Regional Strategy: Programme Communication for Child Survival in West and Central Africa

1. Regional Strategy: Programme Communication for Child Survival in West and Central Africa Neil Ford Regional Chief, Programme Communication West and Central Africa Dakar: 9th April, 2008

2. Why are large-scale community-based communication programmes necessary? • because child survival results depend on adoption of key behaviours at the household and community level, not just in zones of convergence but across entire countries – 90 per cent coverage is necessary. • Large-scale behaviour change in key practices can reduce child mortality by 40 per cent (Lancet) - MDG and AARM commitments can only be achieved if governments design and deliver nation-wide behaviour change communication programmes. • Key behaviours include exclusive breast feeding, hand washing, using an insecticide-treated net, treating diarrhoea with ORS, caring for pneumonia. WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

3. Family and community interventions are the most cost effective source: draft AU report WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

4. Programme CommunicationOrganizing for Large-scale Results HIV / AIDS Child Survival Child Protection Education • Small scale programme communication projects • Duplication of effort • Different methodologies and approaches used by different sections • Results too small to make an impact on the MDGs WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

5. Horizontal Integration Programme CommunicationOrganizing for Large-scale Results HIV / AIDS Child Survival Child Protection Education Participatory Research – baseline development Interpersonal Communication Community-based media Mass Media Vertical Integration Public relations campaigns – in partnership with the private sector Impact evaluation – using community-based management of information

6. What kind of community engagement strategies will produce results? • The smaller basket of key behaviours that must be adopted at scale are: • life-long changes (such as hand washing) instead of short-term interventions (such as immunization) • related to culture, gender relations, tradition and social practice. (The husband might sleep under an ITN instead of the mother and children. The mother-in-law might be a determining influence in breast feeding.) • Interventions based on adult learning principles and group discussion are more likely to produce results than strategies based on one-way delivery of health messages. • Note: short-term interventions (immunization, vitamin A) are still necessary. Both must be delivered at scale. WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

7. Improving Programme Communication for measurable results • The most successful Prog. Communication strategies have promoted immunization campaigns– short time frames, with a focus on information delivery • Recently – a transition to child health days / weeks. Slightly longer time frames, focus on service delivery & information • New vision: • 1. community learning that is more frequent and longer-term, to address key behaviours through adult learning and dialogue. • 2. communication that address collective social change as well as individual behaviour change. • 3. programmes that acknowledge parents and care givers as the duty bearers closest to children – they must be able to learn, change practices and claim rights to service delivery WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

8. Where is the new vision working? • Tostan - participants meet to discuss human rights, health and development issues four times a week for two years, leading to range of child survival results, including the first successes against FGC. • Total Sanitation in Bangladesh – reaching 30 million people by 2011 with a programme for zero open defecation. • Breast-feeding in Benin: improving rates of exclusive breast feeding from 17 to 46 per cent over ten years. • All these programmes require longer time-frames to achieve results WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

9. Increasing the Quality, Intensity and Coverage of Programme Communication • On-going approach: communication of health education messages for behaviour change through health workers • Complementary Approaches to increase quality and coverage: • Facilitate face-to-face community dialogue so that care givers can discuss issues and integrate health information into their culture, livelihood system and social practice – using community volunteers and traditional media such as drama & storytelling • Establish partnerships with established networks that work with communities, such as teachers, traditional leaders, religious leaders, health workers, etc. WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

10. Increasing the Quality, Intensity and Coverage of Programme Communication - 2 • Strengthen community governance structures to coordinate large-scale communication programmes • Increase programme scale and coverage by coordinating community dialogue with mass media programmes at the sub-national and national level, using local language • Forge alliances with the private sector for more effective public relations and marketing campaigns (e.g. Unilever in Malawi), and to make use of new technology such as cell phones or “Wiki” software • An evidence base must be created and good programming ideas shared WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

11. Coordinating structures, channels and levels of government • UNICEF must help national governments to design and deliver effective communication strategies, including: • A national child survival communication policy and organisational structure • Informed, trained health workers • Engaged mass media at national and community levels • Large-scale dialogue through networks of trusted leaders, using schools, churches, mosques and health centres as entry points • Traditional media • Public relations campaigns • Local governance structures that deliver results at scale WCAR Strategy, Programme Communication and Child Survival: 08 April 2008

12. Re-enforcing Human Rights • Instead of prescribing behaviours or “telling people what to do” UNICEF should help governments • Facilitate a process where people freely choose to change their collective practice and individual behaviour • Create opportunities for all people to speak and be heard on CSD issues • Create opportunities for decision-makers in government to listen and respond to community issues • Be guided by the human rights principles of inclusion, empowerment (particularly of women and youth), participation and self-determination, not just because UNICEF is a human rights organization, but to sustain results after the intervention is over. WCAR Strategy, Programme Communication and Child Survival: 08 April 2008