This 15-page report outlines the communication plan developed by the United Nations Children's Fund (UNICEF) to prepare for and address avian influenza (AI) in Egypt. As explained here, in 2006, UNICEF joined forces with the Ministry of Health and Population (MOHP), State Information Services (SIS), and the Communication for Healthy Living (CHL) project (a United States Agency for International Development (USAID)-funded project) to lead national efforts to put forth a bird flu communication strategy with two distinct components: community mobilisation (led by MOHP and UNICEF) and mass media (undertaken by SIS and CHL, with USAID funding).

The report begins by providing a brief description of the pilot phase of these undertakings. Carried out in collaboration with non-governmental organisations (NGOs) such as Terres Des Hommes (TDH), the UNICEF intervention focused on the 7 most affected governorates, offering social mobilisation awareness campaigns as well as house-to-house educational activities at the village level. MOHP deployed more than 2,500 Raidat (community health workers), who were trained to deliver key preventive and behavioural messages to achieve a minimum set of change in practices in these areas. Policy advocacy at the governorate level was also a key strategy, as was networking with NGOs and civil society. Schoolchildren were also educated about key preventive practices. Finally, UNICEF sponsored a national radio campaign that included a celebrity drama, a mini drama, educational spots, children's songs, and question and answer (Q&A) talk shows; this campaign echoed the messages disseminated at the community level.

As detailed here, UNICEF sponsored a qualitative study to assess the outcome of the community intervention in late 2006. This campaign showed that, while some knowledge gaps persisted, AI knowledge had "markedly improved...overall improvement was evident especially in relation to the required protective measures such as cleaning and hand washing and keeping children away." While the study highlighted the positive role of community health workers in providing needed information to the public, it also emphasised the importance of establishing a continuous, effective, and systematic educational programme backed up with media campaigns. UNICEF also undertook a national baseline survey in the late 2006 to assess knowledge, attitudes, and practices (KAP); in general, results showed that the public has a general good knowledge of AI and its symptoms.

UNICEF suggests that these findings revealed several lessons learned during the pilot phase:

• Liaising with the media (especially highly viewed programmes and channels) is a key to ensure the impact of the community message.
• A tight system for monitoring and supervising the community activities must be developed.
• A strong social marketing and awareness campaign in the areas of intervention will increase and support the community intervention programme.
• Intensive social mobilisation campaigning to support community education is indispensable.
• The school programme should be followed up at the central and governorate level.
• Stronger linkages should be made with Ministry of Agriculture (MOA) extension workers at the village level.

Building on these insights, the UNICEF intervention in the 22 infected governorates will involve the following specific communication objectives in 2007-2008:

1. Improve knowledge of certain practices such as the risk of children playing with and/or handling poultry, and hygienic means to dispose of poultry waste;
2. Increase the percentage of the public who believe that they could be infected by AI and/or who think that their children could be at serious risk if they handle poultry;
3. Decrease the percentage of children who play with/handle poultry in the areas of intervention;
4. Decrease the percentage of the public who purchase chicken from unsafe sources (lay merchants);
5. Contribute to the preparation of behavioural messages for home care and hygiene in the case of a pandemic outbreak.

Core strategies and activities will include:


Community Interventions - "For deeply rooted practices in the family, interpersonal communication remains to be the most important tool to achieve any behavioral change. Yet the experience of UNICEF last year shows that it is not an easy task..." To address these challenges, UNICEF will undertake:

1. Support for the MOHP's community outreach programme:
   
   
   • Training of Radiats - Among the lessons learned from the pilot intervention is the need to condense the training materials and eliminate overly technical veterinary information. Having reviewed training content, modified information, education, and communication (IEC) messages and materials will be produced and introduced to approximately 35 training of trainer (TOT) participants. The "step-down" training activities that will follow this process are expected to involve approximately 11,000 Raidat.
   • House-to-house education - This component will draw on the radiates refiat (or, community worker) (RR) programme of MOHP. Refresher training will be provided to both RR and volunteers to update their information and their capacity to use IEC materials.
   • Institutionalisation of the community outreach programme by re-working the monitoring and reporting system for the RR as relevant to the community activities of avian flu and ensuring mechanisms for effective supervision.
   • Community mobilisation and education - Having acknowledged the central role of natural, political, and religious leaders, the community education programme will seek these leaders' full commitment and support by holding meetings at the governorate level during the intervention time, coordinating with the church at the central level, and encouraging community leaders to keep the issue on the community agenda (e.g., by disseminating key messages to their constituencies, and by creating a strong network to facilitate communication and action in the event of an outbreak).

2. Community awareness campaign: Key messages will be placed on large billboards in populated areas like markets, bus and stations, health clinics, post offices, and schools. Other social marketing techniques will be used to reach out to those in remote areas.
3. School programme: Nationwide, announcements will be read aloud as children wait in line in the mornings, posters will be hung in the corridors, stickers will be placed in the bathrooms, and simple stories will be distributed.
4. IEC materials: A quick assessment of the audience feedback (community and schools) to realign the IEC materials developed in the pilot phase will be carried out, followed by a review of the messages based on the completed research. The resulting materials will be distributed, and will likely include: a community flip chart, a community educational video, school posters and stickers, a school educational video, and social marketing materials such as signs and billboards.

The media as a change agent - Findings of UNICEF's research indicate that media is the most important source of information for avian flu as well as other health-related issues. To draw on this influence, UNICEF will undertake:

1. Media partnership and capacity building: UNICEF contends that Egyptian media professionals have made significant progress in the style and quality of reporting of avian flu, but that the issue (AI) is only reported when a case is suspected or confirmed. In response, UNICEF will invite a core group of editors and senior journalists to a media roundtable on AI. Among the materials expected to be shared: an analysis of media handling of avian flu, with a review of newspapers, pages, names of journalists, and space provided to the issue. A media workshop will follow; its purpose will be to train at least 40 participants in practical ways to improve journalistic standards related to AI coverage. Each participant will set up follow-up actions to be carried out after the workshop. As part of this process, a media-friendly package will be developed (based on online research and resources) and distributed; in addition, "brown bag" seminars will be convened on regular basis to keep the link with the group. A final content analysis review, and face-to-face interviews with participating media professionals, will be carried out to assess the outcomes of this part of the initiative.
2. Media campaign: UNICEF believes that use of television (both national TV and satellite channels) can be a cost-efficient way to reach millions of Egyptians with AI messages. The format of the materials will include 15-second educational messages, "key practices reminders", and/or news programmes and interviews with the public. Radio may also be used.

Research - The Partners Research Group that reviewed the baseline survey (described above) will meet on an ad hoc basis to: establish various behavioural indicators and agree on a composite KAP index; identify relevant questions related to communication, KAP, and AI; and establish a databank. Then the outcome of the AI communication intervention will be assessed, and an audience feedback assessment of the IEC materials will be carried out.

Pandemic preparedness - UNICEF will work closely with MOHP and other partners to support the GOE in its avian flu pandemic planning - for example, by providing technical support for the review of communication materials produced. The organisation will encourage national counterparts to conduct a small-scale qualitative study exploring how to control public panic, and will also host a meeting in early 2008 to give participants the chance to share communication experiences in pandemic preparedness.

The remaining sections of the report outline, first, the documentation, monitoring, and evaluation process that will be carried out as part of this AI communication project. To cite only one example, UNICEF plans to undertake photo and video documentation of activities in the field and to develop relevant human interest stories, web stories, and the like to disseminate information to the public about the intervention. Next, several challenges that the GOE may face in moving forward with its handling of AI are outlined - at political, programme/management, and public/socio-economic levels. The final portions of the report include a number of detailed tables and charts outlining various coordination and management plans and issues.

Please contact Sahar Hegazi at the address listed below to request a copy of the full document.