  2. explore partnerships with businesses along the corridor (e.g., tire manufacturers and spare parts businesses).
  3. expand local partnerships (e.g., with hotels that give food to PLWHA) along the corridor.
  4. build the palliative care knowledge and skills of HBCVs and nurse supervisors by linking with University of California San Diego (UCSD) and I-Tech.
  5. add "care for the caregiver" trainings for HBCVs, family caregivers, nurse supervisors, and spiritual counsellors.
  6. provide regular skilled support for volunteers who make home visits to sick clients.
  7. include at-risk populations in the design of strategies and messages intended to change the risky behaviours.
  8. ask community and religious organisations to fund lower-cost activities, such as coffee ceremonies and Community Conversations, which have proven successful in educating communities about HIV.

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4. Findings on South African HIV Prevalence, Incidence, Behaviour, and Communication

 

 

This report is the third in a series of population-based HIV seroprevalence surveys, which started in 2002 and were repeated in 2005 and again in 2008. "South African National HIV Prevalence, Incidence, Behaviour, and Communication Survey, 2008: A Turning Tide Among Teenagers?" seeks to assess the national HIV prevention response in relation to the goals set in the HIV & AIDS and STI Strategic Plan (NSP), in particular, to reduce HIV incidence by 50% by 2011. The research found that although the overall situation remains dire, some solid progress has been achieved, especially among teenagers and children.

 

According to the report, a wide range of national and sub-national HIV/AIDS communication programmes exist in South Africa. These include national communication programmes conducted by government and non-governmental organisations (NGOs); programmes within schools, universities, and workplaces; provincial government programmes; sub-national programmes led by NGOs; and interactive communication, including community-level campaigns such as door-to-door activities, community theatre, and events. Specific findings on what South African prevention programmes have achieved are outlined and further challenges are identified.

 

Recommendations include:

  • more carefully designed intervention programmes in some provinces;
  • programmes to help people to have children without risking HIV;
  • addressing high sexual partner turnover and intergenerational sex by focusing on changing norms at community level;
  • implementing provider-initiated routine HIV testing at all health care facilities;
  • increasing communication programme reach; and
  • defining country-specific indicators including for most-at-risk populations.

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PROMISING CAPACITY BUILDING APPROACHES

 

5. HIV Prevention and Mitigation through Entrepreneurship in DRC

 

This report is the result of a rapid assessment conducted by Education Development Center, Inc. (EDC) in collaboration with Family Health International (FHI) in Bukavu, Democratic Republic of Congo (DRC), in August 2008. This research builds upon the Regional Outreach Addressing AIDS through Development Strategies (ROADS) programme, which is an HIV/AIDS prevention initiative created by USAID/East Africa and currently implemented by FHI in 26 vulnerable communities along the transport corridors of 8 countries in East and Central Africa.

 

Since 2005, ROADS has been working at 3 Bukavu sites with 23 indigenous youth associations that form 3 Youth Cluster groups consisting of both in-school youth from 22 local secondary and tertiary institutions and out-of-school youth, including street youth, AIDS orphans and vulnerable youth, ex-combatants, teenage mothers, and sex workers. The clusters mobilise youth for HIV prevention using participatory theatre and other methodologies, promoting counselling and voluntary testing, undertaking home visits for persons living with HIV and AIDS, sensitising community members on gender-based violence (GBV) and alcohol abuse, providing condom distribution outlets, and referring persons to local HIV/AIDS services.

 

The proposed capacity-building project will start with initial and basic orientation training in entrepreneurship for 100 young people who are currently involved in some level of economic activity, and will include a business simulation game. Those 100 young people will be invited to submit a description of a business idea. Of these, 60 will be selected based on market relevance, representation of group involved (e.g., at least 60% girls as entrepreneurs), and potential for growth. The youth submitting the 60 selected ideas will enter a training and coaching process designed to help them refine the business ideas and develop a business plan for implementing them. The 60 participants will submit their business plans for assessment; those 20 whose business plans are selected for further support will attend more formal entrepreneur workshops. A number of other activities will include all 100 participants in order to help them build their ideas, skills, and knowledge in small and micro business development.

 

This document describes in detail the proposed project plan, activities, and monitoring and evaluation strategy.

 

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6. Expanding the Capacity of the Broadcast Media in Africa

 

The African Broadcast Media Partnership Against HIV/AIDS (ABMP) is a pan-African coalition of broadcast companies created to reinvigorate and increase the effectiveness of broadcast media's contribution to the fight against HIV/AIDS. In February and March 2008, a study was conducted on the implementation of the ABMP and its impact in a select number of participating broadcast companies. The research took place in seven African countries (Kenya, Madagascar, Mozambique, Nigeria, Senegal, Swaziland, and Tanzania) with 18 broadcasting companies and 36 external stakeholder organisations surveyed, resulting in a data-set of 100 face-to-face interviews. The aims of the survey were to: assess the extent to which the key objectives of the ABMP are being implemented; find out how surveyed countries perceive the benefits and challenges of participating in the ABMP; examine institutional opportunities and limitations; and gauge perceived contribution to national HIV/AIDS efforts of the sample broadcasters. This resulting report, entitled “Implementation of the African Broadcast Media Partnership Against HIV/AIDS and its Impact in a Select Number of Participating Broadcast Companies,” found that the ABMP contributed to national HIV/AIDS campaigns and that broadcasters also benefited from improved technical capacity.

 

The survey found that there are five broad types of impact that the ABMP has made on participating companies: fostering collaboration, learning, increasing HIV/AIDS as a programming focus, targeting the youth, and increasing viewership. Most respondents indicated that the ABMP has prompted increased coordination between broadcasters and governments and between broadcasters and organisations. Some also noted that it has helped improve or market their own content. Some respondents found that it increased social responsibility and consciousness. The survey found that respondents learned a lot about HIV/AIDS and about producing high quality creative programming. One respondent also noted that the coalition facilitated organisational learning. For many respondents, a major impact of the ABMP is its ability to make stations incorporate more HIV/AIDS issues in their programmes in a more creative way.

 

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INTEGRATING SERVICES: HIV/AIDS and FAMILY PLANNING

 

7. Integrating HIV Prevention and Counselling and Testing for HIV within Family Planning Services in South Africa

 

The two models studied within "Feasibility, Acceptability, Effectiveness and Cost of Models of Integrating HIV Prevention and Counseling and Testing for HIV within Family Planning Services in North West Province, South Africa," published in September 2008, are the Testing Model - which educated family planning (FP) clients about HIV and AIDS counselling and testing (C&T) and offered C&T within the FP consultation by an FP provider - and the Referral Model - which educated FP clients about C&T and then referred interested clients for testing and post-test counselling to a specialised C&T service. Key interventions included: (a) holding sensitisation meetings at the national, provincial and district levels; (b) reviewing and developing training materials; (c) application of the Balanced Counselling Strategy Plus (BCS-Plus) approach; (d) modification of registers for collection of FP and C&T statistics; and (e) training of health providers.

 

The study found that both models increased the numbers of people aware of C&T and the numbers of people interested in testing. Increases in discussing the client's HIV serostatus changed from 5-6% at baseline to 62-81% at endline. Both models used the BCS-Plus Toolkit, developed by FRONTIERS, effectively to integrate HIV prevention activities, including education about prevention, dual protection, and counselling and testing within FP services. Providers acknowledge that the training capacitated them with the ability to discuss sexual issues with their clients freely, and it assisted in improving client-provider relation. Lastly, provider experience with clients raised a need for further training on new themes to be included in the BCS for better client services.

 

The document proposes the following recommendations:

  • Counselling of all FP clients about sexually transmitted infection (STI)/HIV/AIDS risk behaviours and prevention can address common misconceptions, and provides the opportunity to engage with clients about their sexual behaviour and interest in HIV testing.
  • Client preference for location of HIV testing should be respected and clients should be able to access services in the facility where they receive FP services or through referral.
  • To assure the quality and effect of integrating services at the district level, it is important that records are kept and reported that describe the HIV services provided during FP consultations.

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8. Integrating Counselling and Testing for HIV within Family Planning Services in Kenya

 

The same two models - the Testing Model and the Referral Model - are studied within this July 2008 report, with a focus on the same types of interventions, but in Kenya. Seventy-five health providers were trained at a residential training of five days for the referral model and nine days for the testing model, which included an additional four days for training in HIV C&T and conducting and interpreting rapid HIV tests. Participants developed implementation action plans. Planning for and procurement of key supplies were undertaken with district-level mechanisms for sourcing, storage, distribution and replenishment of supplies. Routine data collection on FP and voluntary counselling and testing (VCT) services was strengthened. To better understand patterns of VCT utilisation, clients in both models were given a set of VCT vouchers during their FP visit. The vouchers had two parts; the front part contained information about the referring institution, while the back side contained information about the receiving institution. Once completed, the voucher was handed over to the midwife in charge of the FP clinic who then filed it. Information on the number of vouchers received was compiled on a monthly basis.

 

Specific sites were studied with pre-post intervention research without a control group, through facility assessments, focus group discussions with FP providers and with FP clients, observations of provider-client interactions, and client exit interviews, as well as a cost analysis.

 

Findings in this report, "Feasibility, Acceptability, Effect and Cost of Integrating Counseling and Testing for HIV within Family Planning Services in Kenya," showed that:

  • Integrating counselling and testing for HIV into FP services is feasible and acceptable.
  • Quality of family planning counselling improved.
  • Quality of counselling on sexually transmitted infection (STI)/HIV issues improved.
  • Counselling on condoms and dual protection and their use improved.
  • Counselling on HIV C&T increased during FP consultations from 39 percent overall at baseline to 88 percent of all consultations at endline. Discussions of the client serostatus increased from 24 to 81 percent of consultations.
  • Clients who were offered and obtained HIV C&T increased.
  • Incremental costs for integrating C&T into FP services are affordable.

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ASSESSING MASS MEDIA APPROACHES

 

9. Impact of a Regional Mass Media HIV Prevention Programme in Southern Africa

 

This is a May 2008 evaluation of the Soul City Regional Programme (SCRP), an HIV/AIDS communication project which involves 8 southern African countries and combined the adaptation of local communication materials with a largescale capacity building programme. The Soul City Institute for Health and Development Communication identified local partners in each of the 8 countries who, with support from Soul City, set up their own health communication programme: Choose Life! in Botswana, Phela in Lesotho, Pakachere in Malawi, Nweti in Mozambique, Desert Soul in Namibia, Lusweti in Swaziland, Kwatu in Zambia, and Action in Zimbabwe. These country programmes produced a total of 20 titles in the 5-year period from 2002 to 2007. Approximately 20 million copies of these were distributed in the region. In addition, the SCRP produced a total of 11 radio drama series and 14 television documentaries/talk shows. The aim of this evaluation was to investigate the impact of the local communication interventions in each country on individuals and communities. The results of a series of surveys (baseline in 2002, mid-term in 2004, final impact in 2007) are summarised here in "Soul City Institute Regional Programme 2002 - 2007 Impact Evaluation Summary."

 

Overall, the 5-year evaluation of the SCRP has shown substantial reach and impact of local media interventions on individuals and communities in the 8 southern African countries. According to the report, a striking finding was a clear shift in HIV testing in all countries from 2002 to 2007, with exposure to Soul City partner interventions associated with testing in all settings. Similarly, in all 8 countries the media interventions were clearly associated with knowledge about antiretroviral treatment (ART) including knowing that one can still transmit HIV while on ART, knowing that a person can live longer on ART, and knowing that ARVs do not permanently cure AIDS. This indicates that the HIV testing and AIDS treatment messages were particularly effective in the media interventions in the region. In all of the 8 countries, stigma reduction associated with one or more of the media interventions was measured suggesting the messages were effective in shifting attitudes.

 

This report outlines the findings for each country.

 

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10. Impact of a Mass Media HIV Prevention Programme in Nicaragua

 

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change initiative implemented by Puntos de Encuentro that aims to prevent future HIV infections in Nicaragua by means of mass communication actions, including entertainment-education (edutainment) programmes, local capacity building, and the development of links, coordination, and alliances within communities.

 

"Catalyzing Personal and Social Change Around Gender, Sexuality, and HIV: Impact Evaluation of Puntos de Encuentro's Communication Strategy in Nicaragua," published in June 2008, presents the results of the SDSI impact study. The purpose of the evaluation was to explore the intervention's impact on a representative group of young people, on collective processes, and on the local environment. In particular, it measured SDSI's impact on the following areas: gender equity, stigma reduction, personalisation of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and personal and collective efficacy for HIV prevention.

 

Evaluation of SDSI included household surveys, as well as in-depth interviews and focus group discussions with participants, non-participants, and key stakeholders The survey findings indicate that greater exposure to SDSI led to positive changes on a population level - all of which are detailed in the report. Broadly, the intervention resulted in a significant reduction of stigmatising and gender-inequitable attitudes, an increase in knowledge and use of HIV-related services, and a significant increase in interpersonal communication about HIV prevention and sexual behaviour. Qualitative findings indicate that SDSI played an important role in promoting community-based dialogue on key topics, strengthened youth leadership, and fostered alliances between organisations.

 

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11. Evaluating the Trusted Partner Campaign in Four Sub-Saharan African Countries

 

This September 2008 document summarises the findings of an evaluation of the Trusted Partner Campaign, a regional project implemented by Population Services International (PSI). According to this report, qualitative research conducted in urban areas of sub-Saharan Africa has found that youth may initially use condoms with a partner, but they stop condom use once they believe they can trust their partner. The Trusted Partner Campaign was developed to alter the misconceptions that resulted in a heightened sense of trust and subsequent lower consistent condom use. The campaign involved 4 television spots that focused on profiling young people whose characteristics were appealing to the opposite sex and deemed responsible and trustworthy. The end of each spot, however, showed that looks and perceptions can be deceiving, as it is revealed that each "trustworthy" person is HIV-positive. Similar storylines were used in 5 radio spots and supporting print materials for posters and billboards. All spots were run in various languages in Lesotho, Mozambique, Uganda, and Zambia.

 

Cross-sectional surveys of youth aged 15-24 were conducted before and after the Trusted Partner Campaign aired in Lesotho, Mozambique, Uganda and Zambia. The surveys measured three aspects of trust (caution, interpersonal trust, and received assurances) as well as condom use for youth who reported having a regular partner.

 

Exposure to this campaign was only associated with consistent condom use in Mozambique, and the impact was only felt among those with the highest levels of exposure to the campaign. The results of this evaluation also indicate that more intense exposure may be necessary to achieve impact. However, regional campaigns appear to be a cost-effective way to reach large numbers of youth and further research with more consistent measures of exposure should be pursued.

 

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REFLECTING ON INTERPERSONAL APPROACHES

 

12. Community Conversations to Address Harmful Traditional Practices and Reduce Stigma in Ethiopia

 

Community Conversation (CC) is an interactive process which brings people together and engages communities to discuss and explore underlying causes fuelling the HIV and AIDS epidemic. CC was initiated in Ethiopia in 2002 by the National HIV/AIDS Prevention and Control Office (NHAPCO). CARE International's Health Improvement and Women Owned Transformation (HIWOT) programme adopted the approach, initiating 105 CC groups in 14 districts on issues related to HIV and sexual and reproductive health between 2006 and 2007. CC recognises that people have capacities, knowledge, and resources to transform individually and collectively once they perceive ownership of a problem.

 

In the Community Conversation approach, community facilitators with leadership competencies are identified and approached to lead CC discussion groups of 50-60 volunteers from diverse backgrounds. According to the authors, after 12 months, the following changes were noted in communities:

  • Some CC groups condemned early marriages in their communities, committing themselves to protecting school girls from discontinuing their education due to forced marriage.
  • Other CC participants decided to stop Female Genital Cutting (FGC) in their areas or penalise traditional circumcisers (frequently traditional birth attendants) who do not use new razor blades for each girl they circumcise. In some places, participants discussed harmful traditional practices apart from HIV/AIDS (i.e. milk teeth extraction), and passed by-laws to stop FGC in their locality.
  • Some CC participants reached a consensus to avoid practicing risky behaviours that predispose to HIV infection, such as going to night clubs and drinking alcohol, which is very common in the community, as well as practices like widow inheritance.
  • Researchers found the sessions have helped reduce stigma and discrimination towards people living with HIV (PLWH), with some CCs providing care to people living with HIV and AIDS or forming HIV/AIDS clubs.

This report identifies challenges, and lessons learned, and common outcomes of CC in practice.

 

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13. Thailand Turns to Education and Dialogue for Youth

 

"Protecting Youth against HIV: Education and Dialogue for Adolescents in Thailand," published in August 2008, describes a 5-year project through which the Program for Appropriate Technology in Health (PATH) is facilitating HIV/AIDS and sexuality education for 11- to 18-year-old youth in Thailand. PATH staff developed a comprehensive 16-hour sexuality education curriculum based on the premise that young people will make good decisions when they have complete and accurate information; it is also tailored to students' needs, abilities, interests, and learning styles. The project includes supervised extracurricular activities, such as camps that incorporate sexuality education into computer games and drama. In addition, the Teenpath website reinforces content from the curriculum and provides a place for peers to talk about the challenges they face.

 

Working with regional partners, PATH identifies schools interested in implementing the Teenpath curriculum and then trains school administrators and teachers (who then train fellow educators) in both content and methodology. The Teenpath team also works with 10 universities throughout Thailand to teach sexuality-education methods to aspiring teachers.

 

To empower youth to educate their peers and model healthy behaviours, Teenpath has held more than 50 camps for young people. Campers have developed a social marketing condom campaign, surveyed adult attitudes toward condom sales at secondary schools, and forged networks of youth leaders to encourage advocacy for sexual and reproductive health and rights.

 

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14. Boosting Prevention through Interactive Games and Conversation

 

Published in September 2008, this publication describes an adaptable HIV prevention tool and the results of its use to date in more than 18 countries. Initially developed by the German Federal Centre for Health Education (BZgA), the "Join-In Circuit on AIDS, Love, and Sexuality" takes the form of a workshop with 5 or more stations, at which trained facilitators help participants learn critical information about HIV through interactive problem-solving, games, and conversation. Throughout each 75-minute session, facilitators engage participants in dialogue about how HIV is transmitted, how to talk about sexuality and love, condom use, non-verbal communication, living with HIV, and so on - all the while emphasising 3 main messages: "Be informed; protect yourself and others; show solidarity."

 

By the end of 2007, the Join-In Circuit had been adapted and used in HIV prevention in Bangladesh, Mongolia, and Nepal; the Russian Federation and Ukraine; Mozambique, Zambia, and Zimbabwe; and Ecuador and El Salvador. The report presents a number of findings gleaned from the experiences of adapting the Circuit in these different contexts. On the whole, evaluators found that "Most organizers and facilitators agree that the Join-In Circuit is an effective tool for HIV prevention among young people. Though primarily viewed as a vehicle for providing information, subjective evidence suggests that the Circuit has a positive influence on people's attitudes (towards people living with HIV, for example) and helps people to change their behaviour (use condoms, etc).”

 

A number of challenges are encountered, however, and are outlined here. For instance, effective interpersonal communication can be a particular challenge, especially in countries with authoritarian communication structures. This applies not only to facilitators, but also to the participants, who may not be accustomed to being asked for their opinion. Several concrete suggestions are offered for overcoming challenges.

 

For more information about the Join-In Circuit approach, please click here.

 

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a social and behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and evaluate programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email: cchange@aed.org.

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please visit The CI website.

 

 

 

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

 

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C-Change Picks - Integrating HIV/AIDS and Family Planning/Reproductive Health Services

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Date: 
July 7, 2009

C-Change Picks #8 - Integrating HIV/AIDS and Family Planning/Reproductive Health Services
Information about Social and Behaviour Change Communication, sponsored by C-Change
July 7 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

 

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #8 focuses on integrating HIV prevention and care with family planning and sexual and reproductive health programming and services. This issue includes reports that address gaps in services for HIV prevention among women during their reproductive years, in particular; pregnancy and vertical transmission of HIV; the broad range of rights issues among people living with HIV including reproductive health rights; and programmatic examples of integration of services for HIV and family planning/reproductive health from several African countries. The issue closes with three recent training resources that may be of use in the field.

 

In Ethiopia, the C-Change programme is working with the President's Malaria Initiative (PMI), the President's Emergency Plan for AIDS Relief (PEPFAR), and the government of Ethiopia to assist pregnant women in accessing antenatal care including services for prevention of mother-to-child transmission of HIV (PMTCT) while at the same time presenting malaria prevention messages.

 

During a workshop run by C-Change in early 2009, local stakeholders developed a package of "Essential Malaria Actions" that is intended to help families focus on key protective behaviours (e.g., "Parents, to protect your children against malaria, insure that all your children sleep under a bed net every night."). A similar collection of essential actions is being compiled for antenatal care to help families deliver "healthy newborns." Communication efforts include community recognition of families who have carried out the essential malaria prevention and antenatal actions. Families are given Malaria Protection Stickers to post on their front door, and are then encouraged to mentor another family so that they too receive a Protection Sticker. One goal of the program is to gradually produce a shift in social norms. This will occur as the number of Malaria Protection Stickers visible on the front doors in the community increases. Recognition ceremonies of Champion Communities - those that have at least 100 families with protection stickers - will be designed to create even greater demand among community members to earn a sticker. These celebrations of success will in turn be amplified through mass media in order to engage other communities in the process. Click here for more information about the C Change programme.

 

 

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

 

In this Issue...

 

HIV and AIDS and Family Planning/Reproductive Health: INTEGRATING SERVICES

 

Strategic Thinking and Programming Approaches

1. Addressing Gaps in Provision and Use of Condoms and Contraceptives in HIV Prevention
2. PMTCT through Integrated Services
3. Protecting Sexual and Reproductive Health and Rights of Women and Girls Living with HIV
4. Evaluation of a Family Planning and Antiretroviral Therapy Integration Pilot in Uganda
5. Peer-to-Peer Support for PMTCT and Family Planning in Ethiopia
6. Radio Soap Integrating Reproductive Health and HIV Transmission Messages in Nigeria
7. Enhancing Life Skills Education for HIV Prevention in South African Schools

 

 

Training Resources

8. A Handbook for Measuring and Assessing the Integration of Family Planning and Other Reproductive Health Services
9. Toolkit for Increasing Access to Contraception for Clients with HIV
10. Training Guide for HIV Counseling and Testing for Youth

 

 

 

HIV/AIDS and Family Planning/Reproductive Health: INTEGRATING SERVICES

 

 

Strategic Thinking and Approaches

 

 

1. Addressing Gaps in Provision and Use of Condoms and Contraceptives in HIV Prevention

 

This Population Action International report, entitled "Comprehensive HIV Prevention: Condoms and Contraceptives Count", presents evidence that scaling up HIV prevention will require much broader access to and use of proven prevention technologies - "namely male and female condoms to prevent primary infection, and contraceptives to prevent mother-to-child transmission by preventing unintended pregnancies". The report details public health strategies and a programming framework that can be applied to address gaps in the provision and use of condoms and contraceptives.

 

The authors state that "behavior change, including condom use, is critical to stemming the number of new infections... High rates of unintended pregnancies, including among women living with HIV or AIDS, is an urgent health and rights crisis. Preventing unintended pregnancies among women living with HIV and AIDS and those at risk of infection is essential for preventing mother-to-child transmission of HIV....Persistent variations in condom use across regions, countries and populations indicate that condom promotion should be targeted to address socio-cultural, political, economic and structural barriers faced by different groups (e.g. youth, married women and men, discordant couples, sex workers, men who have sex with men, and injecting drug users, among other groups)...."

 

Key social and behaviour change communication recommendations include:

  1. Use the more than 20 years of epidemiological, psychological, programming, and marketing data to design a comprehensive prevention strategy that supports national and local ownership and generates local solutions to affecting the social and gender norms that influence sexual behaviour and use of condoms and contraceptives, among other prevention strategies.
  2. Eliminate harmful government policies - the authors cite needs for "strong leadership and coordination - for advocacy and policy dialogue....Scale up also requires a supportive policy environment - one where policies are based on sound evidence that supports the efficacy of condoms and contraceptives in prevention the transmission of HIV. Likewise, the integration of contraceptives into HIV prevention programs must be supported at all policy levels."
  3. Scale up and integrate condoms and contraceptives into other HIV prevention strategies, based on the social marketing concept of supply, demand, and support, and built on a foundation of leadership and coordination.
  4. Put the contraceptives in comprehensive prevention to address high rates of unintended pregnancies, through expanding voluntary family planning services integrating family planning with other HIV services to increase contraceptive use.

 

See also: Comprehensive Condom Programming Framework.

 

 

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2. PMTCT through Integrated Services

 

According to "Missing the Target #7: Failing Women, Failing Children - HIV, Vertical Transmission and Women's Health", published in May 2009 by the International Treatment Preparedness Coalition (ITPC), HIV-positive women provided with testing, counselling, and comprehensive prevention and treatment, including the best drug therapies available, can prevent the vertical transmission of HIV to their newborn children. However, women in the economically poorest countries, particularly in the Global South, are not receiving what they need to prevent vertical transmission. This report focuses chiefly on the following countries: Argentina, Cambodia, Moldova, Morocco, Uganda, and Zimbabwe.

 

The document states and supports its position that "United Nations agencies and global funding initiatives (such as the Global Fund and PEPFAR [United States President's Emergency Plan for AIDS Relief]) have fundamental responsibility for realising the potential of comprehensive services to prevent vertical transmission of HIV." Coordination of agencies, research transparency, and increased programmes are part of what is advocated, as well as favouring "governments that show a clear interest in developing realistic policies and programmes to reduce vertical transmission by global funding partners."

 

ITPC has assembled 6 country reports on studies of services HIV-positive pregnant women receive for prevention of mother-to-child transmission (PMTCT). Each report has a set of recommendations specific to that country. Among the recommendations are the following communication-related strategies:

  • Develop gender-based HIV/AIDS prevention programmes that focus on the specific risk factors and needs of women, and include peer education components.
  • Incorporate people living with HIV/AIDS-provided peer counselling in all strategies and programmes related to prevention of vertical transmission.
  • Integrate services and mobilise resources internationally, nationally, and locally - sexual and reproductive health care and family planning are essential interventions for HIV prevention, care, and treatment. Include women from at-risk groups in the design and planning of programme delivery.
  • Reduce HIV-related stigma and discrimination.
  • Train health workers for sensitivity to human rights and gender-specific issues and compliance with principles of informed consent and confidentiality.
  • Enhance coordination between HIV/AIDS services and anti-violence referral services.
  • Promote treatment literacy among women and children living with HIV.
  • Improve civil society's capacity for and representation in policy advocacy and monitoring of HIV-related policies and programmes at national and local levels.
  • Improve financial support for HIV-positive women and encourage male partners of pregnant women to be tested for HIV and engage more fully in prevention of vertical transmission services as part of a broader effort to involve the entire family in HIV treatment and care.
  • Develop and distribute HIV and prevention of vertical transmission education materials for pupils and students, teachers, and parents.
  • Create a series of advertisements for TV, radio, and newspapers that focus on reducing HIV-related stigma and discrimination against women.
  • Initiate a wide-ranging campaign to raise the level of awareness about prevention of vertical transmission programmes and services.
  • Mobilise and encourage HIV-positive mothers to form or join psychosocial support groups that can also help them engage in income-generating activities.
  • Streamline reporting by initiating a web-based format to improve access to quality data for programme monitoring and evaluation. This step would also help facilitate efficient distribution of drugs, test kits, and other supplies.

Ensure that all health care workers receive adequate training in breast-feeding management and counselling, particularly as it pertains to HIV-positive mothers, in order to ensure that all expectant mothers understand the potential risks and benefits of all options and feel as though they can make realistic choices that will help keep their infant as well-fed and healthy as possible.

 

 

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3. Protecting Sexual and Reproductive Health and Rights of Women and Girls Living with HIV

 

"Sexual and Reproductive Health of Women and Girls Living with HIV: Guidance for Program Managers, Health Workers and Activists" published in November 2008 by EngenderHealth, offers guidance and recommendations for creating programmes that protect and promote the sexual and reproductive health and rights of women and girls living with HIV and AIDS. Based on experiences in Brazil, the resource offers recommendations in four key areas: creating a political and social environment for promotion of sexual and reproductive rights; strengthening health systems to improve the availability of comprehensive sexual and reproductive health; ensuring participation of adolescent girls and women living with HIV and AIDS in public policies and rights initiatives; and strengthening support available to them.

 

Three dimensions of vulnerability of this population of people living with HIV (PLHIV) were analysed: the individual dimension of vulnerability; social vulnerability; and the programmatic or institutional dimension of vulnerability.

 

Among the recommendations are the following communication-based aspects of providing for the right to sexual and reproductive health for women and girls living with HIV through strengthening health systems to improve the availability of comprehensive sexual and reproductive health:

  1. Integrate into the curricula of graduate courses in human sciences and health sciences the themes of human rights, sexual rights, reproductive rights, ethnic/racial relations, gender relations, and diversity, in addition to questions related to overcoming stigma and discrimination associated with living with HIV and AIDS.
  2. Foster the inclusion of the theme "social determinants of health conditions" in all permanent education activities for health workers, including correlating the process leading to poor health and socioeconomic, regional, ethnic, racial, gender, and age-related disparities and other factors (like gender violence against women, stigma and discrimination associated with living with HIV, and other human rights violations).
  3. Guarantee that the themes of human rights and living with HIV and AIDS and rights are addressed in the programmes of permanent education and ongoing training for health workers and community health agents.
  4. Broaden opportunities to update health workers' knowledge about and skills on the sexual and reproductive health of HIV-positive women and girls through training and certification.
  5. Create opportunities for sharing and exchanging experiences and lessons learned in the promotion, defence, and enforcement of the rights of PLHIV.
  6. Guarantee the development of strategies to broaden participation and engagement of the male partners of women and adolescent girls living with HIV and AIDS, particularly in counselling.
  7. Develop communications and information strategies to promote the rights of PLHIV, especially their sexual rights and reproductive rights and the prevention of vertical transmission of HIV and syphilis, among others, by guaranteeing the broad dissemination of communications products directed at health workers, health managers, health service users, and society at large.
  8. Widely disseminate the booklets Users' Rights and Health Service Users among women and adolescent girls living with HIV.

 

 

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4. Evaluation of a Family Planning and Antiretroviral Therapy Integration Pilot in Uganda

 

This September 2008 report presents the findings from a case study of an integrated family planning (FP)-antiretroviral therapy (ART) pilot project carried out in Mbale, Uganda, from March 2006 to April 2007 by The AIDS Support Organization Mbale (TASO/M) in cooperation with the ACQUIRE Project at EngenderHealth and the Ugandan Ministry of Health (MOH).

 

The pilot was designed using ACQUIRE's FP-ART integration framework, which is based on a systems approach to build site capacity in training, referral, supervision, and logistics. To improve the training system, ACQUIRE began by developing the FP-integrated training curriculum. Following a performance needs assessment, ACQUIRE conducted a 2-week training consisting of didactic and clinical practicum portions for 23 TASO trainers, and supported the newly trained trainers to train 15 service providers and counsellors and field officers, as well as 12 community nurses and selected people living with HIV (PLHIV) volunteers. After the trainings, TASO/M staff fully integrated FP into existing ART services. This included giving FP health talks in the waiting area, providing FP methods on-site, and referring clients to the local hospital for long-acting and permanent methods (LAPMs).

 

ACQUIRE worked with TASO to develop and support a communications strategy to increase public awareness of and knowledge about FP within the communities adjacent to TASO/M. ACQUIRE helped TASO integrate FP messages into health education activities, orient AIDS community workers to FP, and conduct awareness sessions on FP for community groups. The TASO staff appeared on local FM radio stations to talk about FP and respond to listeners' questions. To address myths, rumours, and fears about FP methods, community nurses were trained to counsel about and provide FP methods.

 

In November 2007, ACQUIRE conducted a retrospective evaluation using a case study methodology to assess the FP-ART integration pilot. Based on the evaluation, the model will be rolled out to all of TASO's 11 centres and 15 minicentres throughout Uganda over the next several years, as part of TASO's 5-year strategic plan (2008-2012).

 

The evaluation provides an extensive list of recommendations for programmatic consideration.

 

 

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5. Peer-to-Peer Support for PMTCT and Family Planning in Ethiopia

 

Initiated in 2005 by IntraHealth International, Mother's Support Group (MSG) is a peer support model to address the needs of pregnant and postpartum women living with HIV and caring for babies in Ethiopia. According to the project's organisers, the programme is designed to empower mothers and mothers-to-be to access peer-based support and make linkages to services such as family planning, infant feeding counselling, nutritional guidance, antiretroviral therapy, prevention of mother-to-child transmission (PMTCT), and health institutional delivery. The MSG programme is based on the concept that peer support is an optimal model for effective education and social empowerment, and that mothers are particularly well-suited to provide support to other mothers.

 

The MSG programme seeks to:

  • enhance access to and use of PMTCT services by building strong linkages between health care providers and peer support networks;
  • ensure adherence to antiretroviral therapy among pregnant and postpartum women;
  • lessen HIV-related stigma and discrimination;
  • increase HIV-positive mothers' understanding of infant feeding options;
  • reduce the incidence of new sexually transmitted infections and HIV among girls and women;
  • increase acceptance and use of family planning among postpartum women; and
  • build linkages with other programmes and services that strengthen women's health and decision making (i.e., nutritional support, income-generating activities, and skills training).

To achieve these objectives, the MSG programme fosters several mutually reinforcing strategies for peer-to-peer contact. The programme strategy includes the following components:

  • Mentor Mothers: The mentor mothers are the linchpin of the MSG programme. The mentors are recruited by the site coordinators. There are 4 mentor mothers per site, and 2 mentor mothers work on any given day. Mentor mothers must be willing to spend at least 3 full days per week supporting HIV-positive mothers at the health center.
  • Training of Mentor Mothers: The basic content of the 5-day training covers HIV transmission and infection, HIV and pregnancy, psychosocial issues, self-care, antiretroviral therapy, labour and delivery, and infant care. The trained site coordinators also attend the mentor training and present some topics.
  • Support groups: Once trained, the mentor mothers facilitate separate support group meetings for mothers-to-be and mothers. On occasion, a postpartum mother may be invited to attend a group meeting of mothers-to-be to discuss topics such as partner disclosure. The mentor mothers also refer support group members for care such as PMTCT and family planning services.

 

 

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6. Radio Soap Integrating Reproductive Health and HIV Transmission Messages in Nigeria

 

Launched in July 2007, Ruwan Dare (Midnight Rain) is a two-year radio serial drama produced by Population Media Center (PMC) in Nigeria. Through character role-models, the drama aims to enhance knowledge and use of existing health services, provide information about reproductive and general health issues, encourage family planning, promote delaying marriage and childbearing until adulthood, promote small family norms, provide information about HIV transmission, and motivate people to take actions to improve their health and the health of their families.

 

PMC has established Ruwan Dare Listeners' Clubs, which include both male and female audience members, to provide ongoing feedback to the creative team. And, at the encouragement of listeners in the Kano State, PMC has also started a talk show call-in programme, where people can phone in and talk about the issues addressed in Ruwan Dare. Ruwan Dare will air through 2009 on four radio stations in northern Nigeria.

 

To monitor the effects of the programme on listeners, PMC has established 11 clinic research sites where exit interviews are being conducted to find out what is motivating clients to seek reproductive health and family planning services. Monitoring interviews conducted at reproductive health and family planning clinics with 220 clients in October-December 2007 showed that 55% of the clients reported that it was Ruwan Dare that had motivated their visit to the clinic. A second round of monitoring from the same group of clinics was conducted from January to March of 2008, and it showed that 66% of clients reported that the programme motivated them to seek family planning and reproductive health services. This increase of 11 percentage points provides additional evidence that midway through the course of its two year broadcast, Ruwan Dare has demonstrated a measurable impact on the lives of listeners in northern Nigeria.

 

According to PMC, Ruwan Dare was created as a result of the success of PMC's programme titled Gugar Goge ("Tell it to Me Straight"), which was a highly popular radio serial drama that addressed issues relating to maternal health and obstetric fistula. The evaluation of Gugar Goge pointed to widespread changes in behaviours and attitudes among audience members with regard to the issues addressed in the programme. It was this success that inspired the production of Ruwan Dare, which was created using the same methodology, but with new characters, storylines, and aims.

 

See also: Participatory Assessment of Gugar Goge, an Entertainment-Education Radio Soap Opera in Nigeria: A Qualitative Assessment Report.

 

 

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7. Enhancing Life Skills Education for HIV Prevention in South African Schools

 

According to this March 2008 research brief from the Horizons Program, reaching young South Africans with effective prevention programming has become key to slowing the rate of HIV infection. One of the main strategies the South African Government has used to build HIV prevention awareness and promote behaviour change among young people is through school-based life skills education, which is part of the Life Orientation Programme.

To improve HIV prevention programming for youth aged 10-14, Horizons, in collaboration with education specialists and representatives from South Africa's National Department of Education implemented a pilot project that consisted of three main activities: a consultative workshop, curriculum development, and pilot testing of the curriculum. The resulting Dare to be Different (D2BD) module includes messages that promote the advantages of abstinence and faithfulness/mutual monogamy and highlight the consequences of risky sexual engagement. D2BD also incorporates activities to build such critical skills as decision-making, critical thinking, problem solving, negotiation, resisting peer pressure, and communication.

 

A study of the pilot D2BD programme found that learners do indeed want more than just HIV prevention information. Teachers and learners generally agreed that D2BD does more than provide the basics of HIV prevention by building critical thinking and decision-making skills, fostering communication about HIV, and encouraging learners to identify risky behaviours and recognise the consequences of those behaviours. The study also revealed that D2BD improves parent-child communication through its Home Talk component.

 

According to study respondents, the Life Orientation Programme was easily able to incorporate D2BD into its existing curriculum. The report suggests that with a stronger focus on abstinence and partner reduction, the D2BD module helped fill serious gaps in the Life Orientation Curriculum. Horizons plans to revise the curriculum module based on the pilot's findings to further improve its acceptability and usefulness among teachers and learners.

 

 

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Training Resources

 

 

8. A Handbook for Measuring and Assessing the Integration of Family Planning and Other Reproductive Health Services

 

This Population Council manual, published in 2008, provides a roadmap for Assessing Integration Methodology (AIM), which is a tool for describing and measuring attempts to integrate the provision of family planning (FP) information and services with other relevant services. The focus of "Assessing Integration Methodology: A Handbook for Measuring and Assessing the Integration of Family Planning and Other Reproductive Health Services" is on the AIM and the instruments that can be used to collect data at health facilities offering, or considering offering, integrated services.

 

Benefits of integrating FP with other services include: (1) meeting multiple reproductive health needs of a client simultaneously, (2) reducing the stigma associated with providing a service independently, (3) combining several services needed for a multifaceted health condition, and (4) achieving cost efficiencies through sharing staff skills, infrastructure, and equipment. The Population Council's experience indicates, however, that creating service configurations for integrated services is usually not straightforward and can place a strain on the underlying logistics, training, supervisory, and management systems. This may be the case especially if the services are provided through different programmes, as is the case with sexual and reproductive health and HIV/AIDS services. In addition, these situations may overstretch service providers who have limited skills and support.

In this context, AIM has been designed to fill the information gaps embedded in questions such as the following: Which service combinations are feasible? Which services are acceptable to clients and providers? Which services can effectively increase access to one or both services without compromising the quality or safety of their delivery? Does their joint provision lead to a synergistic impact on both the individual client's health status and that of the population served? In short, the rationale behind AIM is that offering services in a combined fashion requires appropriate methodologies for determining the feasibility of various combinations, assessing and monitoring the quality of service received, and evaluating their effect on utilisation.

 

To that end, the handbook:

  • explains the basic principles of conducting studies using AIM,
  • provides tips for the data collection, and
  • makes available data collection instruments that have been validated in projects throughout the developing world for the integration of various types of services.

 

 

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9. Toolkit for Increasing Access to Contraception for Clients with HIV

 

This resource, published in January 2009, has been developed by Family Health International for trainers, presenters, providers, programme managers, and policy-makers to update and expand upon the information provided in an earlier module, Contraception for Women and Couples with HIV.

 

The toolkit includes:

  1. A performance-based training curriculum that includes the resources required to conduct the suggested learning activities.
  2. Counselling tools, checklists, guides, and other job aids for providers and programme managers.
  3. An updated version of the orientation presentation contained in the original 2005 module.
  4. Full-text resources of current guidance and technical information about integrating family planning and HIV services.

 

 

The toolkit, which offers access to multiple resources in pictorial and print formats, is also available on CD for users in developing countries with limited internet access.

 

 

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10. Training Guide for HIV Counseling and Testing for Youth

 

This 2008 training guide, a companion to HIV Counseling and Testing for Youth: A Manual for Providers, produced in 2005 by Family Health International, trains providers on how to use that original resource. This guide is intended to be used to train experienced HIV counsellors how to offer counselling and testing to youth and how to integrate HIV counselling and testing and other sexual and reproductive health services. It contains varies interactive sessions including those focused on interviewing, role-play, case study and discussion, referral mapping, and creating working groups for building community support.

 

The intention is that, by the end of the workshop described session-by-session in the guide, participants will be able to:

  • Use HIV Counseling and Testing for Youth: A Manual for Providers as both a guide to services and programmes and as a reference tool.
  • Describe and understand the concept of integrated services for HIV counselling and testing and other sexual and reproductive health needs and plan how to implement integrated counselling and services within their organisations.
  • Identify and implement the key elements of HIV counselling and testing for youth.
  • Explain the importance of quality referrals in providing HIV counselling and testing to youth and identify the referral systems in place and the gaps in existing referral systems in their communities.
  • Demonstrate improved youth-focused counselling skills, drawing on resources in the manual.
  • Understand how to gain community support for integrated youth services and how to develop promotional and social marketing campaigns for those services.

 

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Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

 

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C-Change Picks - Focus on Family Planning

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Date: 
June 2, 2009

C-Change Picks #7 - Focus on Family Planning
Information about Social and Behaviour Change Communication, sponsored by C-Change
June 2 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

 

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health, as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #7 focuses on social and behaviour change communication related to family planning. It highlights resources and case studies that illuminate strategic approaches to engaging within communities and with policymakers. It also provides a look at strategic thinking on the approaches to and impact of mass media campaigns and interpersonal communication for social and behaviour change.

 

C-Change is applying behaviour and social change communication to family planning programmes in Albania, Kenya, Madagascar, with a programme just beginning in the Democratic Republic of Congo. In Albania, a mass media programme which was launched in April 2009 with TV, radio, and print ads and outdoor displays is working to both promote the reliability and safety of modern contraceptives and counter current misconceptions about them. In Kenya, work is just beginning to build and strengthen the behaviour change communication (BCC) capacity of non-governmental and governmental organisations and align their strategies with the national strategy. For more information on current C-Change programmes, visit the website.

 

 

 

 

You will find the current edition of C-Change Picks online - click here.

 

For the archived issues of C-Change Picks, please click here.

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

 

 

In this Issue...

 

FAMILY PLANNING

 

Behaviour Change Communication and Engaging within Communities

 

1. Revitalising Underutilised Family Planning Methods
2. The Active Community Engagement Continuum
3. Lessons Learned in How to Improve Community Outreach
4. Vasectomy: Reaching Out to New Users
5. Approaches to Family Planning in Afghanistan

 

Social Change Communication and Engagement of Policymakers

 

6. Repositioning Family Planning: Mobilising Audiences
7. Assessing Integration of Services: A Handbook
8. Introducing and Mainstreaming Emergency Contraceptive Pills in Developing Countries
9. Understanding Operational Barriers to Family Planning Services in Conflict-Affected Countries

 

Social and Behaviour Change Using Mass Media

 

10. Mass Media Social Marketing of the Standard Days Method
11. Radio Campaign Suggests Lessons for Other Mass Media Campaigns

 

Social and Behaviour Change Using Interpersonal Communication/Counselling

 

12. Telephone Hotline Key for Family Planning Information in DRC
13. Client-friendly Balanced Counselling Strategy

 

 

 

 

FAMILY PLANNING

 

 

BEHAVIOUR CHANGE COMMUNICATION AND ENGAGING WITHIN COMMUNITIES

 

1. Revitalising Underutilised Family Planning Methods

 

This series of seven 8-page briefs, all with the title "Revitalizing Underutilized FP Methods", looks at how the ACQUIRE Project (which stands for Access, Quality, and Use in Reproductive Health) integrated various communication strategies to stimulate authentic community demand for the intrauterine device (IUD) and vasectomy in seven countries – Bangladesh, Ethiopia, Ghana, Guinea, Honduras, Kenya, and Uganda.

 

The briefs outline a Supply-Demand-Advocacy (SDA) Program Model for reproductive health (RH)/family planning (FP) service delivery. In short, this model envisions ready supply (equipped facilities, proficient staff), demand for services (which includes communications and community engagement), and a supportive policy environment as prerequisites for a productive interaction between family planning client and provider. In this framework, skilled, motivated providers work with knowledgeable, empowered clients at the service site to address the clients' RH/FP needs; advocacy is also key to ensuring increased access to and use of quality services.

 

This model shapes the design and implementation of ACQUIRE's country-specific efforts to stimulate demand for underutilised FP methods. Each of the briefs explores the context in which the revitalisation programme was implemented, then outlines the specific steps taken with regard to the SDA process, shares results, and offers reflections on what ACQUIRE learned.

 

The briefs are focused on vasectomy demand in Bangladesh, Ghana, and Honduras and on IUD demand in Ethiopia, Guinea, Kenya, and Uganda.

 

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2. The Active Community Engagement Continuum

 

This working paper presents a conceptual framework for analysing community engagement in reproductive health (RH)/family planning (FP), and the role the community plays in institutionalising lasting behaviour and social change. It is based on a review of documents, best practices, and the lessons learned from the ACQUIRE Project.

 

The Active Community Engagement (ACE) Continuum that is outlined here can be used by global RH/FP projects for strategic integration of community engagement into service delivery and to build a shared understanding of community engagement when designing, implementing, and documenting programmes. The framework provides a basis for discussion related to indicators, time frames, and definitions of terms and is a tool that global RH/FP projects can use to build a shared understanding of community engagement when designing, implementing, and documenting programmes.

 

Community engagement is one component of the SDA approach (described in item #1 above), and it is a critical aspect of a rights-based perspective on access to RH/FP information and services which acknowledges that political, economic, and cultural structures can be barriers to the public's ability to participate meaningfully in the solutions to their RH/FP health needs. The ACQUIRE project has found that, as communities and their members become more engaged, they can assume new and collective roles in decision making around allocating resources, planning programmes, defining policies, and ensuring their right to quality services.

 

The continuum itself consists of 3 levels of engagement - which move from consultative to cooperative to collaborative - spanning across 5 characteristics of engagement, which can be adapted as needed but which generally include:

  1. Community involvement in assessment
  2. Access to information
  3. Inclusion in decision making
  4. Local organisational capacity
  5. Accountability of institutions to the public

 

The paper lists a number of lessons learned from ACQUIRE's experience with community engagement. In essence, "[t]he ACQUIRE Project learned that communities can be engaged through a variety of interventions. The more engaged we were in building the capacity of the community to be equal partners, the more empowered communities became. Champions emerged who influenced both individual behavior and social change, resulting in mutual accountability between government and communities for RH/FP services and policies."

 

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3. Lessons Learned in How to Improve Community Outreach

 

Published in February 2009, "Community Outreach: Lessons Learned in How to Improve Outreach" outlines an outreach strategy implemented by the Private Sector Project for Women's Health (PSP) in Jordan and designed to first contact women with the highest unmet needs for family planning services, and to then change their attitudes about family planning. PSP joined with 2 local non-governmental organisations: Circassian Charity Association (CCA) and General Union of Voluntary Societies (GUVS)) which both recruit and train women in the communities to become community health workers (CHWs) who provide health information to women aged 15-60 years old in towns and villages across Jordan, through home visits. The CHWs promote awareness and demand for birth spacing and use of modern contraceptives, self-breast exams and pap smears, antenatal care, postnatal care, and contraception options following delivery. Women willing to accept a modern family planning method or other services are referred to a nearby clinic. Interpersonal communication messages are reinforced by mass media communications on TV and radio and in print materials.

 

CCA and GUVS have found that women who are non-method users adopt modern methods at rates higher than women who use traditional methods (safe period, withdrawal). Furthermore, contrary to expectations, few women visited report that cultural or religious beliefs prevent them from adopting a family planning method. In the first visit, women who indicate that they do not use a family planning method because they wish to become pregnant are unlikely to adopt a family planning method. New visit protocol has been developed, and is illustrated in graphic form within the document.

 

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4. Vasectomy: Reaching Out to New Users

 

This June 2008 article based on work by the INFO project discusses how family planning programmes can introduce or expand vasectomy services. The report identifies and addresses the barriers that discourage men from choosing vasectomy, describes the selection of communication channels and the design of persuasive messages, describes the development of provider training for both counsellors and those carrying out the procedure, and advises on planning and scaling up vasectomy services. The section "Vigorous Promotion Attracts Clients" is based on designing messages to change the views of vasectomy of both providers and clients through communication campaigns. Communication foci for moving forward are centred on promotion by mass media campaigns and interpersonal communication.

 

According to the report, a communication campaign needs to:

  1. Make people aware of vasectomy;
  2. Dispel myths and rumours;
  3. Disseminate accurate information about the procedure;
  4. Tell men where the method is offered;
  5. Prompt men to discuss vasectomy with family and friends;
  6. Encourage men to call and visit clinics; and
  7. Increase the number of vasectomies performed.

 

Studies on which sources of information are convincing men to seek vasectomies show that both mass media and interpersonal communication can be effective. Mass media can increase general awareness and willingness to inquire about vasectomies. The incorporation of telephone hotlines with mass media campaigns has shown itself to provide confidentiality and the ability to direct men to service locations and health counselling. Recruiting satisfied clients as promoters and finding venues for their messages can change community attitudes. If men are reluctant to talk about their vasectomies because of perceived community disapproval, communication campaigns, including mass media, can address this barrier.

The document conclusions include adopting a gender perspective: "What works for women clients does not necessarily work for men. To reach men, family planning programs must understand men's point of view, address men's concerns and questions, and tailor services - including the setting, staff, and services offered - to men's needs.”

 

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5. Approaches to Family Planning in Afghanistan

 

This paper presents a culturally-sensitive approach to family planning in Afghanistan that is reported to yield results through the Accelerating Contraceptive Use project. According to this paper, "Challenges and Successes in Family Planning in Afghanistan," the project achieved increases of 24-27 percentage points in the contraceptive prevalence rate in three rural areas of Afghanistan from 2004 to 2006. Although cultural factors and misconceptions about family planning presented obstacles, it was found that religion in Afghanistan, which is 99% Muslim, is not a barrier to expanding family planning services. Strategies found to support rapid scale-up of contraceptive use include: emphasising the use of birth spacing to protect the health of mothers and children, engaging clinicians and communities in culturally sensitive ways, increasing the number of female community health workers, and providing activities to empower women, including a health-oriented literacy programme.

 

Recommendations from the document include:

  1. Provide family planning services to help reduce maternal deaths where there are gaps in maternal health services.
  2. Emphasise the health of mothers and children in family planning and birth spacing messages.
  3. Do not assume that local NGOs understand or support community-based health care.
  4. Question unproven assumptions that narrow the potential for success. Get to know the community and find out what the actual context is.

 

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SOCIAL CHANGE COMMUNICATION AND ENGAGEMENT OF POLICYMAKERS

 

6. Repositioning Family Planning: Mobilising Audiences

 

Published at the end of 2008 by the Population Reference Bureau and Africa's Health in 2010, this toolkit is designed to help those working in family planning across Africa to advocate for the visibility, availability, and quality of family planning services and counselling, including contraceptive use and healthy timing and spacing of births. The toolkit, "Repositioning Family Planning: Guidelines for Advocacy Action", was developed in response to requests from several countries to assist them in accelerating their family planning advocacy efforts.

The toolkit supports family planning advocates in convincing key programme managers, opinion leaders, and policy-makers that family planning confers important health and development benefits to individuals, families, communities, and the nation, so that they will 1) act directly or use their influence to expand and improve family planning services, and 2) disseminate accurate information on the benefits of family planning. The toolkit is intended to suggest a range of audiences that can be mobilised, ways to engage those audiences, and what each can do for family planning. It provides the advocates with the latest family planning data and trends, ready-to-use messages, and suggested activities for reaching out and involving specific audiences.

 

The kit contains eight briefs:

  • one update on population and family planning in sub-Saharan Africa, including regional and country data;
  • four briefs devoted to communication with influential audiences
  • two briefs on how to develop an advocacy strategy and work with the media; and
  • a list of materials, advocacy manuals, and other resources available on the internet.

 

The kit also contains a CD-ROM with copies of the briefs, internet links, PowerPoint slides, and additional advocacy materials.

 

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7. Assessing Integration of Services: A Handbook

 

Published by Population Council, "Assessing Integration Methodology (AIM): A Handbook for Measuring and Assessing the Integration of Family Planning and Other Reproductive Health Services" provides a roadmap for the Assessing Integration Methodology (AIM), which is a tool for describing and measuring attempts to integrate the provision of family planning information and services with other relevant services.

 

Many rationales underlie the move toward integrating family planning with other services. Benefits include: (1) meeting multiple reproductive health needs of a client simultaneously, (2) reducing the stigma associated with providing a service independently, (3) combining several services needed for a multifaceted health condition, and (4) achieving cost efficiencies through sharing staff skills, infrastructure, and equipment. The Population Council's experience indicates, however, that creating service configurations for integrated services is usually not straightforward and can place a strain on the underlying logistics, training, supervisory, and management systems.

 

In this context, AIM has been designed to fill the information gaps embedded in questions such as the following: Which service combinations are feasible? Which services are acceptable to clients and providers? Which services can effectively increase access to one or both services without compromising the quality or safety of their delivery? Does their joint provision lead to a synergistic impact on both the individual client's health status and that of the population served? In short, the rationale behind AIM is that offering services in a combined fashion requires appropriate methodologies for determining the feasibility of various combinations, assessing and monitoring the quality of service received, and evaluating their effect on utilisation.

 

To that end, the handbook:

  • explains the basic principles of conducting studies using AIM,
  • provides tips for the data collection, and
  • makes available data collection instruments that have been validated in projects
  • throughout the developing world for the integration of:
    - family planning and antenatal care (ANC) services,
    - family planning and postnatal care (PNC),
    - family planning in post abortion care services, and
    - family planning and HIV and sexually transmitted infection (STI) prevention and detection.

 

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8. Introducing and Mainstreaming Emergency Contraceptive Pills in Developing Countries

 

Published in March 2009 by the Population Council, "The ECP Handbook: Introducing and Mainstreaming the Provision of Emergency Contraceptive Pills in Developing Countries" provides comprehensive guidance to help managers of integrated reproductive health programmes, health care directors, and policymakers introduce emergency contraceptive pills (ECPs) within local and national family planning programmes. Operations research has demonstrated the feasibility and acceptability of ECPs as a way of preventing unintended pregnancy following unprotected sex or failure of an existing contraceptive method. The handbook presents a step-by-step process for introducing ECPs that can be adapted to each country’s needs and resources. The process, based on research conducted in several developing countries, covers the full continuum of ECP programming, including the following:

  • Needs assessments and operations research
  • Drug registration
  • Training and logistics
  • Introduction of ECP scale-up

 

Additionally, the handbook discusses ways to address the needs of specific segments of the population, including special groups, such as adolescents and rape survivors. The handbook contains four sections:

  1. Introduction and Background' describes the existing situation of ECP programming around the globe.
  2. Addressing the Needs of Specific Populations' describes programming approaches designed for specific populations.
  3. Introducing and Mainstreaming ECPs' describes five chronological steps for making ECP programming an integral component of a national reproductive health programme.
  4. The 'Bibliography' lists resources for ECP programming.

 

A CD-ROM of the handbook is also available.

 

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9. Understanding Operational Barriers to Family Planning Services in Conflict-Affected Countries

 

Published in August 2008 by the USAID-funded Health Policy Initiative, this February-May 2007 study highlights issues affecting provision of family planning in conflict-affected settings, using experiences in Sierra Leone as the focus from which to derive lessons on refugee/internally displaced persons (IDP) family planning needs; barriers to quality, accessible services; policy actions to overcome barriers; and capacity building of local groups to recognise and analyse barriers. According to the study, entitled "Understanding Operational Barriers to Family Planning Services in Conflict-Affected Countries: Experiences from Sierra Leone", the adoption and implementation of appropriate "operational policies" can alleviate barriers to healthcare until international community guidelines and protocols on refugee/IDP health needs are met through national policy and guideline development.

 

The document notes that the range of complementary reproductive health services (e.g., safe motherhood, prevention of gender-based violence, HIV/sexually transmitted infection prevention) are essential and have been identified as part of the Minimum Initial Services Package (MISP) for reproductive health in crisis situations.

 

The report details women's and men's responses on family planning at the three stages of study. Responses show increased availability of condoms with the presence of non-governmental organisations both during and after the conflict, and increased family planning services after the conflict, though clinics were reportedly hampered by stockouts of medicines of up to one month. Reports varied on barriers such as price, and some women reported going to local markets for lower priced family planning products such as injectable contraceptives. Barriers to family planning included lack of availability in the immediate post conflict stage, limited knowledge of contraceptive use, particularly among IDP women, inability to travel to hospitals, and restrictions on family planning access for single women, adolescents, and women with low parity. Some refugee women reported learning from programmes on sensitisation to the need for family planning, provided by national and international organisations.

 

Recommendations for stakeholders include a suggestion that Ministry of Health and non-governmental organisations should collaborate to develop strategies for encouraging male involvement, addressing sexual violence, and increasing knowledge on the availability of emergency contraception; and an identified need to provide in-service training for all health facility personnel on reproductive health.

 

Recommendations for the international community include an identified need to systematically examine and strengthen the reproductive health knowledge of camp providers.

 

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SOCIAL AND BEHAVIOUR CHANGE USING MASS MEDIA

 

10. Mass Media Social Marketing of the Standard Days Method

 

This report by the Institute for Reproductive Health is based on a study conducted to research the potential of socially-marketing the Standard Days Method (SDM) in three countries - Benin, the Democratic Republic of the Congo (DRC), and Ecuador. SDM is a relatively new method of natural family planning that helps couples to recognise when they are most fertile. Most women who use this method use special colour-coded beads called CycleBeads to help keep track of where they are in their cycles. This study, "Social Marketing Final Report: Three Country Overview", sought to assess the feasibility of providing the SDM through social marketing programmes in different contexts, and evaluate the impact of mass media campaigns on knowledge, sales and distribution, and quality of information provided by pharmacists. In each country a social marketing campaign was conducted to raise awareness of the SDM and the benefits of CycleBeads. The study found that the social marketing campaign succeeded in raising awareness of the SDM in all three countries, but was most successful in countries in which television augmented information provided by clinics and other sources.

 

According to the study, the mass media campaign increased knowledge of the SDM in all three countries, with substantial increases observed in the endline survey compared to the baseline in Ecuador (from 5% to 30%) and Benin (35% to 64%). Television was the major source of information about the SDM in Ecuador, while in Benin it was both television and clinic personnel. In DRC, where television was not used, the clinic was the major source of information. In both Benin and Ecuador, more than a quarter of the SDM clients were new family planning users. Very few were using family planning in the months preceding SDM use.

 

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11. Radio Campaign Suggests Lessons for Other Mass Media Campaigns

 

This report presents the findings of a qualitative assessment of the radio serial drama "Rock Point 256" which is produced and broadcast in Uganda under the auspices of the Uganda AIDS Commission. The study explored the impact of the radio programme on the intended youth audience and on others who are considered significant in the lives of young people - such as local community members, teachers, and youth leaders. "Qualitative Assessment of Radio Serial Drama Rock Point 256 in Uganda" shares findings related to programming, composition and delivery of messages, comic books and other supplementary materials, and findings related to behavioural change after exposure to "Rock Point 256". The evaluation found that while the drama resonated with the intended audience in terms of themes and production, the programming, messaging, and the relevance of the storyline to communities could be strengthened.

 

The evaluation found that most people had heard the radio promotions and some had seen the billboard advertisements and T-shirts of both the "Rock Point 256" and the related "Be a Man" radio series. The radio spots had far reaching impact in terms of public perception and listenership. However, many only heard the radio promotions and never proceeded to listen to the actual radio drama. Few people had seen a copy of the comic books; however, participants who had only been exposed to the comic books were able to narrate the "Rock Point 256" stories with clarity.

 

According to the report, the research team observed a level of assertiveness and clarity of thought displayed by youth respondents exposed to "Rock Point 256" in their discussion of issues surrounding transactional relationships. Researchers found that parents optimised the drama as a point to initiate discussion with children. This optimisation was expressed not only by the parents, but also by some young people who, as a result, mobilised their siblings and friends to listen to the radio programme. The report suggests that this is indicative of social change since it was novel that parents were rallied around a common goal of ensuring the survival of their children. Schools have also appropriated the "Rock Point 256" drama as a guiding communication tool for the classroom.

 

Based on the findings, the evaluation makes the following recommendations that could be useful for other mass media campaigns:

  • There is a need to assess the appropriateness of radio stations chosen for broadcasting programmes.
  • There is a need to focus on the technical direction of radio drama in ways that will help the actors to act with a radio audience in mind, with more emphasis on making their characters' voices distinctive. Alternatively, calling a character by name would help late entrants to know who is saying what and to whom.
  • There is a need to find good distribution mechanisms for the comic books and other print materials and to possibly consider schools as a distribution point.
  • To determine behaviour change after exposure, there is a need to follow-up with the audience through audience activation and analysis.

 

For more information on the campaign itself, please see this summary of "Rock Point 256".

 

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SOCIAL AND BEHAVIOUR CHANGE USING INTERPERSONAL COMMUNICATION/COUNSELLING

 

12. Telephone Hotline Key for Family Planning Information in DRC

 

This case study, entitled "Phone Hotline spreads Family Planning Information in DR Congo", describes how Population Services International (PSI), under their Family Planning Project, set up and managed la Ligne Verte (which means "hotline" in French) in the Democratic Republic of Congo (DRC). It also explores the lessons learned that may point to the use of cell phone technology as a powerful new tool for health education, especially in countries like the DRC that have little communications infrastructure, such as standard telephone networks and roads.

 

The programme is based on the idea that if knowledge of two or more methods of family planning is strongly correlated with the uptake of contraception, having a discussion about family planning is even stronger: A woman is 3 times more likely to adopt a modern method if she has a conversation with a knowledgeable person. To increase the number of such discussions, the FPP launched la Ligne Verte in early 2005. By dialling a toll-free number, callers can speak to a trained educator and get accurate information about birth spacing in general, the correct use of family planning methods and how to avoid unwanted pregnancy, and the nearest Association de Santé Familiale (ASF) partner clinic. Important features of la Ligne Verte are both the assurance of caller anonymity and the fact that each call is free (for the caller). The FPP offers the hotline as one element of an integrated package of services.

 

The organisers have found that men make up the vast majority of callers to la Ligne Verte. All calls made to the hotline are free, so lack of money to pay for a call is not a factor (although it is likely that men have better access to cell phones in the first place). Likewise, it is unlikely that men are more exposed to information about the hotline than are women, since most of the FPP's family planning messages are primarily designed for women. The organisers have also found that project activities correlate with hotline calls, and the largest number of calls originated from where the organisation has activities.

 

Based on experience with the hotline, the organisers make the following conclusions:

  • Men in the DRC have a higher unmet need for family planning information than anticipated.
  • Two minutes per call is not adequate.
  • Call data could be mined to further evaluate and guide programming.

 

According to the report, the FPP’s experience in the DRC indicates that a hotline is a valuable asset in a programme that aims to increase knowledge, acceptance, and use of family planning methods; it is perhaps especially important where other forms of communication are not readily available.

 

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13. Client-friendly Balanced Counselling Strategy

 

The toolkit "The Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High HIV/STI Prevalence Settings", developed and tested by the Population Council in Kenya and South Africa, provides the information and materials needed for health care facility directors, supervisors, and service providers to implement the "Balanced Counseling Strategy Plus" (BCS+) approach in their family planning services. BCS+ is described here as an interactive, client-friendly approach for improving counselling on family planning and prevention, detection, and treatment of sexually transmitted infections including HIV.

 

This toolkit includes the following:

  • BCS+ Trainer’s Guide that supervisors and others can use to train health care facility directors and service providers on how to use the BCS+ for counselling family planning clients.
  • BCS+ User’s Guide on how to implement the BCS+. It can be distributed during training or used on its own with the BCS+ job aids.
  • BCS+ job aids comprising: BCS+ algorithm that summarises the 19 steps needed to implement the BCS+ during a family planning counselling session; BCS+ counselling cards that the provider uses during a counselling session; and BCS+ method brochures.

 

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Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Change Picks - Focus on Malaria and Family Planning/Maternal Health

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Date: 
May 12, 2009

C-Change Picks #6 - Focus on Malaria and Family Planning/Maternal Health
Information about Social and Behaviour Change Communication, sponsored by C-Change
May 12 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

 

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health, as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

C-Change Picks #6 focuses on resources that may be useful for implementers, programme managers, policy personnel, and journalists who work on and write about malaria prevention activities. Also included in this issue are resources to support social and behaviour change communication activities for programmes focused on family planning and maternal health, particularly postpartum care.

 

C-Change is working in Ethiopia with the President's Malaria Initiative (PMI) at the community level to increase knowledge about malaria prevention and help communities put into practice malaria prevention actions. These efforts include encouraging the correct and consistent use of insecticide-treated nets (ITNs), increasing acceptance of indoor spraying, and promoting prompt care seeking for malaria symptoms and adherence to treatment. Additional information is available at the C-Change website.

 

 

 

You will find the current edition of C-Change Picks online - click here.

 

For the archived issues of C-Change Picks, please click here.

 

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

 

In this Issue...

 

 

MALARIA

 

Programming Resources:

1. Malaria Supplies Useless Unless Combined with Appropriate Communication
2. Research on Use/Non-Use of Bednets
3. Malaria in Pregnancy Resource Package
4. Malaria: Integrated Campaigns Toolkit
5. Malaria: BCC/IEC Programming Q&A
6. PMI Communication and Social Mobilization Guidelines

 

Resources for Journalists:

7. Journalist Orientation Session: Effective Communication Is Vital for the Elimination of Malaria
8. African Media and Malaria Research Network (AMMREN)

 

 

FAMILY PLANNING/MATERNAL HEALTH

 

Social Change Communication (SCC):

9. Recommendations for Community-Based Postpartum Care Services

 

Behaviour Change Communication (BCC):

10. Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya
11. Strengthening Maternal and Newborn Care Services in Bangladesh

 
Support Resources:

12. Comprehensive Postpartum Family Planning Care Training

 

Upcoming Meetings:

13. XXVI IUSSP International Population Conference
14. International Conference on Family Planning: Research and Best Practices

 

 

 

MALARIA

 

 

MALARIA: PROGRAMMING RESOURCES

 

1. Malaria Supplies Useless Unless Combined with Appropriate Communication

 

This report, "Delivering Malaria Control to Those in Need: How to Succeed in a Time of Renewed Hope" from the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG), explores issues related to the proper delivery of existing tools for malaria control and treatment. According to this report, in many areas, malaria is as much of a problem as it ever was, and in areas associated with conflict, malaria can often increase, as control mechanisms break down. In these areas, "[t]he millions of deaths annually are largely due to failure of delivery of these tools to those who need them, particularly the poorest, and especially children." Thus, the argument here is that, although excellent tools like drugs and ITNs exist, they will be of limited effectiveness if they do not reach the right people, in the right ways.

 

To understand how to enhance delivery, APPMG looks at the multiple ways in which effectiveness can be reduced, proposing strategies to resolve these challenges. Some of the approaches explored in the report are communication-centred. For example, when it comes to ensuring coverage with anti-vector methods, APPMG observes that children and their parents may not have information about how to maximise the effectiveness, and therefore use ITNs at the wrong time of day (e.g., to ward off flies, not mosquitoes), or do not use them in the peak malaria season because they feel too hot.

 

The report extends 3 behaviour change-related key recommendations:

  • Link methods of delivering ITNs through the public and private sector to interventions to promote use and retention.
  • Base decisions on evidence of what works, not on ideology, when deciding how the public sector, civil society, and the private sector can help improve delivery of treatment.
  • Combine interventions as packages tailored to particular settings, since the reasons for failure of delivery of existing tools are complex and context-specific.

 

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2. Research on Use/Non-Use of Bednets

 

This August 2008 report, "Ethiopia Bednet Utilization Study: Why Some Nets Owned Are Not Used" describes a study carried out to determine levels of ownership and use of insecticide-treated nets (ITNs) in households in the Oromia and Amhara Regions of Ethiopia. Although nightly use is optimal, sometimes people use their nets sporadically or do not use them at all. To understand why, and to develop effective communication for optimal net use and public health impact, this research was carried out by NetMark, a project at the Academy for Educational Development (AED) funded by the United States Agency for International Development (USAID).

 

The study used both quantitative and qualitative methods. The survey instrument included close ended pre-coded questions as well as 4 open-ended questions. The study also included observation of nets in homes, in addition to market visits in three towns in order to assess commercial availability of nets, current prices, and leakage. The data were collected during October 2007, at the end of the rainy season when mosquito density and malaria transmission is high. In February 2008, rapid follow-up qualitative visits were made in selected kebeles (urban dwellers' associations) in the same three areas, enabling a seasonal comparison of net use.

 

After obtaining information on nets owned and usage patterns (all reported in the study), interviewers explored reasons for inconsistent or non-use of nets.

 

Responses pointed to the following:

  • Perception that malaria is not a problem
  • Perception - and possibly reality - that ITNs have lost their effectiveness
  • Difficulty hanging nets in Ethiopian dwellings
  • Nets in poor condition
  • Misinformation and lack of information
  • Saving nets for the future
  • Nets being used for other purposes.

"It is imperative that a standard set of straightforward priority messages be developed to be delivered along with the nets...[N]ow that all free nets are LLINs, standard information can be given during distribution. Messages regarding [insecticide] treatment, specifically how long the treatment lasts, are key, along with a statement about maximum washing frequency. Accurate information about potential danger of ITNs should be conveyed in a way that does not cause alarm and rejection of ITNs for vulnerable groups. Community members also need to know how to hang the net properly....In addition to verbal communication during distribution, tested flyers or posters with key messages should be available as back-up reference. It is also important to communicate that as many family members as possible should sleep under a net and that the net should be used year-round. Along with factual information, families need motivation to go to the trouble of using nets, especially in areas where there are few mosquitoes. Our objective is to get people to use nets for malaria protection, but communication strategies should use messages that resonate and are likely to change behavior by drawing on other benefits people like, such as being able to sleep peacefully, nets killing other insects besides mosquitoes, or families saving money by having to buy fewer medicines or make fewer trips to the health center. It is also essential that information be received from a variety of channels..."

 

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3. Malaria in Pregnancy Resource Package

 

This online resource package is designed for policy makers, public health professionals, and managers who are implementing, scaling up, or updating programmes designed to reduce malaria in pregnancy and provide effective treatment for pregnant women with malaria. The resource package includes training resources, programming resources, and reference materials, all free to download and intended to be easily adapted to a specific country's public health context.

 

The package contains the following sections.

  • Training Resources - materials and guides for a two-day workshop to train health care workers to prevent, recognise, and treat malaria in pregnancy. Includes a multimedia tutorial that discusses the impact of malaria on pregnant women and newborns and other important issues concerning the prevention and control of malaria in pregnancy, as well as an orientation package that aims to rapidly disseminate new information in a technical area, such as national policy guidelines, to front-line providers through concise, user-friendly materials.
  • Programme Resources - a programme implementation guide intended to help African countries implement and scale up programmes to prevent and treat malaria in pregnancy, communication strategy and information materials, and job aids that serve to improve communication between healthcare providers and clients about malaria in pregnancy.
  • Reference Materials - information about the Malaria In Pregnancy (MIP) Strategic Framework, MIP monitoring and evaluation guidelines, information sheets, the WHO Technical Consultation Report on intermittent preventative treatment, and a collection of abstracts from key articles on MIP.

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4. Malaria: Integrated Campaigns Toolkit

 

Published in September 2008 by the Alliance for Malaria Prevention (AMP) based on experience integrating LLIN campaigns with vaccination/nutrition campaigns for children under age five as primary platforms, this toolkit provides numerous lessons that can be applied across the goals of universal ITN coverage. With 7 key chapters, "A Toolkit for Developing Integrated Campaigns to Encourage the Distribution and Use of Long Lasting Insecticide-treated Nets (LLINs)" takes organisations through the process of planning and implementing campaigns around ITNs. It covers planning; coordination; budgets and fundraising; logistics; communication; the technical aspects of campaigning; and sustaining campaign results. It also includes examples of chronograms and a sample timeline, as well as a list of resources. The toolkit comes with a CD-ROM containing the documents referenced in the resource list.

 

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5. Malaria: BCC/IEC Programming Q&A

 

"Q&A for Managers of President's Malaria Initiative (PMI) BCC/IEC Programs" explains the difference between managing a procurement programme and managing to change opinion, attitudes, and behaviour on use of recommended malaria preventions, such as: insecticide-treated nets (ITNs); artemisinin-containing combination therapies (ACTs); or intermittent preventive treatment (IPTp) for all pregnant women. The sheet was created by the PMI in March 2009 to give support to those managing behaviour change communication (BCC) and information, education, and communication (IEC) programmes.

 

Topics include:
i. What should I require BCC/IEC programmes to achieve at start up, expansion, and full-scale implementation? (This answer includes a "Checklist for One Year")

ii. Technical questions

iii. Programme implementation questions

iv. Monitoring and evaluation questions

v. Costs and budgeting questions

 

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6. PMI Communication and Social Mobilization Guidelines

 

From the President's Malaria Initiative (PMI), the purpose of the "PMI Communication and Social Mobilization Guidelines" is to assist in the development, implementation, and monitoring and evaluation of programmes to influence behaviours around malaria interventions including the following: correct and consistent use of insecticide-treated nets (ITNs); acceptance of indoor residual spraying (IRS); and adherence to treatment and prevention therapies, including intermittent preventive treatment in pregnancy (IPTp) during pregnancy and treatment with artemisinin-combined therapy (ACT) for children under five within 24 hours of onset of symptoms. Published in January 2008, the guidelines intend to increase demand for malaria services and products, as well as community involvement in malaria control.

 

These guidelines are structured as a planning framework. They explain how to establish goals and objectives, review existing data and conduct a rapid assessment, develop a strategy with a budgeted plan of activities, and monitor and evaluate the process." The cycle diagrammed in the document begins with planning and strategy development, continues with selecting interventions, the programme implementation; and, finally, a rapid monitoring and evaluation process.

 

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MALARIA: RESOURCES FOR JOURNALISTS

 

7. Journalist Orientation Session: Effective Communication Is Vital for the Elimination of Malaria

 

Because of the lack of information among the Cameroonian general public, the Global Malaria Action Plan (GMAP) indicated the necessity of an effective communication programme for the eradication of malaria. In response, the Cameroon Coalition Against Malaria (CCAM), in collaboration with the National Malaria Control Programme (NMCP) and the United Nations Information Centre (UNIC), organised an orientation session for journalists at the CCAM Courtyard in the Bastos neighbourhood in Yaounde, Cameroon, December 17 2008. "Effective Communication Is Vital For the Elimination of Malaria" reports on that event.

 

CCAM brought journalists together with manager of CCAM, Dr. Esther Talla, and the Drive Against Malaria members, David Robertson and Julia Samuel. Robertson and Small explained that many people are not informed about the disease, making it difficult for it to be stamped out, and expressed regret that, although malaria is the highest killer in Cameroon, the prices of malaria medicines are relatively high, making it difficult for the economically poor to purchase these drugs for treatment. According to this report, these presenters contributed to the power of their message by describing their work within Drive Against Malaria, which is bringing attention to malaria as a preventable and treatable disease and is raising money to fight malaria in Africa. Robertson began driving across Europe in 1998 as a one-man mission and now, with Julia Samuel, drives to remote villages in Africa to distribute mosquito nets and information to fight malaria.

 

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8. African Media and Malaria Research Network (AMMREN)

 

Launched in 2006, the African Media and Malaria Research Network (AMMREN) promotes malaria research communication in Africa by strengthening the capacity of African journalists through training. The network also focuses on disseminating information on malaria control initiatives and monitors and advocates for the implementation of malaria policies in Africa. It also advocates and engages policy makers to implement international agreements on malaria control.

 

To support their key activities of information sharing, networking, advocacy, and training and capacity building, AMMREN produces the "Eyes on Malaria" news magazine. This is a 32-page magazine, available in English, French, and Portuguese, which is published bi-annually in hard copy and on the Internet. The magazine seeks to bring to the fore issues related to malaria, including research findings, policy directions, and general issues around prevention and treatment. The magazine also captures events and happenings in the international arena related to the disease.

 

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FAMILY PLANNING/MATERNAL HEALTH

 

 

FP/MH: SOCIAL CHANGE COMMUNICATION

 

9. Recommendations for Community-Based Postpartum Care Services

 

From October 2008, this report, entitled "Community-Based Postpartum Care Services in MotherNewBorNet Member Programs" compiles results from a survey conducted to identify, document, and share information on the status of community-based (CB) postpartum care (PPC) and postpartum family planning (PPFP) services implemented by MotherNewBorNet (MNBN) member organisations in the Asia Near East (ANE) region. MNBN is a network established in 2005 to improve maternal and neonatal health at the community level.

 

In the summer of 2007, USAID's Extending Service Delivery (ESD) Project sent a structured questionnaire electronically to 50 individuals representing member projects and organisations within MNBN, of which 28 responded. The questionnaire covered the following topics: project background, provision of PPC services, newborn care, best and promising practices, challenges faced, monitoring and evaluation (M&E), recommendations for improvement, and lessons learned.

 

Selected findings include:

  • In areas where participating projects are working, 70% of births took place in the home. Only 10% were reported to be assisted by skilled birth attendants, and 37% were assisted by traditional birth attendants (TBAs).
  • The majority of projects are actively mobilising different categories of community-based health workers (CHWs) to identify women in the community for PPC services.
  • According to ESD, 3 common models of CB PPC exist in the field: 1) home visits by professional health care providers; 2) home visits by CHWs with little or no referral provided (primarily used for newborn care home visit programmes rather than maternal health programmes); and 3) home visits by CHWs with referral or health facility support. When asked about the model that best described their PPC services, the majority (18/19) cited model 3.
  • The majority of respondents reported that their service providers have been trained in delivery of PPC. Among those whose providers received such training, the majority reported that PPFP was included as part of that training. According to ESD, "[i]t is important that all service providers are trained in provision of postpartum care, i.e., all elements of PPC similar to training service providers in essential components of focused [antenatal care, or] ANC and newborn care...PPFP counseling should be an essential element of PPC training."
  • As reported by survey participants, effective practices include: presence of referral mechanisms, home visits, community care starting from ANC, establishing community support systems, and focusing on activities valued by the family.
  • The top 3 reasons for not providing FP counselling were: FP is not considered a priority by the woman/family; focus is on the newborn in the postpartum period; and CHWs have not been trained in FP counselling.

Based on survey findings, select prioritised strategic recommendations are as follows:

  • Increase service providers' knowledge and skills related to essential PPC services that must be provided at a minimum, including timing and frequency of postpartum visits and PPFP. To that end, a consensus needs to be reached among international organisations and postpartum advocates for a prototype "essential integrated PPC minimum package" (similar to the essential newborn care package and focused ANC package).
  • Improve community support for PPC by strengthening social mobilisation and community involvement activities to increase community/families' awareness, demand, and use of PPC - particularly in areas where PPC is "not considered a priority by the family," and PPC is "not considered a community norm."

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FP/MH: BEHAVIOUR CHANGE COMMUNICATION

 

10. Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya

 

This June 2008 report describes and assesses an initiative to develop and introduce a strengthened postnatal care (PNC) package into one hospital and 4 health centres in Embu district, Eastern Province, Kenya. Two United States Agency for International Development (USAID)-funded projects - the Population Council's FRONTIERS project and Jhpiego's ACCESS–FP project - formed a partnership to support Kenya's Department of Reproductive Health (DRH) in its efforts to document the feasibility, acceptability, and quality of care of the endeavour to increase both the recommended timing and content of postnatal services a women and her infant should receive to at least 3 assessments within the first 6 weeks after childbirth. This orientation package, which was introduced and evaluated between 2006 and 2008, also provided opportunities to deliver appropriate family planning (FP) advice and methods at several points in time.

 

As detailed within the report, the PNC-FP package incorporated relevant maternal and newborn health care services in the postnatal period with a specific focus on postpartum FP. Job aids were also produced. The 3-day orientation training included staff from the participating health facilities, as well as provincial and district reproductive health (RH) trainers/supervisors.

 

The study used a pre-post intervention design. For the quality of care assessment, data were collected through interviews with health care providers, structured observations of client–provider interactions during the postnatal consultations and a facility inventory. Postpartum women were recruited and interviewed following childbirth on the postnatal ward in Embu Provincial General Hospital and interviewed again in their community after 6 months.

 

Selected key findings included:

  • Comparisons of the quality of care provided at 6 weeks between the pre- and post-intervention groups found that, overall, the total score tripled.
  • Comparisons of the quality of fertility and FP counselling during the 6-week consultations found that the intervention "led to dramatic improvements in all of the indicators, with over two thirds of women being advised about return to fertility and at least two methods, and over 80 percent of women being asked about and receiving their preferred method."
  • Most women interviewed on the postnatal ward within 48 hours said that they intended to use FP during the subsequent 12 months; significantly more women made this statement after than before the intervention (84% vs. 68%). Also, significantly more women were observed accepting an FP method during the 6-week consultation after the intervention (specifically, the intrauterine device (IUD) and the lactational amenorrhoea method, or LAM).
  • Although there was no difference in overall use of FP between the 2 groups at 6 months, there were significant differences in the timing of starting to use an FP method: Before the intervention, only 6% of women had started using FP by 2 months, whereas this had increased to 62% of women in the post-intervention group.

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11. Strengthening Maternal and Newborn Care Services in Bangladesh

 

Through the Strengthening Maternal and Newborn Care Services project, the ACCESS programme is working to increase the practice of healthy maternal and neonatal behaviours at the household level in 7 upazillas (sub-districts) in Bangladesh. Community mobilisation and policy and advocacy activities to strengthen maternal and newborn health care services are designed to support this BCC effort.

 

This project draws on one of the key lessons learned from the community-based newborn care study project called "Projahnmo": interpersonal communication (IPC) in or near the household is considered the most effective means for behaviour change. Supported by USAID and the Saving Newborn Lives (SNL) initiative, Projahnmo was originally carried out in 3 upazilas; here, ACCESS has scaled up the project by extending it into additional areas within the district.

 

As with the Projahnmo initiative, ACCESS is carrying out IPC with the specific goal of involving the entire range of important decision-makers in the lives of pregnant women. To this end, community-based interventions are tailored to reach people at multiple levels - community, family, and individual. At the community level, resident community mobilisers (CMs) conduct group meetings with both men (husbands of pregnant women and heads of households) and women (pregnant and senior family members). These meetings are held at clusters of households or at locations in the community (shops, mosques, etc.). During the group meetings, CMs share information about maternal and newborn health; they also facilitate role-plays around improved practices.

 

Another key focus is negotiation at the home level to identify specific household barriers to maternal and neonatal health, and to arrive at viable solutions. Group-based meetings are supplemented by one-on-one counselling with pregnant women and their families. Resident literate women were trained as community health workers (CHWs). During the visits in pregnancy, CHWs emphasise BCC messages, encourage women to seek antenatal care at the health centre or satellite clinic, and negotiate maternal and newborn care practices with the family. During the postpartum visits, the CHWs assess the health of mother and baby and encourage use of postpartum care. During inclement weather such as floods, the counsellors travel to homes by boat.

 

For lessons learned from the original project on which this current ACCESS project was built, please see "Projahnmo I Sub-study: Maternal Behaviors and Morbidity during Pregnancy, Delivery, and the Early Postpartum Period in Rural Bangladesh - Final Report".

 

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FP/MH: SUPPORT RESOURCES

 

12. Comprehensive Postpartum Family Planning Care Training

 

These resources, available online, are part of a four-volume workshop package from ACCESS-FP on "Comprehensive Postpartum Family Planning Care." The training package addresses the need for family planning during the extended postpartum period and provides information for a three-day training designed with components for participants and trainers, as well as a set of presentations and presentation notes.

 

The package contains counselling checklists, role plays, and case studies for interactive training sessions. These sessions give providers the necessary information to provide clients with an understanding of the lactational amenorrhea method (LAM), transition to other family planning/control of conception methods, counselling for the period of the woman's return to fertility, and the health benefits of waiting at least two years after the birth of their last baby before trying to conceive again.

 

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UPCOMING MEETINGS

 

13. XXVI IUSSP International Population Conference
Marrakech, Morocco
September 27 - October 2 2009

 

This will be the first IUSSP International Population Conference to be held on the African continent and in an Arab country. The Conference will include over 180 regular scientific sessions, poster sessions, and training sessions, as well as plenary and debate sessions, side meetings and exhibitions. Simultaneous translation in French and English will be provided for all plenary, debate, regular and training sessions. In addition, simultaneous translation in Arabic will be provided for all plenary and debate sessions and all sessions organised by the Moroccan NOC on population issues in the Arab world.

 

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14. International Conference on Family Planning: Research and Best Practices
Kampala, Uganda
November 15-18 2009

 

While an extensive base of research on and experience with family planning programmes has accumulated over the past forty years, its recent volume is much lower. The economic impact of reproductive change, such as on poverty or national savings with shifting dependency burdens, needs updating with emerging data. Likewise, full potential of contraceptive practice in preventing unsafe and unnecessary abortions, maternal and neonatal deaths, or the transmission of HIV to newborns warrants more complete study. This international forum for scientific and programmatic exchange will enable the sharing of available findings and identification of knowledge gaps, as well as using new knowledge to transform development policy. The individual abstract submission deadline is June 1 2009, and the preformed panel submission deadline is June 15 2009. Participant registration will be available June 15 2009. More information is available on the conference website.

 

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Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Change Picks - Focus on Multiple Concurrent Partnerships (MCP)

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Date: 
April 2, 2009

C-Change Picks #5 - Focus on Multiple Concurrent Partnerships (MCP)
Information about Social and Behaviour Change Communication, sponsored by C-Change
April 2 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme

 

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C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

Issue 5 of C-Change Picks examines multiple concurrent partnerships (MCP) as a social norm in Southern Africa and its impact on HIV prevalence in the region. The issue highlights regional and local perceptions and knowledge related to the practice, existing initiatives that are addressing the attitudes and behaviours related to the practice, and evaluation of the impact of recent initiatives on changing behaviours among both men and women. Also included is a handbook for journalists on culture, HIV and AIDS, and MCP reporting.

 

Reducing multiple concurrent partners is a focus of HIV prevention programmes under the C-Change programme. In Namibia, C-Change is working on a behaviour change communication (BCC) strategy to reduce MCP as part of the country’s national MCP campaign. C-Change is working closely with the Centers for Disease Control and Prevention (CDC) and the members of the National Prevention Working Group’s Take Control Task Force (part of the Ministry of Information and Communications Technology), which includes the United Nations Children’s Fund (UNICEF), Desert Soul, and Nawa Life Trust, to ensure the MCP strategy is integrated into the National Prevention Strategy and is coordinated with other key national campaigns such as male circumcision and alcohol. C Change is providing technical support to these related campaigns, and identifying interpersonal communication (IPC) materials for the training of volunteers, groups, and individuals, along with key implementing partners. Specifically, C-Change is assisting PACT and its implementing civil society and private sector partners in developing BCC strategies for community and workplace programmes on MCP and the related practices of transactional and cross-generational sex.

 

The 2008 UNAIDS Modes of Transmission Study [PDF] estimates that 65% of all new infections in Lesotho over the next 12 months will come through “casual sex.” In response, C-Change is working with the Soul City Institute and local partner Phela to expand and deepen the OneLove campaign to reduce MCP in Lesotho by increasing the mass media component and by working with community organisations to increase dialogue about healthy relationships. C-Change is funding a call-in radio programme where experts discuss relationships, intimacy, and MCP. The March 23 PBS Lehrer Report highlighted the OneLove campaign, developed by Soul City, which features radio and TV dramas and billboards in nine countries in the Southern Africa region. Soul City Institute is both a C-Change and Communication Initiative partner and has been using the edutainment approach to address development issues in Southern Africa since 1994.

 

With CARE Lesotho, C-Change has developed a community discussion guide on relationships, communication, and risks of MCP. C-Change is training facilitators to use the guide to encourage discussions. Activities related to MCP are also beginning in Swaziland.

 

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Please visit the C-Change Picks website...

...for more resources and thinking recently highlighted by the C-Change project.

 

For the archived issues of C-Change Picks, please click here.

 

C-Change Picks continues to seek new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

~

 

In this Issue...

 

A Focus on Multiple and Concurrent Partnerships (MCP) in Southern Africa

 

1. Know Your Epidemic, Know Your Response
2. MCP: A Coordinated Regional Response is Key
3. Knowledge, Attitudes, and Practices of MCP in 10 Countries in Southern Africa
4. Reduced Partnerships and Increased Condom Use Led to the Decline of HIV in Uganda
5. Need to Re-Focus on MCP in Uganda
6. Addressing MCP in an Urban, Informal Community in South Africa
7. Findings on MCP in Botswana
8. Evaluation of a Radio and Billboard MCP Campaign in Botswana
9. MCP and Condom Use in Zimbabwe
10. MCP and "Small Houses" in Zimbabwe
11. MCP Handbook for Journalists
12. Two Recent Issues of The Soul Beat on MCP

 

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ADDRESSING MULTIPLE AND CONCURRENT PARTNERSHIPS (MCP) in SOUTHERN AFRICA

 

1. Know Your Epidemic, Know Your Response

 

Published as a "Comment" about HIV prevention in The Lancet and presented at the August 2008 International AIDS Conference, "'Know Your Epidemic, Know Your Response': A Useful Approach, If We Get It Right" expands upon the "rallying cry" that the era of standard global prevention is over. The authors discuss the state of global HIV and AIDS as not a single epidemic, but a multitude of diverse epidemics. They distinguish between "concentrated and generalised epidemics, which are fundamentally different - not because of arbitrary prevalence thresholds, but about who gets infected and how." “Concentration” is described as transmission among defined vulnerable groups, such as sex workers or injecting drug users. Transmission among the general population that would persist, resulting from sustained sexual behaviours, despite effective programmes with vulnerable groups, is considered a “generalised” epidemic.

 

Since, as stated here, partner reduction is found to reduce transmission in generalised epidemics, the authors find that "we know too little about how to effectively promote partner reduction. But this is no excuse not to immediately increase our commitment to well-evaluated programmes aimed at reducing multiple and concurrent sexual partnerships. Lessons learned from the successes in reducing population-level HIV prevalence in countries such as Uganda may prove useful for prevention programming. It seems that the Ugandan response stimulated personalisation of risk in a way that fostered community mobilisation for behaviour change, without increasing stigma. Second, the intensive use of a coordinated multilevel approach, involving clear and consistent risk-avoidance messaging at all levels, assisted in changing societal norms of behaviour. And third, it seems that focusing such efforts for risk avoidance and partner reduction on adult men was key to reducing the sexual networks that fuel HIV transmission in high prevalence countries."

 

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2. MCP: A Coordinated Regional Response is Key

 

The UNAIDS Regional Support Team for Eastern and Southern Africa and the Soul City Institute held a meeting, attended by HIV prevention communications practitioners from Eastern and Southern Africa, in September 2008 to explore and share experiences and help shape future plans for HIV prevention communication in the region. Against the backdrop of HIV communication initiatives increasingly focussing on addressing the impact of MCP on HIV incidence, the meeting built on the SADC Regional Consultation: Social Change Communication for HIV Prevention that took place in Swaziland in October 2006. Participants discussed and reviewed experiences and evidence on MCP social change communications and campaigns in order to amplify efforts through greater collaboration and consistency of messaging. They also made proposals on how to promote a coordinated response in order to reduce new infections over the next two years, with a particular emphasis on the hyper-endemic countries of Southern Africa.

 

Overall recommendations within this report "Multiple Concurrent Partnerships: Campaigns and Communications: Towards a Coordinated Regional Response" include:

  • Commit to the further development of an active community of practice for HIV prevention communication in Southern Africa. UNAIDS emerged with a clear leadership role working in partnership with Soul City, Soul Beat, AIDSPortal and SAFAIDS to further define how a regional 'community of practice' will grow and develop.
  • Plan a follow-up meeting for March or April 2009.
  • Work on MCP must not be separated from the broader package of combination prevention efforts.
  • Messaging should be clear and bold, not seek to prescribe an "answer" to MCP or to "try and do it all" - rather, MCP communication needs to acknowledge that the best solutions will emanate from the individual and community levels.

 

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3. Knowledge, Attitudes, and Practices of MCP in 10 Countries in Southern Africa

 

Designed to inform the development of an HIV prevention campaign by the Soul City Regional Programme (SCRP), "OneLove: Multiple and Concurrent Sexual Partnerships in Southern Africa - A Ten Country Research Report" aimed to gain insight into the audience’s understanding, attitudes, and practices around sexual relationships in the context of HIV prevention. Published in August 2008, the research was conducted in each of the 10 countries which were to form part of the Soul City Regional Programme: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe (Botswana decided against being part of the regional campaign and opted to launch an independent campaign). Overall research findings reveal common reasons for multiple concurrent partnerships (MCP) among people in the 10 countries of this study. Most of these reasons are driven by gender inequality and cultural and social norms that create a context for MCP. Transactional sex and alcohol also play an important role.

 

Meta-analysis of the country results showed marked consistency between all 10 countries in terms of perceptions, attitudes, and practices around sexual relationships across gender and age. However, in certain countries some issues were more pronounced than others, and there were some differences in how respondents presented the issues. The research identified several different forms of MCP, including: steady partner and other 'side' partners; intergenerational sexual relationships; transactional sexual relationships; and polygamy. Participants also reported a range of reasons for their involvement in MCP, including: dissatisfaction in relationships; culture and social norms; money and material possessions; and use of alcohol.

 

Based on the findings detailed within the report, recommendations include:

  • There is a need to communicate messages to reinforce the knowledge of the risks associated with MCP.
  • There is a need for sexuality education which includes ways to talk about sex with a partner without fear of negative consequences. Communication needs to promote the idea that a lifelong relationship can be happy and fulfilling.
  • Gender inequalities that reinforce female subservience and male dominance need to be addressed.
  • Cultural norms that both support the idea that it is 'natural' for men to participate in MCP and advocate that women should not even talk about sex need to be challenged.
  • Consistent and correct condom use should be encouraged.

 

For specific audience research for the final 9 “OneLove” countries please see:

Multiple and Concurrent Partnerships in Lesotho

Multiple and Concurrent Partnerships in Malawi

Multiple and Concurrent Partnerships in Mozambique

Multiple and Concurrent Partnerships in Namibia

Multiple and Concurrent Partnerships in South Africa

Multiple and Concurrent Partnerships in Swaziland

Multiple and Concurrent Partnerships in Tanzania

Multiple and Concurrent Partnerships in Zambia

Multiple and Concurrent Partnerships in Zimbabwe

 

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4. Reduced Partnerships and Increased Condom Use Led to the Decline of HIV in Uganda

 

This January 2008 paper works to identify the changes in sexual behaviour that led to an observed dramatic reduction in the prevalence of HIV in Uganda in the early 1990s. Rather than present the evidence from one scientific method, "Changes in Sexual Behaviour Leading to the Decline in the Prevalence of HIV in Uganda: Confirmation from Multiple Sources of Evidence" reviews seven kinds of evidence and examines the consistency among them; they include: models of HIV prevalence and incidence in Kampala and other sentinel sites in Uganda; reports of behaviour change in the primary newspaper in Uganda; surveys with questions about perceptions of personal behaviour change; large demographic and health surveys (DHS) collected in 1988/9 and 1995 and large Global Program on AIDS (GPA) surveys in 1989 and 1995 with questions about reported sexual behaviour; smaller less representative surveys of reported sexual behaviour collected in other years; reports of numbers of condoms shipped to Uganda; and historical documents describing the implementation of HIV prevention programmes in Uganda.

 

All seven types of data produced consistent evidence that people in Uganda first reduced their number of sexual partners prior to or outside of long-term marital or cohabiting relationships, and then increased their use of condoms with non-marital and non-cohabiting partners. "Modelling of the relationship between number of sexual partners and the size of sexual networks demonstrates that, in general, even small decreases in the mean number of sexual partners can sometimes markedly reduce the size of sexual networks. The reductions in numbers of sexual partners in Uganda demonstrated by multiple kinds of data certainly had the potential to break up these sexual networks and thereby reduce the transmission of HIV. The greater use of condoms in the remaining smaller sexual networks further reduced HIV transmission. Then, according to multiple sources, the incidence and prevalence of HIV declined dramatically. These findings are consistent with other analyses of declines in HIV prevalence in other generalised epidemics in sub-Saharan Africa (eg, in Kenya and Zimbabwe), which suggest that giving a strong emphasis to partner reduction while also encouraging condom use (and abstinence) is much more effective than primarily promoting condom use (or abstinence)."

 

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5. Need to Re-Focus on MCP in Uganda

 

"Battling Old Behaviour the New Front in AIDS Fight" looks at the impact of multiple concurrent partners through the history of the HIV pandemic in Uganda, and examines a new campaign initiated by Population Services International (PSI) that aims to discourage the "Sugar Daddy" phenomenon. The article, published in August 2008, argues that a new resurgence in HIV infection in Uganda has been spurred on by an increase in multiple concurrent partnerships (MCP). Although campaigns discouraging the practice in the 1980s led to a decline in HIV prevalence, recent campaigns have shifted the focus to other aspects of prevention, which has led to a new generation that is largely unaware of the risks associated with multiple concurrent partners.

 

A look at President Yoweri Museveni's "love carefully" and "zero-grazing" campaigns from the 1980s reveals that the message was blunt - be faithful because AIDS kills. A World Health Organization study showed more than a 50% reduction in number of people reporting multiple and casual partners between 1989 and 1995. The number of Ugandan men reporting three or more non-marital sexual partners fell from 15% to 3% during the same period. The article points out that today's teenage girls weren't even born during president Museveni's aggressive "zero-grazing" campaign in 1980s that instilled fear into men and women about their personal risks of getting infected by sleeping with multiple partners.

 

A PSI survey found that more than 16% of young women who attend university today have had multiple sexual partners in the past 12 months, many in concurrent relationships with Sugar Daddies and boyfriends. About 36% think such relationships are normal. According to the article, at night, expensive cars stream into university parking lots near the girls' dormitories where Sugar Daddies meet their girlfriends or take them out on dates.

 

PSI’s new campaign involves churches, who use the pulpit to preach against cross-generational sex. Priests and ministers encourage families to talk to their children about the taboo subject of sex and the risks of such relationships. National figures like First Lady Janet Museveni and the Queen of Buganda are also participating. "Go Getter" clubs at universities were created to teach girls life and work skills to foster "self-esteem and empowerment" so they rely on themselves, "not a rich Sugar Daddy."

 

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6. Addressing MCP in an Urban, Informal Community in South Africa

 

This April 2008 study set out to develop a robust surveillance system to measure key risk behaviours and HIV prevalence among adult men who have multiple, concurrent female sexual partners, and who live in an urban, informal community on the outskirts of Cape Town. According to this study, men with more than one, usually younger, female, sexual partners make up a hard-to-reach, high-risk sub-population. This is largely due to them not being captured through conventional HIV surveillance methods. For the study, called Project ooPeto (buddies), men were recruited using the Respondent Driven Sampling (RDS) method, which, as stated in the document, has been extensively and successfully used globally among other hard-to-reach populations (such as injecting drug users, men who have sex with men, and commercial sex workers).

 

Findings within the report, entitled "Sexual Risk Behaviour Among Men with Multiple, Concurrent Female Sexual Partners in an Informal Settlement on the Outskirts of Cape Town," included:

  • HIV prevalence was 12.3%.
  • 98% reported having concurrent sexual relationships 3 months prior to the survey.
  • Most men (83.3%) indicated that their friends would approve if they had sex with women who were not their steady partners or wives and 86.1% indicated that their friends could approve if they changed girlfriends often.
  • 46% of participants thought that their main partners had sex with them because they expected or had received some form of material goods; 82% thought this was the case for their casual partners; and 90.6% thought it of their once-off partners.
  • Shebeens or taverns were most commonly cited as places where men met with friends for recreation (31.2% and 54.4% respectively). Most men (81.8%) reported drinking more than five beers, ciders, or tots of alcohol during these visits. About 74% indicated that they had met a new sexual partner at shebeens or taverns over the past 30 days.
  • 95% of participants indicated that they would attend meetings if they were given the opportunity to talk about relationships and sexual behaviour with a male facilitator once a week (for 10 weeks) with a group of other men.

 

The study recommends that this high-risk group would benefit from specifically-targeted HIV prevention interventions which address partner concurrency, inconsistent condom use, excessive alcohol consumption, and intimate partner violence. It states that individually-targeted and small, peer group interventions aiming to support self-defined behavioural change and shift social norms may be appropriate for this population. Because these men were willing to participate in sexual health programmes, RDS may be employed as a valid entry point into this high-risk sub-population for planning, designing, implementing and evaluating targeted HIV preventive methods.

 

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7. Findings on MCP in Botswana

 

This report, published by PSI Botswana in December 2007, documents the findings of a national tracking survey of youth and adults aged 15-34. The objectives of the study, entitled "Multiple Concurrent Partnerships Among Men and Women aged 15-34 in Botswana," were to compare responses to different ways of asking about MCP; identify characteristics of MCP; and identify behavioural drivers or barriers to MCP at the individual level. Based on interviews with 1,787 youth and adults from districts across the country, the study found that approximately one quarter of the population in Botswana report being engaged in MCP. Men are more likely than women to be involved in MCP, and knowledge about the potential risks of these kinds of relationships is low. Drivers of MCP are different for men and women and include beliefs, attitudes, self efficacy, and alcohol use.

 

The study also offers key recommendations for MCP interventions. According to the research, there is a clear need for MCP interventions to first prioritise addressing the gap in knowledge and risk perception that exists in relation to concurrent partnerships. For example, increasing the proportion of sexually active people aged 15-34 who identify concurrent or overlapping relationships as more risky than monogamous, spaced relationships is essential. Thereafter, the study recommends adopting different messages for men and women, and focusing on social mobilisation around alcohol use and abuse.

 

According to the study, addressing deeper-seated determinants of MCP, such as peer expectations of monogamy, attitudes to sex, love, and commitment or women's lack of ability to decide on sex within relationships will be much more challenging and require more time and resources than addressing knowledge, risk, perception and the associated cost/benefit analyses of MCP. In addition, MCP interventions will not happen in isolation but in the context of other prevention activities, including condom promotion. It is essential that condom promotion is mindful of overall HIV prevention objectives and does not promote condoms as an alternative to partner reduction.

 

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8. Evaluation of a Radio and Billboard MCP Campaign in Botswana

 

This is a September 2008 evaluation of a mass media campaign implemented by PSI Botswana earlier in 2008. According to organisers, the campaign was integrated into community-based inter-personal communication projects in addition to mass media channels. The main messages focused on challenging norms about MCP and HIV risk by using common sayings and pointing out the risks inherent in the behaviours the sayings help to normalise or legitimise. Although the evaluation found that the campaign did not generally teach people anything new, it did cause many people to think differently about how their own behaviour and that of their partner can increase their HIV risk.

 

The reaction to the HIV risk messages contained in the campaign was unanimously positive, indicating that the campaign tapped into points of conflict in the minds of the audience. The campaign succeeded in getting people to reflect on their own behaviour and HIV risk, as well as spark discussion around the issues, though most of the discussion occurred privately between friends and partners, as respondents generally felt uncomfortable discussing the topics in public. Although some men and women reported positive dialogue about the MCP and HIV with their partners, some women reported being afraid to discuss the issues and one woman reported having been beaten by her partner for questioning his comings and goings.

 

"Multiple Concurrent Partnerships Mass Media Campaign: Assessment of Reach, Recall and Effectiveness" concludes with several recommendations. These include expanding the campaign, using television, increasing coverage of billboards and radio airplay, and translating the messages into local languages. The evaluation notes that many respondents also spoke of the importance of combining media messages with facilitated discussions, and also suggested using roadshows and training unemployed youth as mobilisers.

 

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9. MCP and Condom Use in Zimbabwe

 

"Concurrent Heterosexual Partnerships, HIV Risk, and Related Determinants among the General Population in Zimbabwe," published by PSI Zimbabwe in February 2008, documents types of concurrent relationships and explores factors and contexts influencing the practice of engaging in such relationships among the general population. This two-phase study is a follow-up to a 2006 qualitative survey that sought to understand moderating demographic characteristics of concurrent sexual practices. The report suggests that while in the past, HIV prevention initiatives have focused on reducing the number of sexual partners, emerging findings point to the importance of acknowledging overlapping sexual networks or concurrent relationships. Most couples in these relationships eventually stop using condoms, thus increasing vulnerability to the entire sexual network.

 

Results from this study can be used to develop communication campaigns to promote the reduction of concurrent relationships as well as safer sexual practices within these relationships. The report provides key areas to address regarding condom use and the risks associated with unprotected sex. These include:

  • the practice of not using condoms within a short time after a relationship begins;
  • perceptions that young women and men (especially adolescents) are inexperienced sexually and thus low-risk;
  • the lack of condom use among men who keep "small-houses";
  • perceptions that divorced or separated women are low-risk, and the subsequent lack of condom use;
  • the need for money, other goods, and/or services that overrides people's, particularly women's, fears, and perceived vulnerability for contracting HIV; and
  • the fact that young men and women do not usually make the decisions regarding condom use, but acquiesce to the "authority" of the more dominant, older sexual partner.

 

The document also provides key recommendations for interventions that tackle the actual issue of concurrency, rather than just condom use for those practising concurrency:

  • Stimulate more open communications between partners regarding sexual preferences and the need for and possibility of enjoying a stimulating sex life together.
  • Men (and some women) perceive that they need to have sex on a frequent basis and thus seek other sexual opportunities when away from their regular partner. Suggesting alternative forms of recreation or safe ways to vent sexual frustration may represent one element of a communication campaign.
  • A variety of economic and employment factors influence the practice of concurrency. The media and peers add to pressure that result in young women and men exchanging sex to older partners in return for non-essential items such as cell phones or fashion accessories to enhance their status.
  • Corrupt practices and abuse of power practised by some people in authority, including teachers, policemen, magistrates and pastors, whereby sex is requested in exchange for favours such as good exam grades are exposing girls and women to risks for contracting HIV/AIDS.

 

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10. MCP and "Small Houses" in Zimbabwe

 

"Multiple Concurrent Partnerships: The Story of Zimbabwe - Are Small Houses a Key Driver?" looks at the phenomenon of "small houses" in Zimbabwe, and how they appear to be a key driver of the HIV epidemic. According to the author, a "small house" is essentially a longer-term sexual relationship between a married man and another, usually younger, woman. "Small houses" are viewed by Zimbabwean men as a safer alternative to casual sex, which they understand to be high risk, because they see women in "small houses" as being faithful to them. Because of this perception, they are unlikely to use condoms. However, the report states that mutual fidelity is very rare, and that there are many factors that lead women in "small houses", their married male partners, and the men's wives to be unfaithful.

 

Recommendations within this paper identify a few areas where behaviour change communication (BCC) activities can specifically be aimed, such as raising awareness of the risks associated with “small houses”, openly condemning the practice, increasing the use of condoms where concurrent relationships exist, and addressing cultural practices that put women at risk by engaging communities to identify and implement solutions.

 

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11. MCP Handbook for Journalists

 

A product of the Soul City Institute for Health and Development Communication’s OneLove Southern Africa Regional campaign, " Multiple and Concurrent Sexual Partners: What's Culture Got to do With It? A Handbook for Journalists" is designed for journalists as a tool to promote informed discussion around HIV and MCP. The handbook contains findings from research conducted in Southern Africa by Soul City that confirmed that certain cultural practices, social norms, and beliefs promote and even institutionalise MCP as socially acceptable and widely practised. This, in turn, was found to largely contribute to higher risks of HIV infection and prevalence.

 

The handbook goes on to discuss AIDS, MCP and culture, and reporting on HIV/AIDS and culture. It provides case studies of three different types of MCP - steady partner and other 'side' partners; intergenerational and transactional sexual relationships; and polygamy - and provides a number of resources for journalists, including suggestions for sources, websites, and additional reading.

 

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12. Two Recent Issues of The Soul Beat on MCP

 

The Soul Beat 125 – HIV Prevention: OneLove

 

The Soul Beat 119 – HIV Prevention: Multiple Concurrent Partnerships (MCP)

 

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

~

 

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Change Picks - Focus on Family Planning in Eurasia, HIV/AIDS, Malaria

No votes yet
Date: 
March 2, 2009

C-Change Picks #4 - Focus on Family Planning in Eurasia, HIV/AIDS, Malaria
Information about Social and Behaviour Change Communication, sponsored by C-Change
March 2 2009

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme

 

~

 

C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

Issue 4 of C-Change Picks provides a window into the status of family planning in the Eastern Europe and Eurasia (E&E) region, where C-Change has opened an office in Albania. Research shows that prior to the early 1990s, there was not a high value placed on health education, care seeking behaviours, or consumer demand. Under the Soviet system, each person was registered with a local clinic and received services free of charge. According to an assessment led by C-Change and commissioned by USAID, with health reforms currently emerging in many E&E countries, consumers are now able to participate in selecting providers and products. This active participation is working to empower consumers to make their own decisions about their health care and places the responsibility for health care with the individual and the family rather than the state. The C-Change final report, "Empowering Health Care Consumers in Europe and Eurasia" is a highlight of this issue.

 

C-Change Picks issue 4 also addresses developments in social and behaviour change communication in the areas of HIV prevention and malaria.

 

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The C-Change Picks website has been launched!

 

The C-Change Picks website focuses on actions and thinking for improving the effectiveness and sustainability of behaviour and social change communication. While not intended to be comprehensive, the materials available on this website will provide recent as well as time-tested information that may be of value to your work in behaviour and social change communication.

 

You will find this current edition of C-Change Picks online - click here!

 

For the archived issues of C-Change Picks, please click here.

 

C-Change Picks continues to seek new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

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In this Issue...

 

A Focus on Family Planning in Eurasia

1. Empowering Health Care Consumers in Europe and Eurasia
2. Introducing a Natural Family Planning Method in Albania
3. Maximizing Private Sector Contribution to Family Planning in the Europe and Eurasia Region
4. Eastern European and Eurasian Regional Family Planning Progress
5. Normalising Sexual and Reproductive Health Education in Uzbekistan
6. Supporting the Right to Family Planning and Safe Motherhood Information in Eurasia

 

A Focus on HIV/AIDS

7. Strategies for Addressing Cross-Generational Sex
8. HIV Prevention Among India's Long-Distance Truckers
9. Male Circumcision for HIV Prevention
10. UNAIDS Combination Prevention Briefs
11. HIV/AIDS Prevention Outreach Guides

 

A Focus on Malaria

12. Improving Community Health Worker Use of Malaria Rapid Diagnostic Tests in Zambia
13. Community Factors for Participatory Malaria Control
14. Improving Access to Malaria Treatment and Care in Rural Tanzania

 

Upcoming Meetings of interest

15. XXVI IUSSP International Population Conference

 

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FAMILY PLANNING – Focus on Eurasia

 

 

1. Empowering Health Care Consumers in Europe and Eurasia

 

The C-Change final report, "Empowering Health Care Consumers in Europe and Eurasia" explores experiences in Europe and Eurasia (E&E) with motivating health care consumers to take more responsibility for their health. In this region, it is not infectious diseases that are of growing concern but, rather, chronic (non-communicable) illnesses such as diabetes, cancer, and heart disease. These illnesses are frequently related to lifestyle choices such as alcohol, smoking, physical activity, and diet - choices that may be impacted by social norms, social networks, and social systems. The assessment focused on Kyrgyzstan, Albania, and Armenia, and consisted of 4 components: a literature review of the state of health promotion and primary health care; pre-assessment surveys and conference calls with USAID missions; country visits to conduct in-depth interviews and to visit active USAID-funded projects and health facilities in rural sites; and focus groups with health consumers in each country.

 

C-Change recommends working with governments to develop an overarching health promotion strategy that is based on behavioural research and the epidemiology of each country. Affecting behaviours related to chronic disease requires a long-term commitment to interventions that address the individual, the community, and decision-makers, as well as laws and policies related to high-risk behaviours. This strategy centres on a commitment to supporting individual behaviour change related to healthy lifestyles by creating an environment that reinforces the change through structures, programmes, and policies. Thus, multidimensional interventions are needed to initiate and sustain empowered health care consumers and more effectively address chronic diseases.

 

To facilitate this process, the document provides specific recommendations for each of the following areas: governments, health care providers and pharmacists, communities, the private sector, the media, civil society, and research.

 

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2. Introducing a Natural Family Planning Method in Albania

 

Family planning was an essential element of the five-year Albania Child Survival Project (ACSP), which the American Red Cross (ARC) and the Albania Red Cross together implemented in mostly rural Diber Prefecture in eastern Albania. Following its conclusion in September 2008, ARC published this 8-page case study. “Introducing a Natural Family Planning Method in Albania," to explore the extent to which ACSP succeeded in its goal of improving the health of women of reproductive age and children 0 to 59 months old.

 

The project organised a network of village nurse-midwives and Red Cross volunteers that worked to facilitate women's family planning support groups, offer household-level counselling, and refer women for Ministry of Health (MOH)-approved contraceptives, either at the nearest commune-level health centre or in a woman's own village if it contained a pilot delivery point. The project promoted all MOH-approved methods: oral contraceptives, condoms, injectables, the intrauterine device (IUD), and natural contraception, including the lactational amenorrhoea method (LAM). Included in this category of natural contraception - and the topic of the case study - was the Standard Days Method (SDM), which the ACSP introduced to Albania in 2006.

 

SDM has been determined to be especially attractive to couples who fear the side effects of other modern methods and/or in cultures where barrier and hormonal methods are viewed negatively. One tool used as part of this method is CycleBeads, a colour-coded string of beads that comes with a flexible rubber ring. On the first day of her period, the user moves the ring to the red bead. She then moves the ring one bead every morning until the start of her next period. She (and her partner) can clearly see white beads (which mark the days that the user is likely to get pregnant) and brown beads (which mark the days that she is not likely to get pregnant).

 

ACSP and MOH staff trained 89 providers (family doctors, maternity health staff, counsellors, and village nurse-midwives) from the 25 health centres in 3 districts of Diber on the use of SDM. SDM was found to be the second-most popular method (after the pill) among 254 women who chose a modern method to fulfill their stated interest in both spacing births and limiting their family size.

 

The Albanian MOH has since incorporated SDM training for health providers into its family planning curriculum Even though individual counseling sessions for SDM users require somewhat more time than for user of other methods, it is notable that SDM discontinuation was not a direct result of client dissatisfaction or fear of side effects. It is also recommended that couples receive more than one counseling session and providers counsel clients while demonstrating how to use the method with Cyclebeads.

 

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3. Maximizing Private Sector Contribution to Family Planning in the Europe and Eurasia Region

 

Based on review of private sector contribution to reproductive health (RH) and family planning (FP) in the Europe and Eurasia (E&E) region, "Maximizing Private Sector Contribution to Family Planning in the Europe & Eurasia Region: Context Analysis and Review of Strategies," by the PSP-One Project, analyzed information and conducted assessment visits in Albania, Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russia, Tajikistan, Ukraine, and Uzbekistan during 2005-2006. Of these, four countries were firmly classified as having advanced FP private sector markets - Kazakhstan, Russia, Romania, and Ukraine – but clearly needed help with mechanisms for sustained communication between public and private sector entities, such as joint promotional and training programmes. In Russia, for example, they found that communication between public sector programmes and commercial suppliers was often minimal, and that contraceptive manufacturers needed help identifying "champions" in the provider community that could help overcome resistance to hormonal contraception in addition to increasing training and educational opportunities.

 

In Romania, on the other hand, the Ministry of Public Health helped to stimulate demand among the rural population and used a three-pronged approach: information, education, and communication (IEC)/behavior change communication activities, service promotion, and community outreach. Private sector firms worked closely with the Ministry to time the demand-creation activities to correspond with the scale-up of quality services and availability of products to meet demand, thereby avoiding loss of confidence in the programme and the disappointment of the client.

 

Among the countries with less-developed markets, Kyrgyzstan, Armenia, and Georgia were found to have "a sufficient number of positive private sector conditions to be classified in the intermediate category” but require focused interventions to make them more “private sector friendly." In the emerging category, Azerbaijan had room for limited private sector development, while Uzbekistan and Tajikistan had "almost no private sector potential in FP at this time." For many of the Central Asian countries, it was recommended that private providers and pharmacists should be included in public and/or non-governmental organisation (NGO) training on RH/FP clinical skills, interpersonal communication (IPC)/counseling and contraceptive technologies.

 

More information on the status of the private sector can be found in C-Picks 3 in a summary about the report, "Ten Best Public and Private Sector Practices in Reproductive Health and Family Planning in the Europe and Eurasia Region."

 

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4. Eastern European and Eurasian Regional Family Planning Progress

 

"Family Planning Situation Analysis 2007: Executive Summary - The Europe and Eurasia Regional Family Planning Activity" is a summary of a series of country desk reviews conducted by John Snow International (JSI) in 2007 to assess the environment for improving family planning programming in the Eastern European and Eurasian region. This USAID-funded activity explores general issues affecting family planning programming in Albania, Azerbaijan, Georgia, Kyrgyzstan, and Tajikistan and making recommendations for potential action to increase utilisation of modern contraception and reduce reliance on induced abortion. JSI identified 10 family planning policy and programme best practices based on the 2005 report, "An Assessment of USAID Reproductive Health and Family Planning Activities in the Eastern European and Eurasian Region", as well as a current literature review and field interviews in selected countries participating in USAID's Europe and Eurasia Regional Family Planning Activity programme.

 

The following is list of the best practices, against which progress in each country was reviewed:

1. National health regulations require that family planning counselling and services are readily available through a range of health professionals.
2. Family planning counselling, services, and contraceptives are part of the Basic Health Benefit Package. At the primary health care level contraceptives are provided to all women, regardless of ability to pay.
3. Up-to-date and evidence-based policies, regulations, guidelines, standards, and supportive supervision systems are in place to ensure the quality of family planning services at all levels of health care.
4. A broad range of family planning methods are available, accessible, affordable, and acceptable in both rural and urban areas.
5. Programmes are in place that are designed to meet the needs of vulnerable groups such as adolescents, internally displaced persons (IDPs), new urban migrants, prostitutes, and the very economically poor.
6. Family planning is part of pre- and in-service training programmes for health care providers.
7. Planning within the government is guided by a well-functioning Logistics Management Information System (LMIS) that enables targeting of subsidised contraceptives and efficient supply chain management of all contraceptive commodities throughout the country.
8. Adoption of a "culture" in which providers and clients engage in frank, regular conversation about sensitive RH issues, and in which family planning and appropriate services are offered.
9. Family planning is actively promoted through social marketing and behaviour change/social mobilisation efforts, including wide distribution of quality informational materials for clients and "job aids" for providers.
10. A well-functioning national health management information system collects, analyses, and uses family planning data to monitor progress and evaluate and improve programme effectiveness.

Based on an assessment of the above, this overview ends with a summary of recommendations for each country for achieving best practices in family planning. Links are provided to specific-country analyses from the URL above.

 

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5. Normalising Sexual and Reproductive Health Education in Uzbekistan

 

"Reaching Out to Youth: Youth-Friendly Sexual and Reproductive Health Services Through Schools, Clinics, and Communities" describes the implementation and impact of an initiative to increase young people's access to accurate information about their sexual health and reproductive lives in the Navoi oblast of Uzbekistan. By creating a triangular support structure composed of clinics, schools, and communities, the international organisation Project HOPE worked to integrate family planning into its child survival project (2003-2007). With funding from USAID, Project HOPE provided training, materials and guidance; helped the health system develop service protocols; and helped the education system create curricula.

 

As detailed here, a core tenet of the initiative was that sexual and reproductive health (SRH) should be understood and approached as a normal, necessary topic for young people. Project Hope worked to sensitise and train health workers and education workers, and through them, to reach local community leaders, parents, and youth. These trained leaders offered information and advice in official settings (health centres, schools) and in casual settings (homes, coffee shops, sporting events, discos). Posters, informational brochures, and short films were developed and distributed to support the interpersonal conversations.

 

Through these strategies, Project HOPE reached out to more than 25,000 teens via 129 schools, 126 neighbourhoods, 2 new youth-friendly clinics, and 3 youth-friendly rooms within clinics in 5 pilot sub districts. At baseline (February 2004), only 1.3% of youth surveyed knew when during her menstrual cycle a woman was most likely to become pregnant; the June 2007 evaluation showed that this percentage had increased to 35.3%. At baseline, 30% could name 3 or more contraceptive methods, whereas 83% could do so at the end of the project. Over 90% of youth could name 2 or more mechanisms of HIV transmission by the conclusion of the project, in contrast to 44% of those at baseline. The percentage of youth who could name 2 or more ways to protect themselves from STIs increased from 16.7% to 80.3%.

 

The Ministry of Health used the materials and methods piloted in the pilot clinics, schools, and with the community leaders of Navoi to replicate the activities of Project HOPE in non-pilot subdistricts of Navoi oblast and in Surhandarya oblast.

 

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6. Supporting the Right to Family Planning and Safe Motherhood Information in Eurasia

 

The "Services to the People" project in Kazakhstan, Kyrgyzstan, and Tajikistan aims to support the right of mothers-to-be to health information and health care. The key aim is to properly train obstetricians for home deliveries and emergency management; rural reproductive health services are also being equipped and service personnel trained in preventive medicine, family planning, counselling, and community health promotion. An information and health education campaign is being developed in an effort to reach not only the women concerned but also others in the family environment (husbands and mothers-in-law) and community decision-makers.

 

This project uses interpersonal communication approaches in an effort to enhance the access of vulnerable people (women in rural areas, and their children) to quality health services. The project's name reflects the rationale that, if women cannot go to quality services (because these services are non-existent, or due to problems of transport and finances), trained providers will bring these services to them.

 

Core components of this strategy include:
i. Developing the capacity of community members to stay healthy, make healthy decisions, and respond to obstetric and neonatal emergencies.
ii. Increasing awareness within communities of the rights, needs, and potential problems related to maternal and newborn health.
iii. Strengthening linkages for social support between women, men, families, and communities and with the health care system.
iv. Improving quality of care of providers and of health services and of their interactions with women, men, families, and communities.

 

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HIV/AIDS

 

 

7. Strategies for Addressing Cross-Generational Sex

 

This brief, "Cross-Generational Sex: Risks and Opportunities" published in July 2008, is based a larger review entitled, "Addressing Cross-Generational Sex: A Desk Review of Research and Programs," as well as discussions with experts about the findings of the larger review. The brief is designed to broaden the understanding of cross-generational sex, look at how many young girls it affects, describe frameworks that guide current thinking about the behaviour, and propose lessons for improving future interventions. The brief proposes that looking beyond surface portrayals of cross-generational sex to understanding the motivations behind this behaviour and the increased risks it engenders, there are important lessons learned for addressing programmes for women, who are shouldering the burdens of HIV, sexually transmitted infections, and unintended pregnancies.

 

The brief begins with a definition of cross-generational sex, explaining that such a relationship is one in which girls receive money or goods in exchange for sex. It goes on to talk about how widespread the practice really is, comparing the results of various studies conducted in several sub-Saharan African countries. It then looks at the approaches used in existing programmes that deal with cross-generational sex. These include youth mobilisation and empowerment and creating livelihood opportunities for youth; social marketing campaigns; awareness raising and health education campaigns; and addressing power imbalances and social and gender norms.

 

The authors of the brief mention two methodologies they feel are particularly promising: "Stepping Stones" and "Community Conversations". The "Stepping Stones" methodology encourages community participation in facilitated discussions, and often uses drama and role-plays to help people talk about sensitive subjects. It also engages men and women to work together. "Community Conversations" fosters dialogue within communities to stimulate local responses, and according to the report, has had promising results in dealing with various issues including HIV, female genital cutting and other customary practices, and multiple sexual partners.

 

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8. HIV Prevention Among India's Long-Distance Truckers

 

This publication explores the thinking behind the behaviour change communication (BCC) activities comprising one component of Avahan, an HIV prevention programme launched in Foundation in 6 states in India. Avahan sought to provide HIV prevention services along 8,000 kilometres of national highways to "free agent" long-distance truckers, who are three times more likely than men in the general population to have sex with someone who is not a regular partner.

 

As detailed within this report, "Off the Beaten Track: Avahan's Experience in the Business of HIV Prevention Among India's Long-Distance Truckers," each Avahan intervention site offers high-visibility multimedia communication activities set up in and around broker and transporter offices. These natural traffic areas also provide the space for satellite clinic services that are allied with a large static clinic at each location. The project also conducts monthly health camps at the intervention sites on a fixed day to provide truckers with quality specialist health services, building visibility through corporate sponsorship of these events.

 

In order to address the challenge of fragmented engagement with a mobile population, the programme focused on building a uniform look and feel (ie: brand) of services across intervention sites. In an effort to counter messaging fatigue and cynicism among truckers, organisers have made truckers the face of the programme by engaging them as peer outreach workers. Interpersonal communication is complemented by events including street plays, supplemented with kiosks where truckers can play games that reinforce select themes. Films are also used to deliver HIV messages and tell truckers about available services. Audio cassettes which contain popular local songs interspersed with spoofs on Hindi film actors delivering HIV prevention messages and endorsing Khushi services are distributed. The programme also builds recall of services through billboards at popular roadside cafes and along the highway.

 

Key strategies for engaging customers have included:
a. Consumer research to develop the programme's overarching positioning theme included focus group discussions and in-depth interviews with truckers across multiple ethnicities, age groups, and route categories. Based on this research, the project is attempting to move beyond the utilitarian "health benefit" positioning of safe sex practices towards making such behaviour aspirational for truckers. This involves using positive cues (enhanced self-esteem, being responsible, being in control and, hence, masculine) to promote behaviour change.
b. All interpersonal communication and a large portion of the events are facilitated by peer workers using language, anecdotes, and themes with which the population can identify.
c. Peer discussions form the basis of themes presented in all project activities. These insights inform efforts to dispel myths and fears, and help identify psychological barriers to condom usage, such as the belief that condom usage is not the mark of a "real" man.

 

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9. Male Circumcision for HIV Prevention

 

Published by the Bulletin of the World Health Organization (WHO) in September 2008, the paper "Male Circumcision for HIV Prevention: A Prospective Study of Complications in Clinical and Traditional Settings in Bungoma, Kenya" suggests that, based on over 35 observational studies and three randomised controlled trials from sub-Saharan Africa, male circumcision interventions in high HIV prevalence areas would be at least as cost-effective as any of the other evidence-based HIV prevention tools. It points to the need for more awareness-raising and training on male circumcision, as well as increased advocacy and information to place it in the context of HIV prevention.

 

According to this article, male circumcision should not be considered a stand-alone medical procedure for HIV prevention, but rather should be incorporated into a full complement of HIV prevention and reproductive health services, including, but not limited to, counselling about safe sex, diagnosis and treatment of sexually transmitted infections, HIV testing, and referral to HIV treatment and care. Therefore, training for practitioners should include education about all of these HIV prevention methods.

 

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10. UNAIDS Combination Prevention Briefs

 

This series of Combination Prevention Briefs, published by Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2008, is designed to offer an overview of the key interventions needed as part of a combination prevention approach in the countries of Eastern and Southern Africa with high HIV prevalence. The briefs focus on the following 4 areas: modes of transmission, multiple concurrent partnerships, vulnerabilities of women and girls, and male circumcision. Each brief offers background information, outlines challenges to scaling-up within a combination prevention approach, and offers recommendations for action.

 

According to UNAIDS, combination prevention in Eastern and Southern Africa asserts the importance of combining a number of proven social and medical approaches to achieve maximum impact on HIV prevention. Coordinated evidence-informed strategies that work in concert towards shared prevention goals in the context of a well researched and understood local epidemic will have the best chance of success. Resources and efforts should prioritise these approaches rather than those for which evidence of impact is weak. The starting point is sound analysis of what is driving the epidemic in different contexts - modes of transmission modeling and other "know your epidemic", "know the evidence", and "know your responses" synthesis reviews.

 

The following briefs are available for download in PDF format:
i. Focus on modes of transmission.
ii. Focus on multiple concurrent partnerships.
iii. Focus on the vulnerabilities of women and girls.
iv. Focus on male circumcision.

 

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11. HIV/AIDS Prevention Outreach Guides

 

Pact Botswana has developed a series of 10 Outreach Guides to assist HIV/AIDS programme implementers working in HIV prevention interventions. The Guides utilise participatory methodologies and intend to underline approaches that promote behaviour change, especially for the most-at-risk groups, taking co-factors such as alcohol abuse, sexual violence, and intergenerational sex into consideration. Each Guide focuses on a particular aspect of HIV prevention.

 

Six of these guides are particularly relevant to behaviour change communication:

Abstinence Promotion: Developed for use with young people who have not yet had their first sexual experience, the goal of this guide is to encourage the delay of individual’s first sexual encounter, including helping to prepare young people for pressures to have sex.
Values and Goal Setting: This guide deals with looking at the future and what can be achieved in life by setting goals, as well as deciding and living by moral values. The idea is that people make better behaviour choices today if they set their own standards and future goals. Choosing moral values and living by them is also covered.
Sexual Behaviour Changes: Since HIV is very likely going to be transmitted sexually, this guide says that working on making good decisions about sexual behaviour is essential to avoiding becoming infected. Different kinds of sexual behaviour that put people at risk are examined.
Better Couple Communication: Improving couple communication and avoiding infidelity is the focus of this guide. The author says that when couples, whether married or not, are not listening to and understanding each other, they can end up disrespecting and not trusting each other.
Enhancing Parent-Child Communication: According to the guide, parents often have difficulty guiding their teenagers towards making good decisions about avoiding HIV. This guide focuses on building parents’ communication skills and ability to communicate with teenagers without alienating them.
Partner Reduction and Protection: This guide is for conducting outreach with those who practice "risky sexual behaviour." It recommends reducing the number of partners and includes content on how to promote condom use, including how to overcome obstacles to use.

 

 

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MALARIA

 

 

12. Improving Community Health Worker Use of Malaria Rapid Diagnostic Tests in Zambia

 

This Zambia-based study, published by the Malaria Journal, was designed to determine: (i) whether community health workers (CHWs) could prepare and interpret rapid diagnostic tests (RDTs) for malaria accurately and safely using manufacturer's instructions alone; (ii) whether simple, mostly pictorial instructions (a "job aid") could raise performance to adequate levels; and (iii) whether a brief training programme would produce further improvement. "Improving Community Health Worker Use of Malaria Rapid Diagnostic Tests in Zambia: Package Instructions, Job Aid and Job Aid-Plus-Training" describes the methodology used for the study and provides details about the job aid and half-day training programme.

 

Many countries in Africa where malaria is most widespread have been reluctant to allow CHWs to handle blood because of risks of HIV transmission and concerns about whether these minimally-trained providers could accurately use and interpret RDTs. However, this study found that CHWs were able to master the skills needed to administer and interpret RDTs correctly and safely.

 

This study measured two outcomes: 1) ability to conduct test procedures safely and correctly; and 2) ability to interpret the results correctly. Regarding outcome #1: On average, CHWs using the manufacturer's instructions performed 57% of test steps correctly. Those using the job aid alone improved significantly to 80%. Job aid-plus-training CHWs scored highest, at 90% correct. Regarding outcome #2: Accuracy of the RDT test interpretation improved significantly in the job aid-only and job aid-plus-training groups. Manufacturer's instructions CHWs read a mean 54% of test results correctly compared to 82% in the job aid-only group and 93% in the job aid-plus-training group. The study concludes that volunteer CHWs can use malaria RDTs safely and effectively.

 

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13. Community Factors for Participatory Malaria Control

 

"An Exploratory Study of Community Factors Relevant for Participatory Malaria Control on Rusinga Island, Western Kenya", part of the ongoing Rusinga Malaria Project (RMP), evaluates community factors relevant for participatory malaria control on Rusinga Island, western Kenya. Project implementers and community members joined together here in a participatory initiative to study how much local people understood about the existing malaria problem on Rusinga, assess their socio-economic background, and create awareness for the ongoing project while sensitizing community members for active participation. In order to do this, focus group discussions and semi-structured individual interviews (knowledge, attitude and practice (KAP) surveys) were carried out to determine socio-economic and behavioural baselines to identify indicators for monitoring programme effectiveness, and to reveal the perceptions, misconceptions and practices of malaria control.

 

Results showed that, though malaria is considered one of the major threats to life, there is little effective knowledge of malaria prevention, including causal knowledge of the transmission cycle. "[D]espite the fact that there is a lot of knowledge in the community, this knowledge was distorted and causal connections were not understood, raising questions about the quality of past health education messages and whether they might be more confusing than helpful if not implemented in a cultural sensitive way."

 

Socio-economic factors impacted the use of known preventative measures. "Although many (88%) knew bednets prevent malaria, only 48% of households actually owned a net, with... 37% sleeping under one the previous night." The authors found little knowledge of insecticide treatment of nets and no knowledge of a causal understanding of insecticide treatment as killing mosquitoes. Based on the information that bednet use was linked to socio-economic status and education, the authors recommend increased training and increased availability of bednets.

 

The authors conclude that "[t]here is an urgent need to design culturally sensitive but evidence-based education interventions which take local beliefs into account and which help the community to understand the causal connections between mosquito habitats, malaria transmission, malaria symptoms, treatment and prevention." The authors hypothesize that this will be best achieved through participatory, hands-on experience.

 

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14. Improving Access to Malaria Treatment and Care in Rural Tanzania

 

This document describes a research project on malaria interventions that was designed to evaluate the ACCESS programme, a programme intending to understand and improve access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy, as stated within "Understanding and Improving Access to Prompt and Effective Malaria Treatment and Care in Rural Tanzania: the ACCESS Programme", is based on a set of integrated interventions, including social marketing for improved care seeking at the community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores.

 

The research was designed to look at various intervention areas. The communication-related intervention area uses behaviour change campaigns, including:

1. Sensitising community leaders to gain their support and collaboration;
2. Social marketing of information to mothers and caregivers of children under 5 years old and pregnant women;
3. Efficient and cost-effective communication channels and materials to disseminate behaviour change messages include road shows on the platform of a truck used as a mobile stage for a show;
4. Special campaigns in Mother and Child Health (MCH) clinics; and
5. A study of the "shamba component" - the farming period when people live away from the village, a period being studied as a heightened risk period.

 

To date, a number of peer-reviewed articles and an independent document have been published based on this research. Links to these articles are provided at the URL above.

 

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UPCOMING MEETINGS

 

 

15. XXVI IUSSP International Population Conference
Marrakech, Morocco
September 27 - October 2 2009

 

This will be the first IUSSP International Population Conference to be held on the African continent and in an Arab country. The Conference will include over 180 regular scientific sessions, poster sessions, and training sessions, as well as plenary and debate sessions, side meetings and exhibitions. Simultaneous translation in French and English will be provided for all plenary, debate, regular and training sessions. In addition, simultaneous translation in Arabic will be provided for all plenary and debate sessions and all sessions organised by the Moroccan NOC on population issues in the Arab world. Submissions of abstracts should be made on the programme website.

 

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

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This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

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C-Change Picks - Information about Behaviour and Social Change Communication - Family Planning

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October 16, 2008

C-Change Picks #3 - Information about Behaviour and Social Change Communication - Family Planning
Sponsored by C-Change
October 16 2008

 

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

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C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

This issue of C-Change Picks focuses on social and behaviour change communication (BCC) in family planning and reproductive health, highlighting information and reports around issues that include: access to timely, updated, and culturally appropriate family planning information; research and resources for understanding/promoting long-acting and permanent methods (LAPMs); evidence from healthy timing and spacing of pregnancy (HTSP) programmes; and key communication challenges – and solutions – for successful family planning programmes, among others.

 

The C-Change programme is implementing programmes and undertaking research in Africa, Eastern Europe, and India that address behaviour and social change communication in family planning. Factors that influence contraceptive use and method choices are varied and include the cultural conventions and gender and social norms of a society, current and previous government policies and programmes, stockouts of contraceptives due to unreliable logistics systems, and the particular motivations and education of the woman and the couple. In Albania, traditional family planning methods (in particular, withdrawal) have been the norm and abortion has been used when such methods often fail. To address this situation, C-Change is developing an integrated communication programme that includes a national media campaign and community-based interventions to change social norms among young men and women and increase the use of modern contraceptives in Albania. In India, C-Change is evaluating using SCALE® - a systems approach that catalyses widespread social change in a short time - in the state of Uttar Pradesh to address reproductive health practices.

 

C-Change Picks continues to seek new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

For online access to the first two editions of C-Change Picks, please see:

 

 

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In this Issue...

 

A Focus on Family Planning and Reproductive Health

1. Europe/Eurasia: Public and Private Sector Practices in Reproductive Health and Family Planning
2. Identifying Elements of Successful Family Planning Programmes
3. Trainer's Reference Guide for Healthy Timing and Spacing of Pregnancy
4. Long-Acting and Permanent Methods: Addressing Unmet Need for Family Planning in Africa
5. Training to Mobilise Muslim Religious Leaders for Reproductive Health and Family Planning
6. Engaging the Family in Health Timing, Spacing, and Pregnancy
7. Increasing the Accessibility, Acceptability and Use of the IUD in Gujarat, India
8. Promoting Healthy Timing and Spacing of Births in India through a Community-based Approach
9. Supporting Antenatal and Postnatal Care in Impoverished Contexts
10. Empowering Women Leads to Increased Family Planning and Reproductive Health
11. Community Awareness of Post Abortion Care: Bolivia, Kenya, Senegal
12. Interactive, Client-oriented Balanced Counselling Strategy Toolkit

 

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Family Planning/Reproductive Health

 

1. Europe/Eurasia: Public and Private Sector Practices in Reproductive Health and Family Planning

 

This USAID brief, developed through a collaborative effort by John Snow Inc. (JSI) and PSP-One, intends to synthesise some best practices in achieving reproductive health and family planning (RH/FP) goals for the Europe and Eurasia (E&E) region, and highlight the role of the private sector in meeting these goals. "Ten Best Public and Private Sector Practices in Reproductive Health and Family Planning in the Europe and Eurasia Region" is designed for policymakers, service providers, FP organisations, and other stakeholders with an interest in developing better public/private collaboration in achieving RH/FP goals. The criteria used to identify these best practices included effectiveness in improving RH/FP services and outcomes, potential for sustainability and replication, innovation, and ability to address local needs.

 

Though modern contraceptives are easily available in the urban centres in the E&E region, "significant barriers exist that limit access to information, services, and commodities for certain groups. In some cases, the barrier is financial, when free or subsidized commodities are unavailable to low-income users. Other obstacles include legal restrictions in the provision of FP services, unnecessary tests and medical examinations, and a lack of reliable information about modern methods."

 

The report states that private sector interest in FP varies substantially from one country to another and tends to focus on specific and saleable products, which results in limited method availability, impacting on the method mix in the region. "The private sector can help decrease the burden on the public health sector, allowing it to focus its limited resources on vulnerable population groups. The public sector, however, retains a fundamental role in setting the parameters of service provision and ensuring universal access to a broad method mix." According to this report, the private sector can address provider bias and identify special needs groups, which may foster a private sector increase in investment in the provision of mixed methods and improved quality of service.

 

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2. Identifying Elements of Successful Family Planning Programmes

 

The INFO Project, in collaboration with the World Health Organization (WHO) and partners of the Implementing Best Practices (IBP) Initiative, sponsored an online global discussion forum in order to share programme experiences, review research findings, highlight resources, and reach consensus on the core elements of successful family planning programmes. Before launching the forum, the INFO Project at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs conducted an online survey on what are considered the elements of successful family planning programmes. "Elements of Successful Family Planning Programs: Online Survey and Global Forum Discussion" reports the outcomes of both of these activities, undertaken in December 2007.

 

445 health care professionals from 98 countries responded by ranking the importance of a variety of factors involved in running family planning programmes. Results showed that effective communication strategies and outreach ranked second after staffing as one of the most important factors for success.

 

Communication challenges and solutions were summarised as:
a. Challenge: Lack of community interest in family planning messages due to socio-cultural factors, such as religious beliefs.
Solution: Convince local leaders before disseminating messages to the community and convince local leaders to help spread the messages.
b. Challenge: Radio spots have limited reach.
Solution: Repeat radio programmes and spots at different times throughout the day to reach a wider audience.
c. Challenge: Lack of qualified and committed health care providers and outreach staff.
Solution: Capacity-building activities for health care providers and outreach staff.
d. Challenge: Time-consuming for providers to counsel clients.
Solution: Decrease provider workload.
e. Challenge: Expensive to air mass media messages.
Solution: Negotiate with production studios to air mass media messages at a discounted rate.
f. Challenge: Messages reach only female clients.
Solution: Develop messages to address men by organising a community meeting.

 

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3. Trainer's Reference Guide for Healthy Timing and Spacing of Pregnancy

 

Published by the Extending Service Delivery (ESD) Project in August 2008, this guide serves as a resource for trainers in developing in-service training for facility-based healthcare providers and community health workers, who already have some basic experience with and an understanding of reproductive health/family planning. It focuses only on the evidence of the health and social outcomes that are related to too early and too closely spaced pregnancies. It discusses all methods of family planning, including long acting and permanent methods (LAPMs), and provides information on assessing fertility intentions and desired family size with all clients, including older women and/or high parity women, who may be particularly interested in LAPMs. This is not a training manual, but a reference guide, which can be used and adapted by trainers based on whether the trainees are facility-based or community-based.

 

Also see: Healthy Timing and Spacing of Pregnancies: A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders

Also from the ESD Project, this guide provides an overview for health practitioners and programme managers about healthy timing and spacing of pregnancies (HTSP). It discusses key findings from global research on the link between pregnancy spacing and maternal and newborn health outcomes. It also highlights the benefits of timing and spacing pregnancies, shares HTSP messages for educating women, men, and communities, and identifies windows of opportunity for HTSP counselling.

 

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4. Long-Acting and Permanent Methods: Addressing Unmet Need for Family Planning in Africa

 

This series brings together eight advocacy briefs on using long acting and permanent methods (LAPMs) of contraception to address unmet needs in Africa. LAPMs here include: the intrauterine device (IUD), contraceptive implants, vasectomy, and female sterilisation.
Brief 1: The Case for Long-Acting and Permanent Methods
Brief 2: The Benefits of Long-Acting and Permanent Methods for Individuals
Brief 3: The Role of Long-Acting and Permanent Methods in National Programmes
Brief 4: Strategies to Improve Availability, Access, and Acceptability
Brief 5: Contraceptive Implants: Safe, Effective, Long-Acting, Reversible
Brief 6: IUDs: A Resurging Method
Brief 7: Female Sterilisation: The Most Popular Method of Modern Contraception
Brief 8: Vasectomy: Safe, Convenient, Effective and Underutilised

 

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5. Training to Mobilise Muslim Religious Leaders for Reproductive Health and Family Planning

 

"Mobilizing Muslim Religious Leaders for Reproductive Health and Family Planning at the Community Level: A Training Manual", created by USAID and the Extending Service Delivery Project (ESD), is a 5-day training curriculum designed to equip male and female Muslim religious leaders with the necessary information and skills to better understand, accept, and support the provision of maternal and child health, reproductive health, and family planning (MCH/RH/FP) information and services at the community level. The ultimate goal of the training is to build the capacity and leadership of Muslim religious leaders in MCH/RH/FP and gender to support couples and community members in making informed decisions on reproductive health issues such as safe motherhood, child spacing, sexually transmitted infections including HIV/AIDS, and to discourage harmful behaviours, especially gender-based violence. The manual presents concepts of MCH/RH/FP from a perspective that is consistent with and supported by the teachings of Islam. In addition, there are sections devoted to the needs of youth and building the leadership capacity of religious leaders.

 

  • At the end of the training, participants should be able to:
    define RH/FP and describe its components: safe motherhood including child survival and management of complications of unsafe abortion/miscarriage; birth or child spacing (family planning); prevention and management of reproductive tract infections, including sexually transmitted infections and HIV/AIDS; and the prevention of gender-based violence, including the discouragement of harmful traditional practices;
  • dispel myths and misconceptions about RH/FP;
  • identify gender constraints to RH/FP including MCH;
  • describe the Islamic perspectives on RH/FP information and services;
  • identify ways in which religious leaders can help mobilise the community around MCH/RH/FP; and
  • develop action plans in support of MCH/RH/FP information and services in their communities.

 

All of the Qur'anic messages and Islamic information presented in the manual is referenced so that the trainer can research the information him/herself and share the sources with the participants.

 

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6. Engaging the Family in Health Timing, Spacing, and Pregnancy

 

This case study examines the rationale, strategy, and impact of World Vision's child survival project, Pragati, carried out in 3 districts of Uttar Pradesh, in north-central India. Pragati (which is Hindi for "acceleration" or "momentum") strove to improve health outcomes and change behaviours related to women's and children's health, and to ensure that pregnant women and new mothers had ready access to information about and methods of birth spacing and family planning. Pragati was supported by United States Agency for International Development (USAID) resources.

 

As detailed within "The Right Messages - to the Right People - at the Right Time", the innovation in this project was a timed and targeted approach to BCC for all project components. That is, BCC on health, nutrition, and family planning was timed to a woman's stage of pregnancy, the age of her infant, and/or the fertility intentions of the couple. It sought to engage all decision-makers in the family, including but not solely limited to the individual who might accept a contraceptive method. World Vision developed, tested, and launched a package of training, tracking tools, job aids, and supervision protocols in this effort to ensure consistent content and quality of BCC across time and place. This case study stresses that pivotal to Pragati's effort to share information with the right people at the right time in their lives was the project's ability to tap into India's existing community volunteer structure.

 

The Pragati project undertook a baseline survey in 2003 and a final evaluation in 2007 to measure the effect of its work. Each study used a 2-stage, 30-cluster sampling method and a sample size of 300 mothers in each of the 3 districts. Over 4 years, the contraceptive prevalence rate more than doubled in the project zone. In addition, women's knowledge of at least one source of family planning increased from 27% to 99% of mothers of children less than 2 years of age in Ballia, from 21% to 91% of such women in Lalitpur, and from 31% to 75% in Moradabad.

 

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7. Increasing the Accessibility, Acceptability and Use of the IUD in Gujarat, India

 

This May 2008 report details an operations research study carried out to explore the strategy of using behaviour change communication (BCC) to increase use of the Intra Uterine Device (IUD) in rural and urban areas in Vadodara District in the state of Gujuarat, India. The specific hypothesis being tested was that, by improving the demand for the IUD and simultaneously strengthening the technical competencies and counselling skills of the providers, IUD use would increase. The study was carried out by the USAID-funded FRONTIERS Program of the Population Council, in collaboration with the Department of Health and Family Welfare, Government of Gujarat, and the Center for Operations Research and Training, Vadodara. These collaborators were motivated by the observation that, although the IUD is a highly effective (and relatively inexpensive) contraceptive method, it is unpopular worldwide; India is no exception, with less than 2% of women adopting this family planning method.

 

In order to test their hypothesis, researchers first engaged in a diagnostic and preparatory phase that involved formative research designed to understand the users' perspectives about the IUD and its use, as well as prevailing myths and misperceptions about the contraceptive. Similarly, informal discussions and focus group discussions (FGDs) with providers helped in understanding providers' perspectives and their problems in promoting the IUD and personal biases against the IUD, if any. The findings were used for preparing BCC materials and counselling aids, which were then field-tested for language, clarity, and acceptability of the messages and then modified, if required.

 

The impact of the intervention was evaluated 9 months after introduction of the interventions. The methodology involved a pre- and post-intervention design with no control group. Researchers found that demand generation activities and provision of good-quality IUD services, together with a supportive programmatic environment - when carried out simultaneously - showed increased acceptance of the IUD. The IEC and counselling aids developed for the study were well accepted by health care providers, clients, and national and state government officials. A revised version of these IEC materials has been accepted by the IEC Division of the Ministry of Health and Family Welfare (MOHFW) and is expected to be produced for the entire country.

 

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8. Promoting Healthy Timing and Spacing of Births in India through a Community-based Approach

 

This 2008 report details an operations research study carried out in India to assess the feasibility and effectiveness of using behaviour change communication as a strategy for promoting the lactational amenorrhoea method (LAM) and postpartum contraception among pregnant women with a parity of zero or one. Funded by USAID, the study is a collaborative undertaking by the Population Council's Frontiers in Reproductive Health Program (FRONTIERS), the Lala Lajpat Rai Medical College, Meerut, and the District Directorates of the Health and Family Welfare and Department of Women and Child Development. These partners were motivated by the observation that the Indian Family Welfare Program has failed to educate people about the importance of using contraceptive methods for spacing births rather than adopting sterilisation after having children in quick succession.

 

In this context, researchers began in July and August 2006 by carrying out baseline data collection as well as a formative study that included focus group discussions held with newly married and first-time-parent men and women, mothers-in-law, community leaders, and family planning providers. In addition, 30 in-depth interviews of newly married and first-time-parent men and women were conducted. Based on the findings of the formative study, simple, unambiguous messages on the risks of early- and short-spaced pregnancies and the benefits of maintaining at least a 3-year interval between births were developed. These messages were then incorporated into a series of communications products. The educational campaign was implemented by 267 community workers (CWs). CWs visited each eligible woman individually to explain postpartum care, including LAM and postpartum contraception. As part of these visits, the CWs gave each woman a printed, pocket-sized HTSP booklet, instructing her to share it with her husband and mother-in-law. Group meetings both for pregnant women and older women and for husbands, community elders, and village leaders were also held to raise community awareness.

 

Researchers claim that the study showed the following:

  • The BCC model developed to promote HTSP was effective in promoting LAM and postpartum contraception and could be rolled out easily.
  • Misconceptions about the return of fertility and its links to the biological marker of the menstrual cycle are the main barriers in a timely beginning of postpartum contraception.
  • Acceptance of CWs in a family increases if counselling focuses on HTSP and its benefits to mother, child, and family.
  • The complementing effort by CWs of two Ministries to achieve similar objectives is feasible and provides a synergistic effect.
  • The BCC materials, counselling aids, and messages developed for the projects are ready to use in scaling up the programme.

 

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9. Supporting Antenatal and Postnatal Care in Impoverished Contexts

 

"Maternal and Newborn Care Practices Among the Urban Poor in Indore, India: Gaps, Reasons and Potential Program Options," published at the end of August 2008, describes maternal-newborn care practices and care of infants aged 2-4 months (feeding practices, morbidity status, immunisation status, and nutritional status) in urban slum dwellings of Indore city, Madya Pradesh (India). The findings presented in this report are from a study carried out by UHRC between December 2004 and February 2006 in 11 out of 79 slums where its Indore Urban Health Program has been operational since April 2003. Also discussed in this report are reasons for following these practices, what facilitates and what hinders following optimal practices, and potential programme options for their improvement.

 

Strategies for supporting mothers and newborns through antenatal care include:

  • Enable families (pregnant women, their husbands, and in-laws) to perceive the benefits of appropriate antenatal care practices through persuasive reinforcement of optimal practices by trained slum-based CBOs and involving early adopters as change aides in group meetings/home visits. Early adopters include: a progressive early adopter/relative/neighbour/an elder lady of the community.
  • Encourage families and/or pregnant women to join a health savings fund group from which they can draw money if needed for health care.
  • Train 'Basti' Community Based Organisations (BCBOs) through pictorial and group discussion, accommodating literacy issues, to monitor behaviours of mothers and assess their progress.
  • Establish telephone links of slum-based birthing huts with public or private medical facilities that can offer support.
  • Establish "outreach camps" for individual appointments, particularly in the evenings, and group discussions. Attempt to partner with private medical providers when possible to increase confidence in outreach camps.
  • Enabling community members to analyse the benefit of and harm of not practising optimal behaviours through discussions using case narratives and/or use of pictorial material by CBOs.
  • Refresher training for BCBOs and TBAs, related to resuscitation; cutting and tying the cord tie and thermal protection.
  • Engaging in collective dialogue with mothers-in-law (MILs), elder ladies of the community and TBAs to: a) assert the positive role they can play in promoting optimal delivery practices; and b) discuss ways of avoiding harmful traditions.

 

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10. Empowering Women Leads to Increased Family Planning and Reproductive Health

 

This paper, entitled "Women's Empowerment in Ethiopia: New Solutions to Ancient Problems," documents the challenges and successes of two Pathfinder International projects in 4 regions in Ethiopia that aimed to combine increased access to reproductive health care and family planning with comprehensive social change. In collaboration with partners, community and religious leaders, and medical providers, these programmes have, according to the authors, advanced changes in law enforcement and community values to overcome harmful traditional practices.

 

The first project, Empowerment of Ethiopian Women, ran from April 2003 to June 2006 and focused on removing obstacles to women's basic rights, both social and economic. The project was designed to promote access to reproductive health/ family planning (RH/FP) services and freedom from sexual exploitation, violence, forced marriage, and other harmful traditional practices (HTPs). The second project, the Women and Girls Empowerment Project, was designed to continue the work, but also expand the focus to adolescent girls in recognition of a need for early intervention. This second project works to increase awareness and education among girls and women about RH/FP and personal rights, as well as to emphasise education, life skills, and leadership development. It also provides educational support to economically poor girls and promotes female education through role models and mentoring.

 

According to the report, by integrating women's reproductive health needs with economic, educational, social, and legal concerns, people are adopting gender sensitivity across society. The authors propose that by sensitising all levels of society, from national, to regional, to local leaders and throughout local communities, in conjunction with the different interventions, the transformation of beliefs and behaviour takes on a momentum of its own.

 

The report concludes that gender responsive programmes should recognise that practices such as female genital cutting (FGC), early marriage, abduction, rape, lack of access to and control over resources, and the absence of decision-making and negotiation power all negatively affect women's reproductive health and rights. Because many women have limited control over their sexual lives and contraceptive use, integrating gender issues into reproductive health and HIV/AIDS programme interventions becomes critical. Active male involvement in reproductive and family care-giving enhances responsible parenthood and reduces gender-based violence that affects women’s reproductive health and rights.

 

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11. Community Awareness of Post Abortion Care: Bolivia, Kenya, Senegal

 

This presentation for the Post Abortion Care (PAC) Technical Meeting, Washington, DC, United States, March 2008, illustrates the post-abortion care model of the United States Agency for International Development (USAID), which consists of three components: community empowerment through community awareness and mobilisation; emergency treatment; and family planning (FP) counselling, including provision of selected reproductive health care, sexually transmitted infection, and HIV testing and treatment. "Community Empowerment Through Community Awareness and Mobilization: Hearing the Voice of the Community" presents a contextual comparison of the problems and resolutions of PAC model programmes within three countries: Bolivia, with 48 community groups involved; Kenya, with 16 groups; and Senegal, with 16 groups.

 

The needs specific to each country situation are presented. Results of pre- and post-knowledge, attitudes, and practices (KAP) surveys are included. The programmes emphasise the theme of the three delays: delay in recognising the problem; delay in seeking care; and delay in receiving appropriate care.

 

The sections on "recognising the problem" identify the following communication-specific challenges: ignorance of FP and lack of FP information; lack of understanding of contraception (particularly among youth and adolescents); and prevalence of rumours and myths preventing contraception use. Communication strategies used in these cases were: workshops, health fairs, public awareness activities, workshops with psychology students, and work with health care directors.

 

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12. Interactive, Client-oriented Balanced Counselling Strategy Toolkit

 

The Balanced Counseling Strategy (BCS) is an interactive, client-oriented counselling strategy. It uses three key job aids (visual memory aids) for counselling clients about family planning. "The Balanced Counseling Strategy: A Toolkit for Family Planning Service Provider", as well as the job aids, are published by the Population Council with support from the United States Agency for International Development (USAID). The process - tested and refined in Guatemala, Peru, and Mexico - involves a set of steps to determine the method that best suits the client according to her preferences and reproductive health intentions.

 

The BCS toolkit includes:

  • User's Guide
  • Trainer's Guide
  • Three job aids or memory tools for use by the provider and client:

i. An algorithm that summarises the 11 steps needed to implement the strategy.

ii. Counselling cards with basic information about 15 family planning methods, plus a card with the checklist to be reasonably sure a woman is not pregnant.

iii. Brochures on each of the methods for the client to take once a method is chosen.

 

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Communication for Change (C-Change) implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see the C-Change website. To contact C-Change, please email cchange@aed.org

 

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This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

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C-Change Picks - Information about Behaviour and Social Change Communication - HIV Prevention

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Date: 
September 17, 2008

C-Change Picks #2 - Information about Behaviour and Social Change Communication - HIV Prevention
Sponsored by C-Change
September 17 2008

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

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C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

Emerging from the August 2008 International AIDS conference in Mexico City was a distinct emphasis on social analyses and socially-driven responses to HIV and AIDS. Participants discussed the challenges and also the opportunities of social drivers, social complexities, social change, social mobilisation, social movements, social stigma, socio-economics, socio-cultural factors, and social phenomena (from homophobia to gender equity).

 

Reflecting the importance of these contextual factors in behavioural and social change processes, this issue of C-Change Picks focuses specifically on behaviour change communication (BCC) and social change communication for HIV prevention, highlighting information and reports around issues such as multiple concurrent partners (MCP), most-at-risk populations, gender equity, and male circumcision, among others.

 

C-Change Picks continues to seek new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

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In this Issue...

 

A Focus on HIV/AIDS Prevention

 

1. Gender Transformative BCC HIV Prevention Intervention in South Africa
2. Talking About Condoms in India Increases Sales
3. Concurrent Sexual Partnerships: Challenges for HIV Prevention Communication
4. Learning from Adolescents to Prevent HIV and Unintended Pregnancy
5. Festival of Love: HIV Prevention in the Sex Trades
6. Fijian BCC Programme Leads to Ownership of HIV/AIDS Prevention Responses
7. Reviewing Approaches to HIV Prevention Among Vulnerable Populations
8. The History and Challenge of HIV Prevention
9. Integrating Biomedical Interventions with Behavioural Interventions
10. HIV Prevention for Youth Through Sport
11. South African Entertainment-Education Television Drama Influences Youth

 

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HIV/AIDS Prevention

 

1. Gender Transformative BCC HIV Prevention Intervention in South Africa

 

This 2007 research brief offers both qualitative and quantitative evidence from an evaluation of a Stepping Stones intervention in the Eastern Cape, South Africa. Stepping Stones is an HIV prevention behaviour change communication (BCC) programme that aims to improve sexual health by building stronger, more gender-equitable relationships with better communication between partners.

 

The findings here provide evidence of success in bringing about changes that reduced sexually transmitted infections in study participants. This study also shows Stepping Stones to be effective in reducing sexual risk-taking and violence perpetration among young, rural African men. According to this evaluation, the proportion of men in villages participating in the Stepping Stones programme who had transactional sex was lower 12 months after participating in the programme (p=0.01) and the proportion who had perpetrated severe intimate partner violence (defined as more than one episode of physical or sexual IPV) was lower at 12 and 24 months (p=0.11 and p=0.05).

 

The qualitative research showed that Stepping Stones impacted on a range of different areas of participants’ lives. Many of the participants spoke of changes in relationships with their parents and other elders after the workshops, enhanced skills related to talking about sex with older people, and improvements in communication among both men and women with partners. This, according to the study, supports the argument that participants, and particularly men, changed who they were as individuals and how they related to others. The programme brought about changes in attitudes which could critically lessen HIV risk by providing knowledge, generally raising awareness of personal risk, and giving a much greater openness about HIV. In the process it seems to have provided general life skills which made many of them better partners, friends, family members, and citizens.

 

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2. Talking About Condoms in India Increases Sales

 

Implemented under the Program for Advancement of Commercial Technology - Child and Reproductive Health (PACT-CRH) by ICICI Bank with technical assistance and oversight from the United States Agency for International Development (USAID)-funded Private Sector Partnerships-One (PSP-One) project, this public awareness behaviour change communication campaign was launched in India in September 2006 as part of an effort to expand the condom market in Northern India, which had been declining in previous years, and to decrease the embarrassment associated with purchasing condoms. Through the slogan "Condom bindaas bol" ("Condom, just say it") and a series of humourous television advertisements, the campaign encouraged people to talk openly about condoms and to use the word freely at the point of purchase. The campaign sought to reach both consumers and vendors through a mix of traditional and non-traditional media vehicles, public relations initiatives, and activities meant to address the stigma surrounding condom use by reducing the embarrassment associated with buying condoms.

 

During the project implementation period (2003 - 2006), the sales volume of commercial condom brands increased 6.4% (the compounded growth rate), and the value of commercial condom brands sold through retail outlets increased by 10.3% (also the compounded annual growth rate). In addition, organisers cite evidence indicating that the campaign was also successful in improving attitudes: consistent use of condoms with non-spousal partners among sexually active men increased from 75% to 80%; current condom use with spouses among married men increased from 38% to 60%; and there was a 16% increase among those reporting the belief that condoms are not only for commercial sex.

 

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3. Concurrent Sexual Partnerships: Challenges for HIV Prevention Communication

 

This report, from the Centre for AIDS Development, Research and Evaluation (CADRE), looks at the issue of concurrent sexual relationships amongst heterosexual respondents between the ages of 20 and 30, exploring implications for HIV/AIDS communication and offering recommendations and key message concepts for HIV/AIDS communication. It draws on data collected from two studies conducted in South Africa in 2006: 1) a national HIV/AIDS communication survey which looked mainly at the impact of HIV/AIDS communication; and 2) a qualitative study comprising interviews and focus groups which looked at the nature of sexual relationships and sought to identify implications for HIV/AIDS communication.

 

Based on an analysis of the data, the report offers key recommendations for prevention and communication.
i) There is a need for urgent and intensified focus on the risks of high sexual partner turnover, casual sex, and sexual partner concurrency.
ii) Interventions should avoid dualities of meaning embedded in the concept of 'faithfulness' in favour of more direct and pragmatic guidelines.
iii) Within the context of high HIV prevalence in conjunction with exposure to concentrated sexual networks, it is necessary to focus on reducing concurrency. As well, condom promotion should focus on promotion of correct and consistent condom use.

 

This report also includes a number of key concepts/messages related to condoms and voluntary counselling and testing (VCT) for complementary HIV prevention communication.

 

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4. Learning from Adolescents to Prevent HIV and Unintended Pregnancy

 

This research report proposes that new programmes and policies designed to prevent HIV in Africa should focus on providing earlier and more comprehensive sexual health information and reinforcing national health care systems to better serve youth. Published by the Guttmacher Institute and institutional partners in Burkina Faso, Ghana, Kenya, Malawi, and Uganda, the report compiles policy and programme recommendations based on findings from national surveys of approximately 20,000 African adolescents, as well as focus group discussions, and in-depth interviews with hundreds of young people, parents, teachers, and health care providers.

 

The research found that many adolescents are sexually active and need help to prevent negative consequences stemming from such activity. Adolescent females in sub-Saharan Africa tend to have sex at an earlier age than their male counterparts, and, thus, are at particular risk for HIV, unwanted pregnancy, and other adverse outcomes. The research also suggests that many adolescents do not use contraceptives, have experienced unwanted sex, have multiple or much older partners, and lack adequate knowledge about avoiding sexually transmitted infections (STIs) and pregnancy.

 

The research points to mass media as a major source for sexual and reproductive health information. In focus group discussions in the four countries, adolescents cited numerous reasons why radio, in particular, is one of their preferred sources of information. For example, they noted that radio is a reliable source (Uganda), it reaches a wide audience (Ghana), it gets information to young people quickly (Malawi), listeners do not need to go somewhere for the information (Burkina Faso), and parents can listen and teach their children what they learn (Malawi). However, adolescents also noted the limitations of mass media, including both the fact that one cannot easily ask questions and, in the four focus countries, as many as one in four adolescents have no access to the mass media. Similarly, the research suggests that new technologies are promising, but still reach relatively few adolescents.

 

This report identifies comprehensive school-based sex education as an effective and efficient way to educate adolescents, improve their knowledge, and reduce sexual risk behaviours. It goes on to make recommendations for improving school-based sex education in Africa and for specific actions to improve adolescents' access to the formal health sector.

 

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5. Festival of Love: HIV Prevention in the Sex Trades

 

The International Center for Research on Women (ICRW) is conducting a 3-year (Dec 2006-2009), participatory action research (PAR) project that seeks to reduce the risk of HIV among sex workers in Rajahmundry, Andhra Pradesh, India. Working in partnership with CARE India and the Nari SAKSHAM sex workers' collective, ICRW is seeking to understand the factors that encourage individuals to sell sex, and to explore ways to mitigate the impact of HIV risks once they enter the sex trade. The project will generate empirical evidence to be used to inform the development of both programme interventions and policy at the local, national, and international levels, with particular emphasis on reaching United States (US) stakeholders, including members of Congress.

 

The core strategy involves PAR that is designed to empower women by finding ways to value sex workers' subjective experience related to gender, sexuality, and intimacy (e.g., pleasure, power, pain, shame). Sex workers are at the centre of Prema Panduga (or "Festival of Love"), driving the process and determining next steps. Specifically, Prema Panduga revolves around a series of discussions that were designed to establish a common platform among project staff and sex workers for thinking and acting together. Part of this process of building trust and solidarity involved recognising and addressing social and cultural barriers that might impede communication. According to ICRW, the resulting unguarded conversations between the women and staff that took place enabled the open exchange of ideas for how to refine and deepen harm reduction interventions.

 

Building on these connections, the participants felt empowered to gather momentum to suggest and implement real-world applications of the concepts they had discussed in the sessions. For instance, based on the fact that, in southern India, many sex workers entertain clients through song and dance before providing sexual services, the women suggested that Prema Panduga provide skills-building on theatre techniques and mime. This led the women to form a cultural troupe called Nari Kala Vedika that works to generate awareness on the risk of HIV among their peers and with the broader community. These performances reflect what ICRW claims is a notable outcome of the discussions held through Prema Panduga: the women situate the issue of HIV risk from their own perspective, choosing to address issues of violence and exploitation, dowry practices which are at the origin of many women's entry into sex work, and lack of access to health and education services, given prevailing stigma and discrimination.

 

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6. Fijian BCC Programme Leads to Ownership of HIV/AIDS Prevention Responses

 

In June 2006, the Pacific Regional HIV/AIDS Project (PRHP) piloted the Stepping Stones programme in Fijian communities in an effort to improve Fijians' sexual health and to decrease HIV/AIDS in that country through community participation and local-level decision making. This July 2007 evaluation report analyses the effects of the Stepping Stones programme in Fiji as evaluated through both the "Gemscale Model" and the "Most Significant Change (MSC) Technique" (both approaches are described at length in this report), and provides recommendations for the scaling up of the programme into other Pacific Island countries.

 

Evidence from the stories collected showed that Stepping Stones had facilitated improved HIV-related behaviour change amongst both clients and implementers of Stepping Stones. Of the client stories collected, a number of them reported an improvement in communication with their community, family or sexual partner and spoke of new skills and confidence to speak about HIV and sexual health issues. This in-turn led to clients reporting improved relationships with sexual partners, less community fighting, and better communication and trust between parents and children.

 

Evidence from this evaluation found that, when well implemented, the Community Self Assessment evaluation, a part of the MSC evaluation approach, can be an effective way of monitoring programme outcomes and capacity development. Its strengths lie in its inclusive approach and its encouragement of communities to become empowered to find their own responses to HIV/AIDS.

 

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7. Reviewing Approaches to HIV Prevention Among Vulnerable Populations

 

This publication, a Pathfinder International technical guidance series paper, describes approaches to working with populations especially vulnerable to HIV/AIDS. The document outlines strategies effective in prevention of HIV/AIDS among sex workers (SW), men who have sex with other men (MSM), and injecting drug users (IDU). Programmes described include peer education, comprehensive health services and quality of treatment, provider referral networks, and in-service training and sensitisation.

 

Pathfinder’s assessments outline three key elements that should be integrated in effective HIV prevention strategies for these groups: 1) identify, develop, and pursue community-determined and -led actions to change individual and social behaviours that reduce risk of HIV infection; 2) guarantee equal access to comprehensive quality health services; and 3) promote respect of fundamental human rights.

 

As stated here, behaviour change communication (BCC) programmes which focus on the dissemination of large amounts of information related to "healthy" behaviours (usually designed without the participation of vulnerable group members), fail to change attitudes and mold behaviour. Focusing on the "must do's" and "must not do's" seldom has meaning in the priorities and daily struggles of vulnerable communities. Cultural sensitivity within the AIDS epidemic means listening to and respecting the cultural diversity of individuals vulnerable to HIV/AIDS: their life styles, sexuality, values, norms, and rules for daily living. The process of developing communication campaigns and educational materials absolutely must include the participation of the vulnerable groups to be reached, if they are to be relevant and effective.

 

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8. The History and Challenge of HIV Prevention

 

Published in August 2008 as the first in a series of six articles about HIV prevention in The Lancet, this report assesses strategies that have emerged throughout the history of efforts to respond to the global HIV and AIDS epidemic. The authors' primary claim is that the response has for the most part been delayed, fragmented, inconsistent, and - in general - insufficient.

 

Tracing the critical events in the global response to HIV/AIDS since the first cases of AIDS were reported by the Centers for Disease Control and Prevention (CDC) in 1981, the authors outline various shortcomings along the way, such as the mistakes of the mid-1990s, when HIV/AIDS slipped down the political agenda and the pandemic greatly expanded. One reason for these failures is an insufficient focus on the role of communication; the authors claim that "[s]uccessful responses have addressed sensitive social factors surrounding HIV prevention, such as sexual behaviour, drug use, and gender equalities, countered stigma and discrimination, and mobilised affected communities; but such responses have been few and far between." They indicate that it was not until the turn of the millennium that a new receptivity to tackling HIV prevention emerged.

 

The authors conclude by advocating that revitalising the global HIV prevention movement requires that future efforts be grounded in both an awareness of past missteps and in a better understanding of how to combine behavioural, structural, and biomedical approaches - an understanding that is based on scientifically derived evidence as well as the wisdom and ownership of particular communities.

 

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9. Integrating Biomedical Interventions with Behavioural Interventions

 

Published in August 2008 as the second in a series of six articles about HIV prevention in The Lancet, this review discusses the state of biomedical HIV prevention research. The authors focus on sexual transmission, classifying prevention methods by the specific mechanism of action rather than the mode of delivery. They review physical barrier methods, control of other sexually transmitted infections (STIs), male circumcision, topical antimicrobial (microbicide) preparations, the prophylactic use of antiretroviral drugs (oral and topical), and HIV vaccines. For each of these methods, they describe the available evidence for efficacy or effectiveness, make recommendations for use, and suggest future research needed. They also review levels of evidence for effectiveness for each method.

 

The authors stress that communication strategies should play a role in moving forward. For example, to avoid risk compensation and to increase adherence, biomedical methods should be inextricably implemented together with behavioural interventions. Likewise, biomedical interventions, such as male circumcision, offer an opportunity for risk reduction counselling. This review suggests that rather than trying to control for the effect of behaviour on biomedical methods, future studies should embrace this integration and use creative designs to examine strategies that offer a variety of prevention methods.

 

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10. HIV Prevention for Youth Through Sport

 

This paper, published by Mercy Corps, looks at the role of Sport for Development in HIV prevention. The document looks specifically at the role of "plus sport" programmes, as opposed to "sport plus" programming. Sport plus programming involves young people in sport to learn new sports skills and/or improve health and social integration. Here the outcomes are sport-related. The plus sport approach discussed in this document, on the other hand, has non-sport, HIV/AIDS-related outcomes as the primary objective. The document draws on the experiences of two plus sport projects run by Mercy Corps – the Yes To Soccer programme in Liberia and the Sports for Peace and Life programme in southern Sudan - to discuss this approach and assess its value and limitations. Based on these projects, the document also offers tools and recommendations intended to contribute to developing a body of knowledge on practices within sport-based youth HIV/AIDS programming.

 

According to this report, these 2 programmes have demonstrated that a sport-based approach and participatory games-based methodologies are effective in increasing youth HIV/AIDS knowledge and protective attitudes. Yes To Soccer reported a 27% increase in youth knowledge and attitudes from pre- to post-test (from 58%-85%). The programme was placed within an existing youth life skills programme targeting older youth. Sports for Peace and Life, while reaching a larger number of participants, showed a more moderate 12% overall increase in youth knowledge and attitudes (from 69%-81%) across 16 HIV/AIDS related questions.

 

Based on lessons learned through these two programmes, this report makes a number of specific recommendations for successful behaviour change HIV prevention programmes.

 

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11. South African Entertainment-Education Television Drama Influences Youth

 

Tsha Tsha is a South African educational-entertainment television drama series about young adults living in a world of HIV/AIDS. The drama series is set in a rural town in the Eastern Cape of South Africa and is produced in the local language, Xhosa, with English subtitles. The series focuses on the lives of several young people, and explores love, sex, and relationships in a world affected by the realities of the pandemic. The series aims to enhance its young adult viewers' capacity to reflect on their own problems, engage in developing solutions, and become active agents in shaping their future. The series comprised 78 episodes broadcast during primetime television between 2003 and 2006.

 

The Centre for AIDS Development, Research and Evaluation (CADRE), with technical support provided by Health Communication Partnership (HCP) researchers, evaluated audience responses to the first 26 episodes of the television drama Tsha Tsha based on data collected between April 2003 and May 2004. A subsequent evaluation in 2007 provided further information for this impact data.

 

From the July 2007 evaluation, those who had seen Tsha Tsha were 7.9% more likely to have positive attitudes towards people living with HIV/AIDS. Further, shifts towards positive/empowering values, attitudes, and behaviours were not limited to the context of HIV/AIDS but extended into other areas such as relationships (friendships, parental, sexual), poverty, and social problems such as alcohol and drug abuse, crime, violence, and unemployment.

 

Among the study's findings was evidence that people who had seen Tsha Tsha were 6.5% more likely to report condom use at last sex, as compared to those who had not seen it; viewers were also 5.5% more likely to help someone who is sick with AIDS.

 

For additional details on the Tsha Tsha programme, itself, please click here.

 

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Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

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This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

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C-Change Picks - Information about Behaviour and Social Change Communication

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Date: 
August 26, 2008

C-Change Picks #1 - Information about Behaviour and Social Change Communication
Sponsored by C-Change
August 26 2008

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

 

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C-Change Picks is a new e-magazine that is supported by C-Change and implemented by The Communication Initiative and focuses on recent case studies, reports, analyses, and resources on communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

 

Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see the C-Change website. To contact C-Change, please email cchange@aed.org

 

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.

 

C-Change Picks seeks new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com

 

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In this Issue…

 

FAMILY PLANNING
1. The Role of Men and Boys in Women’ Health: Seminar Aims to Build on Lessons Learned
2. Addressing Gender Equity Issues: WHO Evaluation of Health Interventions with Men and Boys Provides Promising Evidence
3. Ugandan “Love Letters” Pull Men to Fetal Heartbeats
4. Going the Extra Mile to Provide and Sustain Family Planning Services in Remote Madagascar: A Case Study on CARE’s Extra Mile Initiative
5. Pathfinder Chart Provides Helpful Family Planning Discussion Topics for VCT Counselors
6. Training and Reference Guides Developed by FHI to Facilitate the Use of Family Planning Screening Checklists
7. Information Bundle on Behaviour Change Communication Compiled by INFO Project to Help Family Planning Programme Managers in Building Effective BCC Programmes

 

HIV/AIDS
8. A Framework for Classifying HIV Prevention Interventions Is Needed, According to Report to the Joint United Nations Programme on HIV/AIDS (UNAIDS)
9. Sexuality and HIV Education: Population Council Brief Urges a Paradigm Shift
10. Zimbabwean Film “Ndizvo Zvandiri” Helps to Create Dialogues on HIV, PMTCT, and Male Participation in Reproductive Health
11. Tewerwari Kewakebt (The Shooting Stars) Serial Comic Book Illuminates HIV Prevention for Ethiopian Police Officers
12. Report from UNAIDS Examines the Role of Social Change Communication on Achieving HIV/AIDS Goals

 

MALARIA
13. Role of Information and Communication Networks in Malaria Survival Is Examined in Research Study
14. Faith-Based Models for Improving Maternal and Newborn Health

 

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FAMILY PLANNING

 

1. The Role of Men and Boys in Women’ Health: Seminar Aims to Build on Lessons Learned

 

This summary document discusses the proceedings of a seminar held May 29 2007 in Washington, DC by the International Center for Research on Women to discuss the importance of working with men and boys to promote healthy lifestyles among women and men, to learn what is happening in the field with this approach, and to develop a consensus on how to move forward. A review of existing programmes demonstrated that most programmes which target men and boys for health care interventions use one of three approaches, or a combination of these. They are: (1) serve men as clients, (2) involve men in improving women's health, or (3) work directly with men and boys to promote a positive shift in gender norms, away from attitudes and behaviours that undermine women's and their own health and well-being. Seminar participants reported that the third approach has had the farthest reach, and shows the most promise for scaling up. Throughout the day’s discussions, participants underscored that successful health interventions for both women and men depend on changing social norms around masculinity that undermine men's and women's health. This emerged as a key recommendation for moving forward in program and funding efforts. Participants also agreed that changing harmful gender norms – while important – is not sufficient to bring about the necessary changes in health care to curb rising HIV and gender-violence rates or to otherwise improve reproductive and sexual health. They suggested that stakeholders also need to build partnerships across organisations working with women or men, and establish links with other social justice movements. This document identifies and details a number of additional recommendations addressed to disparate audiences: programme designers and managers; advocates; and donors.

 

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2. Addressing Gender Equity Issues: WHO Evaluation of Health Interventions with Men and Boys Provides Promising Evidence

 

This review, authored by Gary Barker, Christine Ricardo, and Marcos Nascimento, summarises 58 evaluation studies of interventions that were intended to change the behaviours and attitudes of men and boys to achieve health-related gender equity. The document includes ratings of these programmes based on level of impact, and gives more weight to interventions that confirmed behaviour change on the part of men or boys. Key findings included:
a. Well-designed programmes with men and boys show compelling evidence of leading to changes in behaviours and attitudes; programmes rated as being gender-transformative had a higher rate of effectiveness.
b. Integrated programmes and programmes within community outreach, mobilisation, and mass-media campaigns show more effectiveness in producing behaviour change.
c. Relatively few programmes with men and boys go beyond the pilot stage or a short-term time frame. Hence, little information is available on bringing such programmes to scale. The document suggests that this would require addressing questions of programme coherence, programme use beyond the original sites, cost effectiveness, and the effects of cultural variables, and including these issues as part of programme evaluations and public reflection and debate.

 

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3. Ugandan “Love Letters” Pull Men to Fetal Heartbeats

 

This article, by Rachel Scheier, outlines a behaviour change strategy being used by clinics in the Jinja district of Uganda to encourage men to be involved in the pre-natal care and reproductive health of their wives. When a woman visits a clinic alone, after her consultation she is given a brief letter for her husband, signed by the local district health director, which includes some basic information and a polite request to come to the clinic in person to discuss health matters, such as: HIV testing; what to expect during the delivery; and how to care for a pregnant woman. The letter is designed to encourage men to attend the clinic as an expression of love for their family. When a man arrives at the clinic for a first pre-natal visit, he is weighed and his temperature and blood pressure are taken alongside his partner's to demonstrate to men that they are directly involved in the childbearing process. According to one man interviewed for the article, this letter encouraged him to take the time to come to the clinic and find out what the couple could expect in the time leading up to the birth of their child. In addition to getting more men to come to the clinics, the love letter also gives women much-needed bargaining power, providing them with a way to approach their husbands about sensitive issues related to health care.

 

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4. Going the Extra Mile to Provide and Sustain Family Planning Services in Remote Madagascar: A Case Study on CARE’s Extra Mile Initiative

 

This case study, written by Catherine Toth, documents experiences with the Extra Mile Initiative (EMI), a two-year effort undertaken by CARE in Madagascar to bring education and family planning services to remote communes located in conservation zones that are threatened by the growing population. EMI aimed to increase awareness of and access to family planning services through a combination of community planning, identification of the economically poorest families not able to utilise existing family planning support, expansion of existing community-based distribution schemes, person-to-person training, and information, education, and communication (IEC) materials. This publication explores how the EMI was embedded into the local health system, communities, and local government of the communes it served - providing a network of people and institutions to continue to meet the family planning needs of the population after the project ended.

 

According to this report, when the EMI began, the contraceptive prevalence rate there was about 11% (traditional and modern methods combined), which is well below the national average of 27%. Twelve months later, 24% of women of reproductive age in the project area were using some method to plan their families.

 

A key to the programme’s success, according to this study, was the decision to embed the project not only in the local health system and the communities it serves, but also in local government, forming a triad of implementation and oversight, and essentially changing the “culture” of service provision within the communes served. In Madagascar, the national government mandates the structure of commune government; among the key administrative bodies is the Social Development Committee (SDC), charged with supporting basic services such as health and education. Most SDCs exist in name only, however, since they lack the training and guidance to function successfully. CARE trained and supported the SDCs to become functioning members of the triad and to promote and reinforce the social and behavioural changes that were required to improve family planning within the communes. The integration of the project within the three main spheres of influence - health centres, community leaders, and SDCs - created space for dialogue and collaboration where none previously existed. As trust and communication grew within each triad, they also grew in the communities they served.

[Also see - Extra Mile Initiative (EMI) – Madagascar]

 

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5. Pathfinder Chart Provides Helpful Family Planning Discussion Topics for VCT Counselors

 

This resource, from Pathfinder International, is a two-sided chart of family planning goals for women, men, and couples, with additional information for adolescents, sex workers, men with multiple partners, and pregnant or post-partum women. It includes such topics as having a healthy baby, preventing pregnancy, and postponing pregnancy. It is designed for use by HIV/AIDS voluntary counseling and testing (VCT) counselors wishing to integrate family planning messages into their counseling sessions.

 

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6. Training and Reference Guides Developed by FHI to Facilitate the Use of Family Planning Screening Checklists

 

This is a series of four training and reference guides designed by Family Health International to help programme managers, administrators, trainers, and service providers to use checklists for screening women on a variety of family planning methods. There is one guide each on using checklists to initiate use of oral contraceptives, injectables, and the copper IUD. A fourth guide addresses the use of a screening checklist that enables providers to rule out pregnancy among non-menstruating women who want to start a family planning method. A fifth guide on using a checklist for initiating the use of implants will be available in the future, according to the FHI web site. Each guide provides a four-to-six-hour curriculum for training service providers to use the checklist and a CD-ROM containing key resources needed during the training. Each guide also provides reference information to supplement the training.

 

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7. Information Bundle on Behaviour Change Communication Compiled by INFO Project to Help Family Planning Programme Managers in Building Effective BCC Programmes

 

For use in planning behaviour change communication (BCC) programmes, this is a bundle of reports focused on BCC in family planning, reproductive health, HIV prevention, and other health and development areas. Compiled by USAID's INFO Project, the bundle includes the Population Reports issue, "Communication for Better Health" (see below for more information); two companion INFO Reports issues, "Tools for Behavior Change Communication" and "Entertainment-Education for Better Health"; several online tools such as a PowerPoint presentation; and a Question and Answer summary. Links to two short online courses, one on "Monitoring and Evaluation Fundamentals" and the other on "Fostering Change in Health Services,” are also available.

 

The "Communication for Better Health" issue of Population Reports, authored by Ruwaida M. Salem, Jenny Bernstein, and Tara M. Sullivan, is intended to help family planning programme managers to build behaviour change communication (BCC) into their overall strategies. The contents include a concise summary of BCC with examples of its use and efficacy in different context, an outline of the BCC process, two practical case studies - briefs on an Ethiopian radio serial and a multi-media campaign in Egypt - an article about scaling up BCC programmes, and a brief about participatory BCC approaches. A summary of this issue is available – click here.

 

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HIV/AIDS

 

8. A Framework for Classifying HIV Prevention Interventions Is Needed, According to Report to the Joint United Nations Programme on HIV/AIDS (UNAIDS)

 

Authored by Michael Sweat, this document is premised on the claim that there is little consistency in how interventions to address HIV and AIDS are described and defined. Based on a review of the scientific literature, the author and his colleagues first examine how the field of HIV behavioural prevention science has been described and categorised historically. The initiatives explored include the following features: voluntary counselling and testing (VCT), condom social marketing, partner notification, family planning for HIV-positive women, mass media, messages focused on abstinence and/or abstinence-only, needle and syringe exchange, psychosocial support, and the impact of medical treatment on HIV risk behaviour. Citing specific examples of interventions reflecting the above-cited approaches, the author finds that most interventions were combinations of multiple activities. Despite this, according to the author, investigators tended to identify the intervention by a single, often prominent, component. In addition, "frequently, detailed descriptions of interventions were missing completely and only a word or brief phrase was used to describe the activities conducted." Sweat argues that "the current ad hoc manner of conveying the content of interventions results in difficulty in establishing quality standards."

 

The solution proposed here is an ontology, which is a specific system of classification based on an explicit logic and purposefully designed with objective criteria in mind. The following steps are recommended for establishing clear definitions for HIV and AIDS interventions: "(1) Identify brief definitions describing activities or services and commodities provided in the intervention. When relevant, also refer to key message content included with the intervention. (2) Through consensus meetings with key stakeholders and experts, provide a rich description of other requisite components of the intervention, including message content, the method of delivery, how to tailor the intervention to audiences and settings, the intervention's desired outcomes, and its theoretical basis. With the establishment of clearly defined interventions with associated quality standards, estimated costs and optimal bundling strategies, it will be possible to provide improved recommendations to programme planners and policy-makers striving to intensify HIV prevention programmes. Consensus in these areas would enhance our ability to plan, allocate requisite resources - including human resources - advocate prevention, and monitor and evaluate the success of prevention programmes."

 

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9. Sexuality and HIV Education: Population Council Brief Urges a Paradigm Shift

 

This brief from the Population Council (and written by Nicole Haberland and Deborah Rogow) examines curriculum-based sexuality education as a cornerstone of school- and community-based efforts to improve young people’s sexual and reproductive health, and, more recently, to prevent HIV infection. A review of the impact of school-based sexuality and HIV education programmes in developed and developing countries found that two-thirds of the programmes reduced the risk associated with one or more reported sexual behaviours. To further increase these programmes' effectiveness, the authors examine several key areas in need of rethinking to further address curricular effectiveness.

 

These areas include: focusing on underlying gender attitudes and behaviours as an element in developing curricula; examining and teaching about the broader social contexts in settings with younger adults; investing in training teachers in interactive and participatory methods, as well as expanding the focus on critical-thinking skills (instead of rote learning); examining the outcomes of same-sex versus coeducational programmes in different settings; and examining the demographics of the youth reached to determine who is being “missed” by existing programmes.

 

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10. Zimbabwean Film “Ndizvo Zvandiri” Helps to Create Dialogues on HIV, PMTCT, and Male Participation in Reproductive Health

 

"Ndizvo Zvandiri" is a 30-minute film that aims to promote advocacy in prevention of mother-to-child transmission (PMTCT) of HIV, to encourage disclosure of HIV status, and to urge male participation in reproductive health issues. "Ndizvo Zvandiri," which means "This is What I Am," tells the story of Miriam, who discovers that she is HIV positive when she seeks antenatal care. Representative of the challenges that many women in Zimbabwe face, the film chronicles the gender challenges Miriam faces in disclosing her status to her husband, as well as how the couple eventually join hands to protect the future of their unborn child.

 

Intended to be shown and discussed in public health institutions, churches, workplaces, schools, community meetings, and any other group setting where dialogue on HIV/AIDS can be initiated, the film is complemented by a discussion guide to help facilitate discussion on the various PMTCT and social issues portrayed in it.

 

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11. Tewerwari Kewakebt (The Shooting Stars) Serial Comic Book Illuminates HIV Prevention for Ethiopian Police Officers

 

This is a 52-edition serial comic book designed to reduce the risk of HIV infection among members of Ethiopia's police force. It is distributed to officers within the Federal Police for use during ongoing peer group discussions. According to the press release issued on the launch of the comic book, the Ethiopian Police Force is known for its swift and efficient response in crises. The main characters of this comic serial, who are also members of the police force, are seen using their crisis-handling skills in responding to HIV and AIDS. By combining humour, action, and drama, the comic book aims to enable officers within Ethiopia's Federal Police to better understand the risks they face from HIV and to develop strategies that will keep them safer.

 

The Shooting Stars is part of the Modeling a Reinforcement to Combat HIV/AIDS (MARCH) project, which aims to be a model for HIV prevention. MARCH promotes behaviours that reduce the risk of HIV infection, such as faithfulness, condom use, and early detection and treatment of sexually transmitted infections (STIs) by using role models to demonstrate positive behaviour change through serial dramas and entertainment education.

 

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12. Report from UNAIDS Examines the Role of Social Change Communication on Achieving HIV/AIDS Goals

 

This document provides an overview of the discussions at the Joint United Nations Programme on HIV/AIDS (UNAIDS) technical consultation on social change communication on August 2-3 2007. The meeting explored the role of social change communication in achieving the ends of matching HIV/AIDS epidemic responses at the country level to the social drivers prevalent in each country, such as gender inequality, HIV-related stigma and discrimination, and human rights abuses, through activities that are effective, measurable, and can be taken to scale. Challenges to achieving those ends within the field of health communication and social change communication include a lack of coordination, investment, and consensus on key issues.

 

Key issues in social change communication described in the document include:
• Participation and the limits of participation - Participatory communication, participatory monitoring and evaluation, and local ownership were cited as central to good health communication, but the knowledge, skills, and technical capacities required for social change communication are not always resident within a community. Also, there may be local aversion to tackling the topic of sexual transmission of the virus.
• Building the body of knowledge - Using the example of social marketing of condoms, the report suggests that the lack of investment in generating good baseline information before interventions is now hindering development years after the first social marketing interventions took place.
• Civil society’s role - The experiences of participants highlighted the fact that any effort to place communication solely within the hands of national governments would possibly jeopardise the initiative, innovation, and energy within civil society.

 

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MALARIA

 

13. Role of Information and Communication Networks in Malaria Survival Is Examined in Research Study

 

This research, by Pallab Mozumder and Achla Marathe, investigates the impact of information and communication network (ICN) density variables on malaria death probability. It pools data from 70 different countries from 1960 to 2004 to construct a panel dataset of health and socio-economic variables that are used to study the effects of the density of telephone lines and television sets in malaria-exposed populations to see if higher ICN density improves the effectiveness of existing resources for malaria prevention and treatment.

 

The study states that "[w]ell-communicated information and collective decision making can lead to faster and superior home-based treatment." Through the use of ICN, sources of shared information on treatment of disease can be made available to a community as a kind of social capital. Because studies have shown that communities with high social capital have lower disease rates, and that "mass media and interpersonal communication channels can create a sense of urgency to react and take initiative at the early signs of malaria," the value of ICN for increasing problem identification, decision-making, and resolving problems collectively "can increase the level of confidence of those infected, and it can pool resources and expertise at the community level to provide treatment in a timely manner."

 

"The results suggest that information and communication networks can substantially scale up the effectiveness of the existing resources for malaria prevention...Furthermore, the impact of TV density is much higher compared to telephone density across all models, implying that public and mass media has a higher influence on establishing effective ICN outreach...Expanded information and communication networks will widen the avenues for community based 'participatory development' that encourages the use of local information, knowledge and decision making. Timely information, immediate care and collective knowledge-based treatment can be extremely important in reducing child mortality and achieving the millennium development goal."

 

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14. Faith-Based Models for Improving Maternal and Newborn Health

 

This brief by Sarla Chand and Jacqui Patterson highlights the contribution of faith-based organisations (FBOs) to health care by focusing on four FBO programme models that, despite multiple challenges, have been effective in improving maternal and newborn health (MNH) outcomes. The programme models are based on FBO health networks, community health behaviour change programmes, congregation-based health programmes, and comprehensive health care programmes. Using project examples mainly from Africa, the document shows how these models can strengthen and expand health services and contribute to the achievement of the health-related Millennium Development Goals (MDGs). The brief concludes with recommended actions for all stakeholders - FBOs, policy makers, and donors.

 

One of the programme models, a malaria prevention programme of the Synod of Livingstonia, Malawi, illustrates how congregations can be mobilised to promote behaviour change to improve health and save lives. As the document states, every village has at least one faith community which can provide a strong foundation for positive change.

 

Established in 2000, the Synod of Livingstonia’s malaria prevention programme provides: health education about prevention and early treatment of malaria; insecticide-treated nets (ITNs) at subsidised prices to pregnant women and children five and under; re-treatment of nets; and follow-up services for pregnant women and children who have had malaria. "The programme was implemented in 26 of 150 Church of Central Africa, Presbyterian (CCAP) congregations, primarily in hard-to-reach areas along the lake shore of northern Malawi and in the interior of the country...This region has received fewer services than other areas of the country. The Synod Health Department trained women from the congregations to deliver messages about malaria prevention and treatment.

 

In 2004, a post-intervention survey about malaria prevention and treatment was conducted in 43 villages with 1,035 respondents who were either pregnant women or caretakers of children under the age of five. The survey highlighted the programme’s successful outreach efforts (transfer of knowledge and availability of ITNs), with a high percentage (81%) of the respondents aware of the benefits of sleeping under a mosquito net. In addition, there was a significant increase in the percentage of respondents who reported having nets in their homes. The results also suggest that there are reasons, in addition to people’s knowledge about malaria transmission and prevention, that still influence their decision or ability to purchase mosquito nets or ITNs. These barriers must be identified and removed to enable widespread use of ITNs for malaria prevention."

 

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This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-CHANGE project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.

 

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Sent to you from The Communication Initiative...where communication and media are central to social and economic development...

 

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