Johns Hopkins Bloomberg School of Public Health Center for Communication Programs
"Wazazi Nipendeni (Love me, Parents) is a national safe motherhood social and behavior change communication (SBCC) campaign that aims to encourage Tanzanian women and their partners to take steps for a healthy pregnancy and safe delivery."
This Health COMpass Social and Behaviour Change Communication (SBCC) Spotlight describes the process and strategy of the Wazazi Nipendeni campaign in Tanzania (See related summary below for more information.) This malaria in pregnancy campaign was expanded to include several key safe motherhood behaviours, including early and complete antenatal care attendance, HIV testing, prevention of mother-to-child transmission of HIV (PMTCT) enrollment, utilisation of long-lasting insecticide-treated bed nets (LLINs) , uptake of sulfadoxine-pyrimethamine (SP) for the prevention of malaria in pregnancy, individual birth planning, and delivery at a health facility.
In the "Inquire" phase of the SBCC process, the team did a review of data, policies, guidelines, strategies, and research. The team then consulted stakeholders, formed a task force led by the Ministry of Health (MoH), and conducted a decision-tree modelling exercise (model available online). "The campaign Task Force's stakeholder review of barriers to healthy pregnancy practices revealed a culture of secrecy around pregnancy in Tanzania, and a fear that any interference with God’s plan will cast an evil eye on the unborn baby and the mother, which often resulted in late disclosure of pregnancy to health providers and birth supporters. In addition to the distance to health facilities and associated costs of leaving home or work, many women did not see the need to go the clinic or take medication if they were not sick, feared the side effects of SP, or felt that they’d be seen as 'weak' if they delivered in a health facility, especially after having the first child."
In the "Design your Strategy" phase, formative research expanded the messaging topic from malaria prevention to safe motherhood, with love as the driving factor and focal point of message design. Message objects increased to: "Attend ANC [antenatal care] within the first 16 weeks of pregnancy; Attend ANC at least four times during pregnancy; Sleep under a treated net every night; Receive two or more doses of SP for the prevention of malaria in pregnancy; Test for HIV together with their partner and receive the results; Make an individual birth plan; Deliver at a health facility with a skilled health provider." The team created a profile of a typical audience member, naming her Furaha: "The typical audience member is Furaha. She is 24 years old married, mother of one and five weeks pregnant."
In the "Create and Test" phase: "The first step was to jointly prepare and review the campaign creative brief, which outlined the campaign’s goal, objectives, target audience, messaging approach, communication channels, timeline, and key monitoring and evaluation indicators." (The campaign's main messages are available online.) Local advertising agencies were solicited through a request for proposals for a campaign renamed by the Task Force as “Love me, parents” instead of Love me, mama”. Resources available through links to this website include, for example: posters, radio spots an ANC card, a pregnancy wheel, TV spots, SMS text messages, a billboard, banners, and promotional materials such as T-shirts, stickers, and a spare tire cover. Links include a campaign creative brief and evaluation results summary.
The "Mobilize and Monitor" phase began with an official launch preceded by a partners' orientation, "as well as a media orientation, during which radio DJs, presenters, and print and electronic journalists were oriented on the campaign objectives, messages, and materials, the SMS platform, and the media’s role in the campaign." Print materials distribution to hospitals, health centres, and dispensaries was facilitated by regional and district health management teams prior to launch. At launch, the media campaign included 6-12 radio spots daily on 16 regional and national stations and 3 per day on 6 TV stations for a month, followed phases of maintenance messaging, then a resumption of broadcast for 6 months. The SMS text message system through mHealth Tanzania Partnership was interactive with registration available for regular messaging on pregnancy, which as designed for pregnant women, mothers of newborns, birth supporters, or general information seekers.
- At 2 weeks into the campaign (December 2012): 22% of respondents had been exposed to the campaign.
- March 2013, June 2013, October 2013, and April 2014: "33%-46% of respondents had seen or heard the campaign. Radio was consistently the most frequently cited source of campaign exposure."
In the "Evaluate and Evolve" phase: "An impact evaluation was conducted in October 2013, ten months after campaign launch. Exit interviews were conducted with 1,708 ANC/PNC [postnatal care] clients, and an observation checklist was used to determine if campaign materials were available in 122 health facilities in five regions. Key findings from the evaluation include:
- Campaign Reach and Recall
- Over a third of surveyed women (35.1%) were exposed to the campaign, with 16.5% reporting daily exposure.
- The primary source of exposure was radio (83.3%), which also provided the highest frequency of exposure.
- Almost a third of those exposed to the campaign recalled multiple messages.
- Only 7.1% of 1,708 women reported hearing anything about the SMS system. Of the 36 women who texted, 30 (83.3%) completed the SMS registration process.
- Availability of Campaign Materials
- Twenty percent (20%) of health facilities had all five campaign materials, 70% had some (1-4), and 10% had none.
- The pregnancy wheel was most widely available (82.0%), followed by the SP reminder cards (67.2%) and Individual Birth Planning (IBP) brochures (57.3%). SP and IBP posters were available in 39.3% of the facilities visited.
- Exposure to the campaign was a significant predictor of number of ANC visits, HIV testing, individual birth planning, delivery at a health facility, knowledge of malaria in pregnancy, receipt of SP, number of doses of SP received, and net use.
- Campaign exposure was not a significant predictor of timing of the first ANC visit or partner testing for HIV.
- Campaign exposure was not a significant predictor of timing of the first ANC visit or partner testing for HIV."
"Planning for the Future": "Key recommendations for future programming include:
- Establish mechanisms to ensure campaign materials reach their final intended destination, and that providers are appropriately oriented on their use.
- Institute a system to capture health facility data from partners before, during, and after the campaign in order to determine if campaign implementation is associated with an increase in uptake of services and intended health outcomes.
- Utilize existing community outreach structures to strengthen community engagement in the campaign.
- Enhance promotion of the SMS platform by giving it its own dedicated radio/TV spots and print/promotional materials,
- Broadcast the campaign on local and regional radio stations in addition to national stations in order to increase rural reach.
- Include messaging encouraging women to move closer to the health facility as their due date approaches."
Health COMpass website, July 23 2015.