1. Achieving large-scale results




UNICEF’s current C4D activities in West and Central Africa are neither designed nor delivered at a scale large enough to make a measurable contribution to the health-related MDGs or to improve rates of child survival and development (CSD). UNICEF’s Office in Nigeria, for example, is currently implementing more than 11 different C4D activities - but few reach more than a few hundred communities. Each communication initiative focuses on an individual sector such as immunization or avian influenza and each employs a separate communication strategy such as micro-planning or the production of posters.




To improve impact and achieve results, it will be necessary to deliver fewer initiatives at a much larger scale – to tens of thousands of communities rather than to hundreds.




Two strategic changes are required to achieve this level of coverage:




  1. UNICEF must focus on two or three broad communication methodologies and coordinate them for maximum impact. One of the methodologies should address interpersonal communication at scale – community dialogue is a good example. The other should mobilize community and national media around child survival issues - taking perspectives from interpersonal dialogue and giving them greater reach; creating channels for decision-makers in government to listen to care givers and engage them on child survival issues. A third possible methodology is community-based management of information – empowering care givers to monitor the survival and development of their children, thus helping them take ownership of child health. These communication methodologies must be coordinated and sustained if they are to create a social environment where large-scale change becomes possible. They can be reinforced by short-term public relations campaigns, but campaigns by themselves cannot be substituted for longer-term engagement.
  2. UNICEF must focus on partnership development at the community level, so that all possible networks are mobilized to engage care givers on issues related to child survival. Potential networks include community health workers, primary school teachers, traditional and religious leaders, micro-credit organizations and youth groups such as scouts or guides. If UNICEF identifies these networks in each country, develops their capacity for interpersonal communication and provides them with simple tools (such as picture cards) to stimulate dialogue on child health, it will dramatically improve the reach of its communication.




This engagement can then be strengthened with community management of information and enriched by mass media programmes on the same topics.




2. Focusing content




In order to achieve the intensity of communication that is required for sustained behavioural and social change, UNICEF should focus C4D for child survival on a small number of topics that:



  1. have the greatest impact on reducing under-five mortality; and
  2. can best be addressed by changing behaviours and social norms as well as improving supply chains or strengthening health systems.




The topics that best match these criteria are:




  • exclusive breast feeding, especially convincing mothers not to feed newborns water in addition to breast milk;



  • hand washing with soap at critical times;



  • use of insecticide-treated nets by children and pregnant women; and



  • care-seeking behaviour for diarrhea, pneumonia or neo-natal disorders.




To this short list of high-impact communication topics could be added a country or typology-specific priority such as abandonment of female genital cutting or prevention of HIV. But more intense communication (using just two or three methodologies) on a smaller number of topics will be required if measurable results are to be achieved.




3. Defining outcomes and measuring results



To achieve quality results, UNICEF must learn how to measure communication outcomes more precisely and then assess the contribution of each outcome to overall results in child survival. Specific communication outcomes could include:




  • large-scale increases in the number of people engaged in interpersonal communication and learning about CSD behaviours and social norms;



  • improved reach of mass media programming on CSD issues, based on the number of people that listen and respond to radio programming or read local language newspapers and information sheets;



  • higher standards for mass media programming - based on audience satisfaction surveys, development of in-depth programmes rather than jingles or PSAs, improved coordination with interpersonal communication, etc.



  • an increase in the number of groups (especially marginalized groups) that participate in discussion and action on CSD issues;



  • an increase in the number of communication channels established that allow decision-makers to listen and respond to community members; and



  • raised public awareness of CSD issues through public relation campaigns, etc.




These communication outcomes would then contribute to the overall goal of large-scale, measurable improvements in knowledge, behaviour and social norms related to CSD, which can also be measured quantitatively (through surveys) and qualitatively (through measurement techniques such as Most Significant Change).




4. Emphasizing human rights




A shared set of communication values must underpin WCAR’s strategy for programme communication in support of child survival. They are based on the human rights principles of inclusion, participation and self-determination – both to reflect the UN system’s commitment to rights and to ensure sustainable programmatic results. The most successful child survival initiatives are based on the active participation of all stakeholders - so that care givers freely choose to change individual behaviour and collective practice, rather than have change imposed upon them through prescriptive or persuasive techniques. Communication values flowing from these principles include:




  • giving a voice to everyone involved in the change process, especially people from marginalized groups;



  • basing communication on two-way dialogue and the exchange of information, rather than on one-way messages;



  • appreciating local culture and ensuring that proposed changes are consistent with traditional values; and



  • recognizing that in many societies and situations, individual behaviour is determined by social norms - and using communication to facilitate a process of collective rather than individual change.




Communication that is consistent with these principles and values creates space for communities to determine their own entry points and to establish their own priorities for child survival, based on situation analyses that they themselves perform. It contributes to governance and sustainability by creating effective communication channels between care givers, community-based organizations and government at local, sub-national and national levels - so that issues can be discussed at all levels, leading to consensus on the way ahead.



Neil Ford