1. 1 16-18 January 2013 Addis Adeba Rocio BERZAL Ethiopie C4D Specialist Niger African leadership for child survival

2. Promoting social and behaviour change for Child survival Setting the basis - (from 2006 to mid-2008) Research LANCET, pilot design, secure resources (HR and financial) Identify & develop coordination mechanisms (national and local) 1.Social & Behaviour change communication IPC / community workers + participatory communication for individual change (proximity and traditional media, cinema, theatre, community radios…) Community empowerment / participation for collective change (community learning, community-led design, implementation and M&E of action plans) 2.Social Mobilization Creation of partnership and networks (trad. chiefs, women, youth) Media campaigns 3.Advocacy Local (imams, traditional chiefs) and national levels (partners)

3. Community empowerment From Collective learning… Introduce approach, build trust …To Collective action: Participatory community assessment Village plan of action Meetings to discuss the progress Annual celebration of champions Community advocates

4. Community empowerment From Collective learning… 1.Advocacy meeting in each village Introduce approach, build trust 2.Village meeting to elect the community workers 2-day election process, based on defined criteria 3.Training of key persons from each village …To Collective action: 4. Creation of a local core group for the promotion of KFP 5.Participatory community assessment / auto-diagnosis 6.Development of the village plan of action on KFP 7.Organization of mothers’ and youths’ peer-support groups 8.Monthly village meetings to discuss the progress 9.Annual assessment of progress and revision of the action plan 10.Annual celebration of champions (villages and families) 11.Community advocates: study visits and joint celebrations

5. SITAN DIFFUSION SITAN PLAN ANALYSIS PLAN ACTION ANALYSIS CONTACT ACTION DIFFUSION Scaling up: communities, agents of change Identify acteurs Establish trust relationships Using stimulus guiding dialogue Community self- diagnosis Community plan of action Promotion KFP Celebration of progress Certification «communauté Modèle» Amplication horizontale et verticale Community assesment

6. Catalyseurs Facilitators/ volunteers Supervisors (NGO) Traditional Mass media/ actors of change Modern Mass media Step 1 Identification of problem Step 2 Involving leaders and participants Step 3 Clarification perceptions Training Etape 4 Expression of individuals and collectifs needs (census/ cartographie) Step 5 Evaluation current situation Vision Establish’ objectifs Reaching consensus about activities Step 5 Evaluation current situation Vision Establish’ objectifs Reaching consensus about activities Step 6 Analyse and action plan Step 6 Analyse and action plan Step 7 Sharing responsabilitie s (relais, village chief and religious Step 7 Sharing responsabilitie s (relais, village chief and religious Step 8 Social Mobilisation Step 8 Social Mobilisation Step 9 Implementatio n activities Step 9 Implementatio n activities Step 10 Community based monitoring system Step 10 Community based monitoring system Step 11 Participatory assessment Step 12 Recognition of model families and villages Changements individuels Individual Changes Competencies Ideation : Knowledge, Self- Confidence, Risk Perception, subjective Norms, self Image, Emotions, Self-efficiency, Social Influence, personal advocacy Intentions Behavior Social Changes Leadership Level and equity of participation Information equity Collective Self- efficiency Ownership Social Cohesion Social norms Community Dialogue Collective action Societal impact Constraintes and external support

7. Analyse data on KFP and community interaction with health system Community-based monitoring form allows gathering data on KFP adoption and sharing /discussing indicators with health workers at village level. The purpose of the village action plan is outline different actions to help the practices adoption. A problem of supply/resource issues could be outlined in the action plan to stress this issue and find solutions, included advocacy actions. Monitoring tool.pptxMonitoring tool.pptx

8. Community model tested in 2 regions (from mid-2008): CommunesVillagesTotal pop.Children 0-5 5176140,33128,766 Extension of KFP in an integrated ACSD program at the level of 2 Health Districts in 15 communes, total pop. 600,000 Pilot of Cash Transfer + KFP in 8 communes, total pop. 280,000 Alliance with FAO on “listeners’ clubs” and community radios to promote KFP in 4 communes, total pop. 120,000 Integration into the Commune Development Plans Research of synergy between CLTS and KFP interventions Development of education for health curricula for children and promotion of KFP in 200 centers of “better parenting” Scaling up through other programme entry doors (from 2011)

9. SCALING UP FROM 140,000 TO 2 MILLION FAMILIES CommunesTotal pop.Children 0-5 5140,33128,766 CommunesTotal pop.Children 0-5 301,076,159183,859 Scaling up in 5 regions with 6 NGOs (from mid-2009) Scaling up through other programme entry doors (from mid 2011) WASH, EDUCATION, CASH TRANSFER CommunesTotal pop.Children 0-5 15 (WASH/HEALTH)600,000120,000 8 (CASH TRANSFER)280,00056,000 4 (EDUCATION)120,00024,000

10. Individual behaviour changes are supported and accelerated Results accelerated in individual & social change (INS Survey and LASDEL study in 2012) Social change: increased participation, sense of ownership, change of social norms (EBF, assisted delivery..), the community enters in a dynamic of change (various initiatives related to hygiene, education..) PracticesIntervention zonesControl zones Early breastfeeding initiation (within 1 hour after delivery) 88.7%76.5% Exclusive breastfeeding 77.4%53.7% Vitamine A (one dose received in the past months)86.8%79.1% Women hand washing with soap78.9%76.2% Mothers using ORS treatment58.3%29.1%

11. Empirical evidences Public sanitation days

12. Building of public garbage bins

13. Lessons learned from empirical evidences Results in community empowerment and social change: -Increasing demand for products and health services among the population -Increasing knowledge and information about care-seeking thanks to « relais » -Developing know-how in organization system at village-level -Providing skills to community members (in diagnose local problems, planning, implementing and evaluation…) to gain control and power to transform their environments -Building on influential leaders (traditional, religious…) to change traditional ways of child care

14. “Social cohesion”: The village had created a “food bank,” solidarity system organized to invest in nutrition activities

15. Organization of transportation of pregnant women to the health centers Husbands more supportive of health facility attendance The “community cart” gives community members access to health services Young leaders

16. Model leaders “You can see the change by looking at the health of our children. I think I can convince the others. When women saw my baby recently they all commented on how healthy my baby looked”.

17. KFP A mbassadors Local media trained in KFP becomes spokespersons and organizes public broadcasts with population

18. Volunteers create demand for products and health services among the population Volunteers generate knowledge and information about care-seeking and monitor behaviours Volunteers assist the health staff of the health center by holding communication sessions for patients

19. Approaches for scaling up in 2013: consolidating gains and increasing impact Increasing alliances to scale –up coverage focused on ICCM, nutrition and social safety nets: MDG Initiative at level of 8 health districts supported by EU Modelling a community-based nutrition program to reduce and prevent chronic malnutrition Safety nets: Cash transfer + KFP in 1,000 villages Alliance with WFP in 1200 CRENAMs and 29 Health Districts Alliance with UNFPA, Mens involvement initiative « Schools for husbands » in 1 region

20. Evidence: Almost 60,000 children’s lives saved in 2009! Proportion of child lives saved in 2009, by intervention or risk factor reduction (List JHU team)

21. Trends in the adoption of the Key Family Practices [1] [1] Indicators (%) 2006 2012 Mothers who exclusively breastfed their child from 0 to 6 months 1323 Children with an episode of diarrhoea received treatment with ORS 1844 Under-5 children having slept under the insecticide treated mosquito net the night preceding the survey 720 Pregnant woman having slept under the insecticide treated mosquito net the night preceding the survey 720 Children completely vaccinated (12-23 months) 29 52 Pregnant women having had prenatal check-ups 4683 Delivery in health institution 1730 [1][1] EDSN MICS 2006, EDSN MICS IV 2012

22. 22 LANCET series 2003, 2004 Proposal for Spanish Government : Fomentar la incorporacion de practicas familiares a fin de promover la supervivencia del niño en Niger, Unicef Niger, 2008 KAP study on KFP, KONE Mariatou, Niger, juillet 2008 EDSN MICS III 2006, EDSN MICS IV 2012. INS NIGER Narrative of an Action Research project in Communication for Social and Behavior Change, in five municipalities of Maradi and Zinder, Niger. Manuela Varrasso Enquête quantitative sur les Pratiques Familiales Essentiels. INS, Niger. Avril 2012. La promotion des Pratiques Familiales Essentiels au Niger, LASDEL-Avril 2012. Figueroa M.E., Lawrence Kincaid D., Rani M., Lewis G., Communication for Social Change: An Integrated Model for Measuring the Process and Its Outcomes, Communication for Social Change Working Paper Series I, The Rockefeller Foundation and Johns Hopkins University Center for Communication Programs, New York, 2002 LANCET. Reduction in child mortality in Niger: a Countdown to 2015 country case study Agbessi Amouzou, Oumarou Habi, Khaled Bensaïd, and the Niger Countdown Case Study Working Group Qualitative research to identify solutions to local barriers to care-seeking and treatment for diarrhoea, malaria and pneumonia in Niger. Juliet Bedford, 2012 Review/analysis of UNICEF Community-Led Total Sanitation and Essential Family Practices Communication for Development Interventions in Niger. Karen Greiner 2012 Bibliography

23. Many thanks