Cletus Asare (Nets for Life), Anna McCartney- Melstad (JHUCCP), Elena Olivi (PSI) 1 The Alliance for Malaria Prevention Behavior Change Communication Workshop for Long-Lasting Insecticide-Treated Net (LLIN) Scale-Up to Universal Coverage and Use Bamako, Mali 21 – 24 September, 2010

 Top-down LLIN distributions are unlikely to ◦ Effectively increase net ownership via campaign ◦ Increase behavior change around net use over sustained period  Working with community leaders to make sure that they understand and are committed to campaign interventions and the resulting health impacts will help the wider community learn about, and engage in, the activities. Community leaders will be your best champions!  Communities can be involved in many different ways. 2

As many social circles within the community as possible 1. Religious leaders 2. Traditional leaders (elders) 3. Political leaders (elected or appointed) 4. Unions (women, youth) 5. Teachers 6. Health care workers 7. Opinion leaders 8. Influential individuals 9. CBOs, local NGOs 10. Volunteers (Motivation)

Assemblyman of Sandema, Ghana, in a demonstration at a sensitization program on malaria prevention Durbar of chiefs to testify the importance of using LLINs and encourage their subjects to use them every night

 Bring the community to own the project right from the beginning  Initial strategies include: ◦ Community Entry ◦ Orientation of community leaders ◦ Holding advocacy sessions with community leaders ◦ Other? Discuss  Effective because community members see themselves as part of the project *American-speak for “them”

6 Stage of Campaign Increase LLIN Ownership (Social Mobilization) Increase LLIN Use (BCC) Pre-campaign Information on dates and venues and target population for the campaign (mass media, community and religious leaders, community volunteers, health workers), which interventions are included, and goals of the campaign During campaign - registration Specific information on dates and venues for the particular household; which interventions are included; what they need to bring with them to the distribution site; Net use and care and repair messages; general malaria and/or other child health messages During campaign - distribution Reminders (mass media, community leaders, community volunteers, health workers); Motivation to participate. Net hanging demonstrations and IPC at site; net care and repair messages Post-campaignMass media and IPC on net use and hanging; door-to-door Hang Up visits; net care and repair messages. Motivation to hang nets and use nets. Respond to general malaria questions. Refer fever cases.

Primary school children in Ghana acting a play in malaria prevention An Anglican Bishop in Namibia himself involved in a net distributing to church members to add importance

 Organization of training ◦ BCC sub-committees are often not responsible for budget/planning training but must at least provide quality materials/manuals to be incorporated  Flow of information from central to community level ◦ Good training, and training materials. Make sure all volunteers have the correct information and can disseminate it by the time they finish the training. ◦ To cascade or not to cascade?  Volunteer job aids or checklists will help to ensure that clear and consistent messages are passed to community members. 8

◦ Develop and understanding of campaign interventions and their importance for child survival ◦ Key messages on importance of owning and using LLINs ◦ Knowledge and directions to the closest campaign site and what is available at that site and when ◦ Identification of community level barriers to LLIN access and how to discuss them with the population ◦ Understanding the importance of BCC

 Not cheap (both human and financial resources)  Include ◦ Transport ◦ Per diems ◦ Communication (phone credit, etc) ◦ Trainings (Lunch/coffee breaks/room/projection) ◦ Duplication of materials and job aids ◦ More innovative ways to motivate volunteers (in kind) 10

Mr. McCauley, Commissioner, Harmonville Township, Grand Bassa, Liberia (2 nd left) with a monitoring team during H2H hang-up campaign in Liberia A pastor in Yelwoko, Upper East Region of Ghana, expressing a point to create awareness about malaria

Commissioner of Harmonville Township in Liberia telling school children that they HAVE to see a net hanging on the bed today. During the first hang-up campaign in Liberia A chief in the Neekreen district of Liberia serving as a PPS Volunteer during one of the hang-up campaigns

Cletus Asare, NetsforLife What other examples can you share?

Cletus Asare, NetsforLife

 Distribution strategy ◦ Who is receiving LLINs? How many? How? ◦ Manage expectations  Political ◦ Who is responsible?  Toxicity/Danger of LLINs  Cultural/Religious misconceptions about LLINs 16

 Engage malaria network of journalists  Crisis group (NMCP, WHO, pharmaceutical division) to vet messaging and create dissemination strategy to squash rumor  Toll free hotline with standard response  Brief village leaders and other authority figures before rumors begin and again if rumors develop – create special team  TV/Radio messages 17