“The development of the campaign focused on filling gaps identified through formative research in order to create a positive environment for men and women, health workers, religious and community leaders to actively discuss health problems, find ways to tackle them together and then take actions to change individual behaviors and community norms.”
This programme report outlines the communication strategies and outcomes of the Support for Service Delivery Integration (SSDI)-Communication project, a five-year (2011-2016) US Agency for International Development (USAID)-funded social and behavior change communication (SBCC) project that worked with the Ministry of Health (MOH) and other stakeholders in Malawi to promote normative and behaviour change in several health areas: maternal, neonatal and child health (MNCH); family planning (FP); malaria; HIV and AIDS; nutrition; and water sanitation and hygiene (WASH). Impemented by the Johns Hopkins Center for Communication Programs (CCP), along with several local partner organisations, the project’s vision was that by the end of 2016, families in Malawi would be better able to advocate for their own health, practice positive health behaviours, including timely use of essential health package (EHP) services, and would be engaging with a responsive health care system. Coordinated SBCC systems would be in place within national, district, and community level structures accompanied by broad stakeholder commitment, leveraged funding, and sustained institutional leadership.
The report discusses the projects design and approach, as well as the activities undertaken to achieve its objectives. One of the approaches used by the project was the life stages approach to segment key audiences, which enabled health communication to focus on what was most relevant to people at various points in their lives. Four key life stages were identified in the SBCC strategy: young married couples; parents of under five children; parents of older children; and adolescents. In order to overcome the challenge of multiple health topics and audiences, the project created a unifying platform, Moyo ndi Mpamba, Usamalireni (life is precious, take care of it), which was essentially a three-year multi-level multimedia campaign. The activities falling under the Moyo ndi Mpamba, Usamalireni brand are discussed in detail in the report. In brief, they included:
- Radio based initiatives: Radio spots, national radio dialogue sessions to promote discussions on issues that affect people’s health and wellbeing, and three radio programmes (one radio serial drama, and two “reality radio” programmes).
- Transformative tools: A Family Health Booklet and a flipchart for Community Health Workers/Volunteers, a participatory toolkit for adolescent girls and young women to prevent HIV, a booklet for couples who are about to get married or who are newly married, and a comic book for children that promoted both malaria prevention and literacy.
- District Health Promotion Roadshows held at trading centers and market places, which used interactive entertainment education approach to promote positive health behaviours, utilisation of health services and encourage dialogue and discussions on priority health issues.
- Music4Life Initiative: Using the power and reach of music in Malawi, the project worked with musical artists to produce and perform songs that incorporated health messages. Music festivals were held at regional and national level, and a music album and all star video were produced and distributed to radio and TV stations in Malawi.
- Other supporting materials: Billboards, posters, leaflets.
The project also implemented capacity building activities to strengthen the capacity of national, distric,t and community level actors to design, implement, and coordinate SBCC interventions.
SSDI-Communication conducted a variety of research, monitoring, and evaluation activities throughout its implementation period and the results are shared throughout the report and in the appendices. Overall, as outlined in the executive summary, the results were as follows:
“SSDI-Communication made significant gains in promoting normative and behavior change around the six health topics, and in strengthening capacity of national, district and community level actors to design, implement, and coordinate SBCC activities. The Moyo ndi Mpamba brand has become very popular and is widely recognized across the country. The SSDI endline survey (2016) carried out in 19 districts in Malawi reports that 89% of men and 78% of women have heard of Moyo ndi Mpamba. An SSDI Activity Performance Evaluation conducted by Dev Tech on behalf of USAID Malawi in 2016 concluded that the ‘Moyo ndi Mpamba platform has value, denotes value and should be continued’. Recognizing the popularity and effect of the campaign, the MOH has adopted the brand name as the unifying platform for all activities in the National Health Communication Strategy (2015-2020) and in the Malaria Communication Strategy (2015-2020). The project’s flagship Family Health Booklet reached approximately 3 million people in 15 districts in Malawi with essential health messages. The Moyo ndi Mpamba radio program was very popular with 57 percent of men and 33 of women being exposed to the program. The SSDI Activity Performance Evaluation (2016) noted that radio was one of the most effective channels for dissemination of messages and was good value. At least 78% of men and 71% of women were also exposed to at least one Moyo ndi Mpamba campaign activity (SSDI endline survey 2016).
Both the SSDI Endline Survey (2016) and the USAID’s commissioned SSDI Activity Performance Evaluation (2016) have noted that exposure to the Moyo ndi Mpamba campaign activities was positively and significantly associated with positive knowledge, attitudes, social norms and health practice. During the 2016 endline evaluation survey conducted by SSDI-Communication, significant changes were found among those exposed to the Moyo ndi Mpamba campaign in the areas of WASH, malaria, fertility preferences, contraception use, SSDI-Communication MNCH, HIV and AIDS, sexual behavior, and gender norms. For example, those exposed to the campaign were significantly more likely to wash their hands with both soap and water, use modern contraceptives, attend antenatal care (ANC) visits, get tested for HIV, not have concurrent sexual partners, and jointly make decisions with their spouses.
An external evaluation of SSDI-Communication also found that the project spurred improvements in SBCC capacity in Malawi. The evaluation report noted that SSDI-Communication succeeded in developing an environment where evidence-based SBCC strategic planning has become the norm. This led to the development of the first ever-National Health Communication Strategy to inform planning and implementation of health communication activities in Malawi. Additionally, SSDI-Communication’s capacity strengthening of private sector firms (radio production, advertising agency, media agency) brought dividends and led to the delivery of high quality outputs by these firms. The report also noted that the project’s support to media houses helped to increase the coverage of health issues in both print and electronic media.”
Finally, the report discusses some of the lessons learned, as well as recommendations emerging out of the project. Challenges to implementation included economic and natural disasters, as well as lack of service coverage to meet the increased demand created by the project. Recommendations include the continuation of the model that integrates all health messaging under one umbrella, as well as continuing with the Moyo ndi Mpamba brand.
Knowedge for Health website on July 4 2017.