The "Permanent Smile" campaign drew on television, radio, a documentary, printed information, education, and communication (IEC) and promotional materials, and public relations efforts. Based on initial research findings (see the "Key Points" section, below), the following communications objectives were set for the campaign:

• To create awareness of and a positive image for vasectomy;
• To provide correct information on vasectomy (and on no-scalpel vasectomy, or NSV) and to educate both men and women about its benefits;
• To increase awareness of the names and locations of sites where NSV services are available; and
• To encourage acceptance of vasectomy by using testimonials from satisfied clients.

Organisers determined that the campaign needed to be positive and upbeat to help change the method's image. A decision was made not to translate or change the term "vasectomy," but, rather, to change the image and dispel the myths surrounding the method. Informed by this approach, organisers selected an advertising agency to create and develop appropriate communication plans and materials. Throughout the campaign, vasectomy was positioned as a family planning method that can enhance men's lives and their ability to care for their partner and children.

Media Campaign

The lead medium in the vasectomy campaign was television. Two television advertisements were produced - one with a local orientation and one with an international focus. Both positioned vasectomy as a viable family planning option for men in stable relationships - a choice that can help them thrive at home and in their careers. The "international ad" portrayed vasectomy as a method widely accepted internationally and featured men and families of all races, whereas the "local ad" featured a Ghanaian family and the man's success in the local context. Television and print materials were produced in English, and the campaign's two radio spots were produced both in English and in two local dialects. Both television and radio advertising were scheduled to air in 4-week intervals separated by 2-week periods of no advertising. This "flighted" strategy was selected to maximise the impact of the campaign, given the programme time frame and budget. Both television and radio spots were aired on national television and radio stations during primetime hours.

The majority of the IEC print materials were provided to site-level staff, who then distributed the materials at their facilities, within their communities, and during their launch events. In addition, the advertising agency distributed some IEC materials in public places where men were easily reached (e.g., bars and garages).

Community Outreach

Staff at each project clinic designed and implemented programmes for reaching out to their local communities to increase awareness of the availability of vasectomy services. The key component of the outreach programme at all sites was a campaign "mini launch." Conducted by the nurses from the family planning department of each of the project clinics in the community surrounding each site, these events featured speeches by providers, by public health officials, and by satisfied clients, as well as other activities designed by the site. According to organisers, each of the mini launches was attended by approximately 300 people.

The outreach programme activities included printing vasectomy T-shirts for community health nurses to wear, dedicating several monthly "health walks" in Accra by La General Hospital nursing staff to vasectomy (in which health information was projected by megaphone during a walk through communities), and a quarterly Daddy's Forum. Several clinics' community health nurses made visits to places where men can be reached, such as truck stops and transport unions.

Hotline

The project established a hotline service in an effort to provide men and women interested in seeking more information about vasectomy with a convenient, anonymous, and reliable mechanism for addressing their initial questions about the method. Virtually all of the communication materials encouraged men and women to call the hotline if they were interested in more information about vasectomy. Male and female operators were trained to answer questions, provide information about vasectomy, and refer callers to vasectomy service sites. The hotline operated 6 days a week, from 8h00 am to 10h00 pm, during the first 4 months of the campaign, and was set up again during the second period of advertising that aired from September 20 to October 20. In both periods, the hotline operated for 2 weeks after the campaign stopped airing.

Gender, Reproductive Health.

The results from qualitative research conducted by EngenderHealth in 2001 on clients' perceptions of vasectomy were used as a basis for designing the communications strategy. Among the key findings from the 2001 assessment were:

• Users of vasectomy were very satisfied with the method;
• Nonusers had very negative attitudes toward vasectomy;
• Men who were aware of vasectomy frequently had incomplete or incorrect information about the procedure; the primary misconception was that vasectomy is “castration”.

In 2006, the Access, Quality and Use in Reproductive Health (ACQUIRE) Project released a comprehensive evaluation of the project exploring the viability of vasectomy as a contraceptive choice in Ghana. The report, 'Get a Permanent Smile'--Increasing Awareness of, Access to, and Utilisation of Vasectomy Services in Ghana, describes the results of the project and suggests that using a combination of site interventions focused on access and strategic interventions aimed at demand awareness can significantly impact attitudes and utilisation.

Results indicate the project was successful in increasing awareness of, access to, and utilisation of vasectomy services. In 2004, service volume was 6.6 times higher than the average number of procedures provided in the 10 years prior to the project (1994-2003). The number of men aware of vasectomy nearly doubled, and men’s “intention to consider vasectomy” also doubled.

Among the several campaign concepts that the agency developed for evaluation by the target audience, the “Permanent Smile” campaign was the strongest. It was well-understood and well-liked by members of the target audience. The campaign slogan “Vasectomy…Give yourself a permanent smile” anchored the campaign as its theme and was included in all advertising materials. A satisfied user of vasectomy from Kumasi was identified to be the “face” of the campaign; his smiling image was featured in all campaign materials.

The ACQUIRE Project is a collaborative project funded by the U.S. Agency for International Development (USAID) and managed by EngenderHealth, in partnership with the Adventist Development Relief Agency International (ADRA), CARE, IntraHealth International, Inc., Meridian Group International, Inc., and the Society for Women Against AIDS in Africa (SWAA). The ACQUIRE Project mandate is to advance the use of facility-based reproductive health and family planning services.