The Regional Health Communication Program

1. The Regional Health Communication Program Bongiwe Ndondo Manager: Monitoring & Evaluation Soul City Institute

2. Soul City Regional Program (SCRP) was launched in 2002 • Implemented in Lesotho, Malawi. Mozambique, Namibia, Swaziland, Zambia, Zimbabwe. • Introduced a systematic large-scale capacity building programme in eight Southern African countries - combining country–based health communication programmes with a broad regional approach.

4. Regional Health Communication program • Designed on the premise that ‘BCC programmes are particularly appropriate to a regional approach, where consistent, coherent messaging is vital given high inter-regional mobility’. • Key principles • Skills and resource sharing • Creating synergy and consistency • Economies of scale

5. Objectives of the RP • To reduce HIV (and TB) infection and related morbidity, especially among women, children and other vulnerable groups in Southern Africa, by facilitating social and behaviour change • To strengthen the social and behaviour change sector capacity to respond to HIV, broader sexual and reproductive health and other related areas of health.

6. Operational strategy • Setting uniform standards for research and product development • Building on regional synergies (e.g. in research output and message development) • Sharing skills and resources • Developing cross-border outputs • Capitalising on economies of scale. • Building and working through local (in-country) and regional partnerships and networks

7. The Research Process

8. Training • TV, radio and print media • Formative Research, • message development, • Script writing • Drama film production (including camera, lighting, sound and art direction) • 11 writers ; 9 producers from across the region • Finance and budgeting • Leadership & corporate governance • Resource mobilisation • 130 people who were exposed to a skills building programme.

9. Mass media outputs: TV • Television • The ‘Untold Stories’ : 7 films each in a local language, series subtitled in English, shown across the Southern Africa region. In four countries, it was the first locally produced edutainment drama ever on TV (Malawi, Zambia, Lesotho, Swaziland). • ‘Love Stories in a time of HIV and AIDS’; a 10 part TV series consisting of country stories, each dealing with an aspect of love and MCP.

10. Mass media outputs: Radio • Radio • OneLove radio drama series on MCP

11. Key Outcomes 1 • Shared methodology with common standards • Production of quality materials with both local relevance and regional flair (Ability to deal with matters with regional significance) • Consistency in programming and messaging therefore high impact Economies of scale • ‘print booklets could be ordered in greater quantities thus saving costs’. • ‘Bringing people together for regional training by expert facilitators, whose time was limited achieved efficiencies both in terms of costs and time’. Key staff informant

12. Key Outcomes 2 • Increased influence, extended footprint and experience in managing a regional program • In the process of establishing and formalising a regional alliance

13. Lessons learnt • regional branding was important for consistent messaging and responding to regional migration – a feature of southern Africa which plays a critical role in the spread of HIV. • ‘the experience has brought the region to my doorstep – I see the entire Southern Africa as one village now that can be understood and we can share approaches to solving regional problems’. External Service provider • The RP played a key role in dealing with issues that are difficult to discuss at a national level but can be discussed at a regional level’. External service provider/trainee

14. The airing of all films in all countries as a series allowed people to recognise the commonality of their problems which transcend national boundaries. • ‘powerful way to connect audiences in different places. In seeing our problems are not unique to us but shared we are better able to relate to each other and share ways to overcome them… this interconnectedness empowers us, strengthens empathy towards each other’. External service provider

15. The EE skills building workshop • Culmination of all the lessons from RP • Process of developing materials for SBCC programs (In-field challenges)

16. Formative Research For Evidence Based Programming Pyke Chari Presentation at the HIV Capacity Building Summit 19 – 21 March 2013 South Africa

17. Overview of presentation • What is formative research? • Formative research process

18. What is formative research? • an open exploratory way of doing research • allows research participants to give their own emphasis and meaning to their experience • allows critical self-reflection

19. What is formative research? • encourages research participants to express their • experiences • feelings • views in their own terms

20. Quote 1 • In my view, sometimes us parents, contribute to this problem. You find that in some homes, parents will sleep in the same room with their young children. We think they are young and cannot see what we are doing. The truth is, these children can see, even though they won’t talk about it to us. They then go out there to want to try what they saw their mother and father doing. Rural Males 35+ Yrs

21. What is formative research? • is the preferred way of: • message development audience research • pretesting of material as it allows the researcher to explore audience reception of material in much more detail

22. Quote 2 • I did not like this book because it doesn’t mention about rural life, but only mentioned urban life. (Peri Urban Primary) • Well here we are only seeing children from towns but we also want to see children from rural areas, we want to be there too. (Rural Secondary)

23. Quote 3 • What I like is that these LOVE stories make men, children or rather the whole family learn. After the film I can be able to tell my children about the happenings from the scenes. They can assist me to teach the children.Urban Females 25+yrs

24. Qualitative formative research is NOT • about how many people said something; • about counting responses from research participants • adding up responses in the form of tables • a way of getting lots of information from lots and lots of people

25. Formative Research Process • Collect data from these sources: • Literature review • Stakeholder consultations • Target Audience research

26. The Research Process

27. Literature reviews • Terms of reference/scope of work • Findings • Recommendations to guide the messaging

28. Stakeholder consultations • Identify the stakeholders and key experts • Obtain their buy-in • Consider their views when messaging and developing the intervention

29. Target Audience Research • Identify the target audience • Consider ethics and language • Determine suitable methodology: • dealing with children • dealing with adults /couples • handling sensitive issues

30. Challenges • Dealing with divergent views • Lengthy time frame due to the rigorous process • Collecting too much data which may not be used • Triggering people’s emotions and being unable to offer solutions

31. How to create a message brief Message design: Bringing entertainment into the education Simon Sikwese

32. Message Brief • Provides a detailed outline of what you want to communicate to achieve the desired change

33. Problem analysis: What is the problem? Why? Audience analysis: Who is affected? Who are they? Barrier analysis: What are the barriers to change? Communication objective: How much change to effect? Message brief: what should we tell them? Creative workshop: Mass media? Interpersonal communication?

34. Using Research Findings to develop a message brief Case study: Findings from Formative Research • Teenage pregnancy as a health issue • What are the health and social problems that comes about because of teenage pregnancy?

35. Using Research Findings to develop a message brief • Adverse life outcomes for mother and child • Social disapproval • Personal development: school drop out; negative effect on school performance • Unsafe abortions, HIV and STIs • Infant at high risk of death, more likely to be preterm birth, low birth weight and asphyxia

36. Find out who is (most) affected/where is the problem? • Location: Rural or urban teen age girls? What percentages? • Provinces/Region: Which parts of the country has the highest rates? • Education: Among who in terms of educational status are most pregnancies occurring? • Ethnicity: what tribe? clan • Age: Which ages will more likely fall pregnant ?

37. Analysis of factors that are leading to teenage pregnancies

38. Individual & Environmental Factors Individual Age Gender Culture SES Education Knowledge about contraception Personal goals Environmental Support systems Parents Peers Mentors Community resources (health care facilities)

39. Risk (Behavioural) analysis

40. What are the risk Behaviours for Teenage Pregnancy? • Early sexual debut • Engaging in unprotected sex • Failure to use oral/ injectable contraception • Alcohol and substance abuse which may lead to bad decisions and risky sexual behaviour

41. Determinants of teenage pregnancy: Multi-level analysis • Individual: • Low education level • Low knowledge levels • Lack of access to information about contraception • Lack of access to contraception • Absence of father figure • Low socio-economic status

42. Theoretical Risk factors:Analysing the identified behaviours into theoretical risk factors that need to be addressed

43. Theoretical risk factors: Individual • Low self-efficacy (SCT/HBM) Confidence to perform a behaviour • Subjective norms/normative beliefs: what do the relevant others say about the behaviour (TPB/TRA) • Perceived benefits/severity; financial grants? Social status – fertility? Is it a serious problem? (HBM) • Perceived barriers; Unfriendly health care workers? (HBM)

44. Audience analysis • Primary: who you want to change. • Secondary: They directly influence the primary target • Tertiary: They indirectly influence/affect the target audience

45. Who is the primary target audience?

46. Primary target audience is comprised of rural unmarried (location) teenage girls aged 13-16 who are attending school and are at risk of teenage pregnancy.

47. Why this age group? We are aiming to target younger adolescents in order to delay them from having early and unprotected sex and if they are having sex, to equip them with the knowledge and skills to obtain and use contraceptives.

48. Why?

49. These girls have low knowledge about the risks (e.g. physical, social, emotional) of teenage pregnancy and low self-efficacy of their ability to delay their sexual debut.

50. Who is the secondary target audience?