Behavior Change Communication (BCC) Strategy

1. Behavior Change Communication (BCC) Strategy Pakistan Safe Drinking Water and Hygiene Promotion Project (PSDW-HPP)

2. Basic Facts: • 4,900 children under age of five die worldwide each day from infectious diarrhea due to unsafe drinking water • Diarrhea caused by unsafe water, inadequate sanitation, and poor hygiene accounts for 15 to 18 percent of child deaths annually • In Pakistan, diarrheal diseases are estimated to kill 200,000 children under age of five/year (548 per day)

3. Background of GOP Water Projects • In 2001, the Ministry of Environment presented National Environmental Action Plan in which one of the core areas of NEAP is Clean Drinking Water. • Pakistan, as a signatory to the Millennium Development Goals (MDGs), has committed to meet the targets set at the World Summit on Sustainable Development in 2002 through: “Providing access to safe drinking water & adequate sanitationfor maximum population by the year 2015”

4. Clean Drinking Water Initiative (CDWI) • PC-1 for a project, CDWI was approved to install 445 water purification plants of 2,000 gallons per hour capacity at each District and Tehsil of the country to provide clean drinking water to the masses. CLEAN DRINKING WATER FOR ALL (CDWA) • Realizing the utility of clean drinking water another project namely, “Clean Drinking Water for All” was approved to install 6,035 water purification plants, one at each Union Council of Pakistan at a project cost of Rs. 7,871.740 million.

5. Pakistan Safe Drinking Water and Hygiene Promotion (PSDW-HPP) ProjectObjective: • To provide technical assistance in hygiene and sanitation promotion, BCC, and community mobilization, along with extensive capacity building in order to complement Pakistan's substantial investments in hardware for safe drinking water.

6. Project Geographical Coverage: 28 Districts, 6 FATA Agencies and 6 Frontier RegionsPopulation- 30 million peopleNationwide media campaignFunding:USAID: $17.9 million for three years

7. Project Components • Implement a comprehensive hygiene and sanitation promotion strategy reaching 30 million people • Institutional capacity and comprehensive technical review • Monitoring and evaluation Stages: • Strategy development :January 2007- March 2007 • Implementation: April 2007-June 2009 • Implementation Mechanism: • Technical assistance • Grants to non-governmental organizations (NGOs)

8. Development of a Successful BCC Strategy • It is essential to identify and understand different elements that can have an impact, positive or negative, on an individual’s willingness and ability to adopt a new practice. • While BCC can be quite effective, it does not operate in isolation and it can be undermined both by an insufficient understanding of how initiatives and activities support communication and, in turn, how communication supports these same initiatives and activities.

9. STEP 1 Formative Research Forms the basis for all key behaviors to promote STEP 2 Behavior Analysis and Intervention Design with a focus Communication Analyzes behaviors, identifies “feasible” behaviors to promote, develops broad activities for the main intervention areas, determines specific communication and training activities STEP 3 Monitoring and Evaluation Assesses process, outcomes, and impact of key behaviors; lays the foundation for the next phase; encourages replication of things that have worked; continues to involve community Framework for Designing the BCC Strategy

10. Process of Developing the BCC Strategy Desk Review – Nov-Dec 2006 • Lack of prevalence of hand washing with soap • Lack of information on barriers and facilitators • Lack of awareness on causes of diarrhea- appreciation of seriousness considerably higher • Need for more research – focusing on specific groups, in specific settings, on specific activities

11. Formative Research – December 2006 • Rural & Urban; Six locations: Lahore, Lasbela, Muzaffarbad, Mansehra, Thatta, Mohmand Agency • Techniques: FGDs (mothers, teachers, and health service providers), In-depth Interviews (Molvis), Observation and Trials for Improved Practices (TIPS) - mothers, fathers and school children) • Respondents: Mothers/fathers with children under five years old, primary school children, teachers, Molvis, and lady health workers (LHWs) • Groups: Mostly low socio economic strata, with low education

12. Findings….. • Current behaviors/practices – what are they doing? • Barriers and Facilitators – for primary and secondary groups • Key influencers – what and how can they act?? • Target groups’ aspirations, perceptions and information needs • Recommendations and ‘voices’ captured from primary and support groups – prioritization of messages • Target group specific materials. Resources and channels of information

13. Going Beyond Research – BCC Strategy and Plan- April 2007 Formative Research Provided; Set of key recommendations which helped us to move forward: • Develop a BCC Framework – the identification of highest success areas • A set of feasible behaviors • Intervention Design and M&E • BCC plans for mothers and fathers • What can the channels do and how will they do it

14. BCC Strategy Recommends: • Cooperation within the family and among community members is critical to the successful adoption of key hygiene practices.

15. BCC Strategy Recommends: • ‘Cluster behavior’ promotion approach, in three intervention areas: • access to hardware • hygiene promotion • enabling environment

16. BCC Strategy Recommends: 3.Womenare critical to the success of hygiene promotion program. Dynamic female-to-female interactions designs should be given priority consideration.

17. BCC Strategy Recommends: 4. For safe storage of drinking water, the practices of using a long-handled scoop to remove water or pouring out drinking water should be promoted as key behaviors.

18. BCC Strategy Recommends: 5. Hand washing should focus on hand washing with soap at two critical times – before eating and preparation of foods and after defecation.

19. BCC Strategy Recommends: 6. Water purification should focus on two stages: (1) on awareness and knowledge of the need to purify home water sources, and (2) on two practices that provide acceptable, mutually reinforcing options.

20. BCC Strategy Recommends: 7. Safe feces disposal should focus on households with latrines, where reinforcement of present positive latrine use could be combined with the hand washing with soap behavior. Where latrines are not available and where open defecation occurs, feces should be buried.

21. BCC Strategy Recommends: 8. Emotion based approach: The attributes of strength and beauty should be used repeatedly and often as they are strong motivators for changing behaviors.  They should be considered as part of the unifying theme of all materials produced.

22. BCC Strategy Recommends: 9. Develop a new female cadre of volunteer hygiene promoters to reinforce and facilities the desired behavior among mothers.

23. BCC Strategy Recommends: 10. Involve primary school children as they can be motivators and supporters of desired behaviors within the household.

24. BCC Strategy Recommends: 11. The Imamsshould be considered as an excellent communication channel for husbands and other community members.

25. BCC Strategy Recommends: 12. Mothers have placed an equal amount of importance on “how” messages are passed, as on “what” messages are passed. There should be emphasis on this tone in all its materials, media, and training.

26. BCC Strategy Recommends: 13. Initiate possible social marketing initiativeswith soap manufacturers.

27. BCC Strategy Recommends: 14. Initiate possible social marketing initiatives with water purification manufacturers for; • promotion or enhancement of acceptable products for purification • creation of distribution channels through local faith-based organizations (FBOs) and community-based organizations (CBOs), • dirty water demonstrations • school fairs

28. Behavior Change Communication Strategy- • BCC strategy is the basis over which the whole hygiene promotion component of the project was built on • Emotion-based approach • Targets four key stakeholder groups: • Community • Schools • Mass Media • Private Sector

29. BCC Strategy- From Theory to Action Primary Target Audience: • Mothers and fathers of children under five years Channels to Reach Target Audience: • Hygiene Promoters • Religious leaders--- Molvis/Imams • Doctors • Women volunteers • Teachers • Students of grade four • Local NGOs/CBOs • Media • Private sector partners

30. BCC Plan….Touching the family through integrated, multiple activities:

31. HP Activities in Communities:-Mother & Father group sessions-Interactive Theater-Melas-Word of mouth activities-Physician-provided certificates-Activities and education at Mosques-

33. Fun, interactive learning activities for grade four students in schools:- Students as message carriers to their parents- Ten activities-form the learning component- Teacher activity book- Promotional material w/private sector partners- Student monitoring of assignments- Calendar take home to reinforce messages for mothers

35. Project Website: www.safewaterpak.com

36. A Way Forward……….National BCC Strategy PSDW-HP project with the assistance of USAID will coordinate with MOE, MOSI & UNICEF to develop “ a National BCC Strategy” for the water and sanitation sectors.

37. Thank You