advocacy and communication strategy to support …...advocacy and communication strategy to support...

Advocacy and Communication Strategy to Support the Implementation

of Revised ART, PMTCT and Infant Feeding Guidelines in Zimbabwe

2010Keeping Up With the World Health Organization:

Adopting New Treatment Guidelines

Advocacy and Communication Strategy to Support the Implementation

of Revised ART, PMTCT and Infant Feeding Guidelines in Zimbabwe

2010

Keeping Up With the World Health Organization:Adopting New Treatment Guidelines

Developed by SAfAIDS in collaboration with the AIDS and

TB Programme, Ministry of Health and Child Welfare

Advocacy and Communication Strategy to Support the Implementation of Revised ART Guidelines in Zimbabwe ‘Keeping Up With the WHO: Adopting New Treatment Guidelines’

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Acronyms

AIDS Acquired Immune Deficiency Syndrome

ACSM Advocacy Communication and Social Mobilisation

ART Antiretroviral Therapy

ARVs Antiretrovirals

ASO AIDS Service Organisation

CBO Community-Based Organisation

CBV Community-Based Volunteer

CDC Centers for Disease Control and Prevention

CHAI Clinton Health Access Initiative

CHS College of Health Sciences

DMO District Medical Officer

EGPAF Elizabeth Glaser Pediatric AIDS Foundation

ESP Expanded Support Programme

HBV Hepatitis B Virus

HIV Human Immunodeficiency Virus

IEC Information, Education and Communication

JSI John Snow, Inc

LSU Logistics Sub Unit

MSF Médecins Sans Frontières

NAC National AIDS Council

MoHCW Ministry of Health and Child Welfare

MOU Memorandum of Understanding

MRD Media Resource Desk

PLHIV People Living with HIV

PMTCT Prevention of Mother-To-Child Transmission

SAfAIDS Southern Africa HIV and AIDS Information Dissemination Service

SCM Supply Chain Management

SRH Sexual and Reproductive Health

SRHR Sexual and Reproductive Health Rights

TB Tuberculosis

UZ University of Zimbabwe

VCT Voluntary HIV Counselling and Testing

WHO World Health Organization


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Acknowledgements

This advocacy and communication strategy, ‘Keeping Up With the WHO: Adopting New Treatment Guidelines’, has been developed by the Ministry of Health and Child Welfare (MoHCW), AIDS and TB Unit, in collaboration with Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS). The Ministry of Health and Child Welfare is grateful to the members of the Adaptation Committee for their technical expertise and input during the development of this document. Thanks are due in particular to the following key personnel for their instrumental role in the development of this communication and advocacy strategy:

Tsitsi Apollo National ART Programme Manager, MoHCW

Joseph Murungu Deputy ART Programme Coordinator, MoHCW

Andrew Nyambo Advocacy Communication and Social Mobilisation (ACSM) Officer, MoHCW

Angela Mushavi PMTCT and Paediatric HIV Coordinator, MoHCW

Rumbidzai Mugwagwa Deputy PMTCT Coordinator, MoHCW

Ancikaria Chigumira Acting Deputy Director, Nutrition, MoHCW

Betty Muhlwa Training Officer, AIDS & TB Unit, MoHCW

Denver Raisi Deputy Logistics Subunit (LSU) Manager, MoHCW

Misheck Ndlovu Supply Chain Management (SCM) Coordinator, MoHCW

Solomon Mukungunugwa District Medical Officer (DMO), Mazowe, MoHCW

Lois Chingandu Executive Director, SAfAIDS

Sara Page-Mtongwiza Deputy Director, SAfAIDS

Monica Mandiki Country Representative, SAfAIDS Zimbabwe

Vivienne Kernohan Information Production Manager, SAfAIDS Zimbabwe

Mary Leakey New Business Development and Communications Manager, SAfAIDS Zimbabwe

Tinashe Moses Visual Communications Consultant, SAfAIDS Zimbabwe

Special mention also goes to the following organisations; the World Health Organization (WHO), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Centers for Disease Control and Prevention (CDC), University of Zimbabwe College of Health Sciences (UZ-CHS), Médecins Sans Frontières (MSF) Spain, MSF Holland, the Clinton Health Access Initiative (CHAI), John Snow Inc (JSI) and Zvitambo.

The development of this strategy has been made possible through support from the Expanded Support Programme (ESP).


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Foreword

Zimbabwe has achieved signifi cant milestones in the multi-sectoral response to the HIV epidemic, as evidenced by the progressive sliding trend in the incidence and prevalence rates, as well as the increase in access to and availability of HIV prevention, care and treatment services. The Government of Zimbabwe remains committed to ensuring high quality care for all People Living with HIV, including vulnerable and at risk populations. The adoption of the revised WHO 2010 guidelines for antiretroviral therapy for adults, adolescents and children, Prevention of Mother-To-Child Transmission (PMTCT) and infant feeding, is an indication of the commitment to the scaling up of evidence-informed quality services for People Living with HIV (PLHIV) in Zimbabwe.

The guidelines advocate for earlier initiation of PLHIV on more patient friendly regimens and earlier initiation of prophylaxis for PMTCT. Whilst we endeavour to mobilise resources to facilitate the complete roll out of the new guidelines, a phased approach to implementation is being adopted. The advocacy and communication strategy aims to support the coordinated and standardised implementation of the revised HIV treatment and prevention guidelines, through the dissemination of accurate and target specifi c information, as well as minimising confusion and negative feedback around the adoption and implementation of the guidelines.

The Government of Zimbabwe aims to fully implement the new guidelines within the following three years, and revisions and changes to the phasing strategy will be communicated as and when necessary. In the meantime, I urge you to make use of this Advocacy and Communication Strategy to guide Antiretroviral therapy (ART), PMTCT and infant feeding service provision and to enable roll out of the revisions to be conducted in a standardised and coordinated manner, as we work together to address the HIV situation in Zimbabwe.

Brigadier General (Dr.) G. GwinjiPermanent Secretary

Ministry of Health and Child Welfare, Zimbabwe, 2011

Contents

Acronyms ........................................................................................... i

Acknowledgements ............................................................................ ii

1. Introduction .................................................................................. 1

1.1 Background ................................................................................1

1.2 Why an Advocacy and Communication Strategy? .............................2

2. Communication Strategy Goal and Objectives ................................ 4

2.1 Specific Objectives of the Advocacy and Communication Strategy ......4

2.2 Expected Results .........................................................................5

3. Target Group ................................................................................. 6

3.1 Service Provider Level Interventions ..............................................6

3.2 Funding and Technical Partner Interventions ....................................7

3.3 Policy Level Interventions .............................................................7

3.4 Community Level Interventions .....................................................8

3.5 Media Level Interventions ............................................................9

4. Advocacy and Communication Strategy Activities ........................ 10

4.1 Rapid Appraisal .........................................................................10

4.2 Information Materials for Service Providers ...................................10

4.3 Information Materials for Donors and Technical Partners .................11

4.4 Information Materials for Policy Makers ........................................11

4.5 Information Materials for Community Members and General Public ...11

4.6 Information Materials for the Media .............................................12

5. Managing the Advocacy and Communication Strategy ................. 14

6. Eighteen Month Implementation Plan .......................................... 16

Table of Figures

Figure 1: Model showing strategy for collaboration in theimplementation of the advocacy and communication strategy .......2

Figure 2: Model to show the advocacy and communicationstrategy in action ..................................................................14

Figure 3: Proposed Implementation Plan page .......................................18


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1. Introduction

1.1 Background

In November 2009, the World Health Organization (WHO) released a rapid advice on Antiretroviral Therapy (ART) and Prevention of Mother-To-Child Transmission (PMTCT) of HIV, including infant feeding, intended to improve HIV prevention and treatment at individual, national and global levels.

The Government of Zimbabwe adopted these international guidelines, adapting them for country specific implementation and replacing the previous ART guidelines of 2006 with the release of ‘Guidelines for Antiretroviral Therapy in Zimbabwe’, in May 2010.

There are significant differences between the 2010 guidelines and those issued in 2006, necessitating a phase-in and phase-out approach towards full adoption of the new guidelines. The transition to new guidelines demands sensitisation of beneficiaries, stakeholders and service providers on the roll out process as accurate information is critical to ensure support of the transition strategy, curtail misconceptions and distrust and reassure all stakeholders and beneficiaries on the ethical soundness of the transition strategy. Possession of accurate information will facilitate scale up and adherence and bolster efforts to improve HIV treatment and prevention in Zimbabwe.

This advocacy and communication strategy has been developed through comprehensive consultation with key stakeholders, guided by the new WHO guidelines adaptation committee.

Whilst this advocacy and communication strategy has been developed specifically to support the roll out of the revised WHO guidelines on ART, PMTCT and infant feeding, it is acknowledged that there are a number of partners with a role to play in advocacy and communication, and it is envisaged that this strategy will feed into and complement the broader national communication and advocacy strategies. Similarly, the Ministry of Health and Child Welfare (MoHCW) recognises that a number of civil society organisations, private and public partners are implementing communication and advocacy activities on issues which interlink with the topics to be addressed by this strategy. This publication aims to provide a framework for collaboration, enabling roles and responsibilities to be identified and distinguished, in order to guard against replication of efforts, ensure that messages and information disseminated are compatible and that individual advocacy and communication efforts complement each other, as well as the national strategy. The document also aims to provide a streamlined and harmonised framework for resource mobilisation and donor support. Figure 1 depicts a suggested model of collaboration.


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Due to the dynamic nature of the epidemic and the subsequent need for flexibility with regard to response mechanisms, this strategy may be revised or adapted, as required, to cater for situational changes. Such revisions will be communicated to stakeholders.

1.2 Why an Advocacy and Communication Strategy?

By the end of December 2010, a total of 326,241 patients i.e. 297,338 adults and 28,903 children below 15 years of age, were accessing antiretroviral therapy from the public sector. About 63,7% of the patients on ART are females, whilst 8,9% are children. Most ART patients (99%) are receiving first line ART regimens, while 1% (2,648) are on second line regimens (National ART Progress Report, December 2010).

According to the 2009 national HIV estimates, and using a CD4 threshold of 350 for initiation of ART, an estimated 593,168 people are in urgent need of ART.The new guidelines, whilst improving HIV treatment and prevention through the introduction of earlier ART initiation and providing for more efficacious regimens, also exert increased pressure on the health delivery system. Sustained efforts will, therefore, be required to mobilise resources and inform people of the planned changes and expected implications, whilst also reassuring them that the changes constitute an improvement in HIV treatment and prevention efforts.

Access to antiretrovirals (ARVs) is already viewed with scepticism amongst certain sectors as, for a number of reasons, some PLHIV continue to encounter challenges in accessing the treatment services they require. It is critical, therefore, that people be informed about the strategy that is in place, what it means and the steps that are being taken to ensure universal access. There should be a nation-wide common understanding of the situation at hand. This means that, even prior to approaching service providers, people should be well informed of the possibilities to remain on the old, or be moved to the new, treatment regimens. Similarly, pregnant women need to understand the reasons for, and implications of, the new treatment regimens they are likely to be initiated on. Service providers also need to be adequately informed and prepared so that they can interface comfortably with an informed clientele.

Elimination of vertical transmission of HIV is possible through scale up of PMTCT (about 90% of infections in children are due to vertical infection), assuming the continuity of adequate supplies to meet PMTCT requirements. There is need to support the roll out strategy through sensitisation and coordination of all stakeholders, including civil society, the private sector, donors and, most importantly, the community (especially pregnant women, women of child bearing age and their partners), to enable universal access to these services. Furthermore, health service providers and community members must be supported to address the reasons for low uptake of PMTCT services, including infant feeding recommendations. It has recently been found that a number of women are receiving conflicting advice regarding PMTCT and infant feeding, hindering national efforts to eliminate paediatric transmission of HIV. One example is the high proportion of women introducing solid foods prior to the six


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month exclusive breastfeeding period advised by the WHO. Early introduction of solid foods is primarily a result of a mother’s fear that low food intake will result in the amount of breast milk produced being inadequate to sustain her child. Whilst mothers are encouraged to increase their nutritional intake during pregnancy and breastfeeding to ensure good health, the amount of food the mother takes has no bearing on the amount of breast milk produced, except in very extreme circumstances. Materials developed as part of this advocacy and communication strategy will help health service providers to communicate these links between a mother’s nutritional status and that of her child, as well as to sensitise community members and partners on these issues, to reinforce good practices in PMTCT and infant feeding, towards ultimately eliminating vertical HIV transmission in Zimbabwe.

It is vital that accurate information be provided to community-based organisations (CBOs) and the private sector to enable mainstreaming of PMTCT into existing activities and to bolster efforts to mobilise resources for this key area of work. It is also important to create synergies with existing campaigns and guidelines for related programmes and conditions, e.g. tuberculosis (TB), malaria, hepatitis B (HBV), sexual and reproductive health and rights (SRHR) and maternal and newborn health. This is possible only through clear communication and understanding of the broader HIV prevention and treatment strategies being implemented.

The advocacy and communication strategy outlined herewith proposes a multi-faceted, holistic and comprehensive national communication strategy. Central to this strategy is a desire to reach all key population strata with relevant and accurate information to support the roll out of the new ART and PMTCT guidelines, by diffusing potential backlash and opposition born of fear or lack of understanding; facilitating buy-in and support from all levels; ensuring a standardised treatment response by all service providers and for all patients, and providing an enabling environment for the new guidelines to be implemented successfully.

The implementation of an effective national advocacy and communication strategy is vital to the successful roll out of the new Antiretroviral Therapy Guidelines for Zimbabwe, harmonised in line with new WHO guidelines to improve HIV treatment, reduce vertical HIV transmission and enhance the quality of life for PLHIV.


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2. Communication Strategy Goal and Objectives

The overall goal of the strategy is to contribute to the reduction of HIV transmission and improve the quality of life for People Living with HIV (PLHIV)through supporting the roll out of the revised 2010 HIV and AIDS guidelines for ART, PMTCT and infant feeding.

The implementation of the advocacy and communication strategy will result in more effective roll out of the guidelines, by steering public opinion to ensure positive responses to, and buy-in and support of, the revisions.

2.1 Specific Objectives of the Advocacy and Communication Strategy

The advocacy and communication strategy aims to:

• Support the implementation of the revised HIV treatment and prevention guidelines, through the dissemination of accurate and target-specific information

• Minimise confusion and negative feedback around the adoption of the revised HIV treatment and prevention guidelines by guiding and shaping public opinion to promote positive attitudes and a supportive and enabling environment amongst men, women, youth, national and community leaders, service providers, private sector and media personnel

• Promote early testing and treatment of HIV

• Promote early HIV testing and booking for all pregnant women and women of child-bearing age and their partners, to enable access to treatment in order to minimise, and ultimately eliminate, vertical transmission of HIV, during labour and post-partum

• Disseminate accurate information in line with the revised guidelines around infant feeding, to promote HIV-free survival of infants

• Harness existing information dissemination channels to reduce the cost of disseminating information around the revised treatment guidelines

• Provide a framework for action for all stakeholders to facilitate mutually reinforcing and harmonised collaboration, in line with national strategies and priorities

• Facilitate integration of HIV, TB, sexual and reproductive health (SRH), malaria, Hepatitis B (HBV) and maternal and neonatal health programmes

• Provide a framework for harmonised and structured resource mobilisation.


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2.2 Expected Results

• Increased understanding, buy-in and support of the roll out process of country-adapted revised WHO HIV and AIDS guidelines amongst policy makers, service providers, the private sector, the community at large and specifically, PLHIV

• Increased tolerance by communities and other stakeholders of efforts and strategies adopted by the Government of Zimbabwe to achieve universal access to ART and elimination of vertical HIV transmission

• A more coordinated approach to roll out of the new ART, PMTCT and infant feeding guidelines, and resource mobilisation thereof

• Increased uptake of HIV-related services (early HIV testing, family planning, uptake of PMTCT, inclusive of early booking and adherence to infant feeding recommendations).


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3. Target Group

The advocacy and communication strategy aims to reach all key stakeholder groups with relevant information about the new ART guidelines being adopted in Zimbabwe. The target groups are as follows:

• Service providers

→ Health workers (including village health workers and community-based volunteers (CBVs) as strategic information dissemination hubs)

→ AIDS service organisations, community-based organisations and non-governmental organisations

→ Networks of PLHIV → Private sector

• Funding and technical partners

→ Donors → Technical organisations and committees

• Policy makers

→ National policy makers and leaders (politicians, parliamentarians, constituency leaders, etc.)

→ Community level custodians of culture and community information hubs (traditional leaders, church leaders, etc.)

• Community members

→ General public (both urban and rural) including young people, adolescents, men and women

→ PLHIV (both those currently on HIV treatment and those not yet initiated)

→ Pregnant women, women of childbearing age and their partners → Workforces

• Media

→ Journalists, reporters, etc. → Popular and influential public figures and opinion leaders, including

Goodwill Ambassadors, musicians, artists, radio DJs, presenters, etc.

3.1 Service Provider Level Interventions

It is important for service providers not only to be equipped with knowledge and skills to manage the transition from the old treatment regimens to the new, but also to be able to interface effectively with an informed community. Information and messages will target public and private service providers at all levels of care. Service providers need to be able to generate understanding amongst clients regarding the new treatment regimens, including the phasing out and prioritisation strategy, to allay anxiety related to delayed transition.

Community and primary health care workers such as village health workers and other community-based volunteers are key and strategic information sources for


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community members. As such, their engagement and integration is crucial to a national communication strategy. These cadres, who interact with community members on a personal level and outside the sphere of clinical infrastructures, will be appraised of the new guidelines and assimilated into the communication strategy, through provision of appropriate tools to aid community information dissemination.

The workplace is also a key and strategic institution for the dissemination of information to men and women, particularly those of childbearing age. Materials developed for popular consumption will, therefore, be distributed through workplaces as a means to reach these key end-user beneficiaries. Similarly, networks of People Living with HIV will provide strategic communication channels for the dissemination of information to PLHIV. Information targeted at clinic, medical and hospital staff (private and public sector), as well as AIDS service organisations (ASOs), will ensure coherent and coordinated communication of information on the revised guidelines, and support management of the roll out process.

3.2 Funding and Technical Partner Level Interventions

The support of funding and technical partners is critical to the sustained implementation of the revised ART, PMTCT and infant feeding guidelines, as continued and sustainable material support is required for effective roll out. Information will be packaged for the benefit of donor and technical agencies to aid buy-in and resource mobilisation.

3.3 Policy Level Interventions

Whilst there is commitment amongst policy makers and leaders to scale up access to and the availability of HIV treatment in Zimbabwe, it is imperative that policy makers and leaders are fully acquainted with the revised guidelines and the implications for health delivery. Support and buy-in of leaders is vital to ensure commitment of the necessary resources - both material and human - required for effective implementation of the strategy. Furthermore, all policy makers and leaders must be fully cognizant of the new policy implications to enable confident and standardised responses to potential backlash or resistance. Policy makers and leaders have the responsibility of garnering public support for the new guidelines and as such, it is imperative that all policy makers and leaders support the changes wholeheartedly, whether involved in the health sector or otherwise. The implementation of the new guidelines will have cross cutting implications and cannot be viewed purely as a health issue. The advocacy and communication strategy aims to renew political will and commitment and to effectively implement revised HIV treatment guidelines and encourage:

• Mobilisation and commitment of resources to systematically coordinate existing strategies and generate stakeholder (including donor, civil society and private sector) commitment to support guideline implementation at national and community levels


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• Improvements in accountability for HIV treatment and for the realisation of commitments made with regard to targets set

• Standardised understanding and articulation of the new guidelines and the implications thereof, to be able to address concerns regarding ART, PMTCT and infant feeding, at national and community levels

• Receptiveness and responsiveness to the emerging policy issues around implementation of the guidelines, to enable timely policy revisions where necessary.

Whilst policy makers and leaders are commonly considered to be those at national level, the significance of community and traditional leaders in information dissemination cannot be overlooked, as well as the importance of their support in ensuring a harmonised approach to communication. Community level custodians of culture, leaders and community information hubs such as church leaders, influential in their ability to communicate accurate information at community level, will also be targeted in this communication strategy.

At the policy maker level, messages will focus on raising awareness of the intricacies of the revised ART, PMTCT and infant feeding guidelines, how the new and old treatment regimens will be phased in and out respectively and the expected impact of the implementation of these guidelines on the socio-economic development of the nation and on HIV prevalence. Emphasis will also be on highlighting the role of leadership in informing and supporting their constituencies to understand the longterm expected results of these guidelines.

3.4 Community Level Interventions

The strategies being proposed at community level aim to mould community attitudes and perceptions on HIV treatment, particularly with regard to perceiving the revised guidelines in a positive light. The strategy also aims to ensure buy-in of the new requirements and guidelines, from a patient or potential patient’s perspective, at community level, e.g. to support the idea that patients should be initiated onto ART before experiencing HIV related illness. Whilst information dissemination involving custodians of culture, traditional leaders, community-based volunteers, village health workers and community-based organisations, which have already been highlighted, are intended to increase understanding at community level as the end target group, direct involvement of community members focusing on key groups, is also integral to the success of a communication strategy.

The messages at this level will be clear, concise, instructive and relevant to the needs of community members. Communication strategies will target different key groups including:

• PLHIV who are on HIV treatment: to provide assurance that the Government of Zimbabwe is scaling up access to the new regimens in a systematic manner within available capacity and that the new guidelines are intended to better serve PLHIV, whilst ensuring that demand is managed, and to dissipate anxiety related to the prioritisation strategy


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• PLHIV who know their status but are not yet initiated on ART: to explain the reasoning, and garner support for the criteria identified for initiation on the new treatment regimens, and for earlier initiation on treatment

• Pregnant women, women of child bearing age and their partners: to promote HIV testing and seeking of comprehensive antenatal care; explain the benefits of such and ‘normalise’ testing and antenatal care, in an effort to minimise and ultimately eradicate vertical transmission of HIV. Strategic promotion of male involvement and community sensitisation will support efforts to scale up PMTCT

• Workforce: whilst it is acknowledged that the majority of workers are involved in informal sector employment, the workplace is still a strategic entry point to reach men and women of productive and reproductive age with key information. Strategic alliances with workplaces, including both private and public sector, will be forged and programmes serving the world of work will be created to facilitate access to information through the various media developed as part of this strategy

• General public (both urban and rural): including young people, adolescents, men and women: whilst information disseminated through village health workers and community-based volunteers as well as other clinical infrastructures and institutions, is effective as a means to reach key groups with targeted information, other members of society, who have less incentive or tendency towards seeking health promotion information, will be reached through mass media campaigns and subliminal messaging. This form of information dissemination aims to sensitize the general populace without discouraging or causing ‘information fatigue’.

3.5 Media Level Interventions

The media has substantial influence over public opinion and their buy-in and support can have either a very positive or negative impact on roll out of a national strategy. Ensuring that media personnel are accurately informed about the issues at hand and support the introduction of the revised guidelines, will facilitate accurate, relevant and positive reporting. Bringing the media on board effectively will play a key role in influencing all other key stakeholders.

Specific materials and messages targeting each of these groups will be linked through design aspects and messaging which will be common to all materials developed under the strategy, giving the campaign an identity and branding. This will make campaign materials instantly recognisable, making them more relevant to the individual and reinforcing key messages.


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4. Advocacy and Communication Strategy Activities

4.1 Rapid Appraisal

• Prior to development or implementation of the advocacy and communication materials and initiatives, a rapid appraisal, including a literature review, as well as key informant and stakeholder interviews, will be conducted to identify potential issues that service providers and community information disseminators need to be appraised on and prepared for. The rapid appraisal will also guide stakeholder mapping and key message development, and inform material content development to ensure relevance and effectiveness.

4.2 Information Materials for Service Providers

• Sensitisation tools and reference guide: the guidelines will be repackaged into easy-to-access sensitisation tools and a reference guide, including treatment protocols, for service providers at all levels. The kit will include a booklet with clear sections indicating what the changes are and how to communicate these changes, as well as posters to be displayed in consultancy rooms and health institutions. The guide, which will have multiple user-modalities, will also act as a tool for existing trainers, including those involved with networks of PLHIV, to sensitise participants on the revised guidelines, taking advantage of the opportunities presented by any ongoing trainings or workshops being conducted. It will include information on the reasons for revised guidelines; detail on the phased approach to implementation; address frequently asked questions and common concerns, and by containing all the essential relevant information, will enable quick and easy reference during consultation and interfacing. This will ensure reaching all service providers with key information and facilitate a standardised response to the queries and questions likely to be faced, enabling effective management of negative feedback (and preventing de-railing of the implementation of the guidelines), as well as facilitating a national sensitisation campaign

• The same sensitisation tools and reference guide will prove valuable to AIDS service organisations, community-based organisations, non-governmental organisations, private sector focal people, networks of PLHIV, and other health communicators, by providing a concise breakdown of the guidelines and associated implications

• Sensitisation workshops: Sensitisation workshops will be conducted throughout Zimbabwe on how to communicate the treatment revisions using the sensitisation tools and reference guide as the primary training tool. Once trained, the sensitisation trainers are expected to take advantage


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of any existing health trainings or activities to sensitise participants on the new guidelines. Circulars will be disseminated to all service providers using existing channels and systems, to alert the pool of trainers to any communication opportunities (ongoing trainings, etc) to enable sessions for sensitisation on the new guidelines to be incorporated.

4.3 Information Materials for Donors and Technical Partners

• Donor’s brief and budget: a donor’s brief highlighting, in particular, progress made and gaps identified, including funding deficits and opportunities to support the national strategy, will be developed and updated as necessary. An electronic database will be developed as a means of sharing the donor e-bulletins to minimise costs. This will support the mobilisation of required funds.

4.4 Information Materials for Policy Makers

• Sensitisation tools and reference guide: the sensitisation tools and reference guide detailed under the Information Materials for Service Providers section, will be disseminated to policy makers and leaders. This will enable accurate understanding of the issues amongst policy makers, aiding the dissemination of standardised information

• Policy maker sensitisation meeting: a national sensitisation meeting for policy makers and service providers will be conducted to ensure that the importance of being fully cognizant of the changes is recognised.

4.5 Information Materials for Community Members and General Public

• TV and radio programmes: ‘Positive Talk’, a TV and radio series pioneered by SAfAIDS which enables frank and open discussion around key health topics, has gained a lot of popularity and a large following in Zimbabwe. During each episode, experts are invited to share information on a given topic and community members pose questions to the experts for responses. The programmes have received, and continue to receive, positive feedback and are an effective mass media strategy to disseminate accurate and relevant information. As such, the format will be adopted as a means to disseminate key information to the wider public

• Leaflets: leaflets focusing on the three key areas of change (ART, PMTCT and infant feeding) will be produced for wide distribution in Zimbabwe. The leaflets will contain critical information simply articulated for the general public, on each of the key thematic areas. Community health personnel, including village health workers and community-based volunteers, will be engaged for dissemination of the leaflets


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• Posters: a series of posters will be developed, each aimed at specific groups (e.g. general public, pregnant women, women of child-bearing age and their partners), to promote the new guidelines using target-specific messaging. The posters will promote the national efforts to improve health care in Zimbabwe and will motivate all Zimbabweans to play their part in supporting the initiative, minimising vertical transmission and reducing HIV prevalence. Posters will be distributed to places of public gathering, e.g. salons, kiosks, restaurants, bus terminals and workplaces, among other key distribution points

• Subliminal messaging: for population groups, particularly young people and men who are less inclined to seek information on health promotion strategies, subliminal messaging will aid the dissemination of information in a more subtle manner, in an effort to engage these individuals and stimulate a desire for further information. Subliminal messaging will be positive and highlight the individual benefits of the revised treatment and prevention guidelines, as well as disseminating the key messages and encouraging effective branding of the strategy. Such messaging will take the form of printing ‘info-bytes’, catchphrases and short reminders, on goods typically used by community members, e.g. on match boxes, cell phone top-up cards, etc.

4.6 Information Materials for the Media

• Media briefings: periodic media briefings will be conducted for journalists, reporters and other media personnel at key stages of the roll out of the treatment guidelines, e.g. prior to each stage of phasing, to ensure positive and accurate reporting. The media personnel, sensitised and trained on general HIV reporting through previous activities, will be briefed on the new treatment guidelines, and the importance of precise and positive reporting reiterated

• Media flashes: regular updates on the key issues will be posted, using existing media communication channels, such as the SAfAIDS media resource desk. This web-based resource site is regularly visited by journalists seeking information for upcoming articles and reports, and is a key strategy for guiding reporting on HIV

• Newspaper column: a regular column will be published in a national newspaper, in a question-and-answer format. In each column, a different question relating to the revised guidelines will be posted and answered by the respondent, an experienced doctor

• Sensitisation of popular public figures and opinion leaders: popular public figures and opinion leaders will be engaged and sensitised on the guidelines, in an effort to motivate these influential figures to harness their public appearances as a means to support the treatment changes.


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EXPECTED OUTPUTS:- Greater understanding- Better service delivery- Increased demand

implementation

OVERALL GOAL:Decreased HIV incidence and

improved quality of life for PLHIV

Service Providers:- Health Workers

- Village Health Workers- Community Volunteers

- ASOs, NGOs, CBOs- Donors

Policy Makers:- National leaders

- Community leaders- Custodians of culture

- Traditional leaders- Church leaders

Media / Communications:

- Journalists

Community:- PLHIV

- Pregnant women, women of childbearing age

& their partners- Young men and women

- Workforce- General Public

buy-in and supportbu

y-in

and

support

buy-in and support

INPUTS:

relevant information

ART Advocacy and Communication Strategy: Towards Adoption of the New WHO Guidelines

Figure 2: Model to show the advocacy and communication strategy in action


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5. Managing the Advocacy and Communication Strategy

Different partners will support the implementation of the advocacy and communication strategy with the Adaptation Committee providing guidance. The Ministry of Health and Child Welfare and SAfAIDS will take the leading role and have overall responsibility for coordination and implementation of the strategy, ensuring harmonised roll out and effective integration with other key communication sectors. Whilst specific roles and responsibilities will be refined with input from all relevant parties, initial guidelines for the division of key roles and responsibilities have been indicated below and are further elaborated in the implementation plan.

Role of Government:

• Mobilise and leverage adequate resources for implementation of the advocacy and communication strategy

• Provide relevant information and input to ensure appropriateness of advocacy and communication strategies and information materials

• Review, approve and endorse strategy, methodology and content of the various information packages

• Create an enabling and supportive environment for successful implementation of the advocacy and communication strategy

• Provide expertise and where necessary, resource persons, to facilitate sharing of relevant and accurate information at the various platforms.

Role of SAfAIDS:

• Update, where necessary, the advocacy and communication strategy

• Coordinate relevant subcommittees instituted to provide input and expertise for material content

• Facilitate repackaging of existing guidelines into user-friendly, accessible and target specific tools, and develop, edit, design and print target oriented information materials

• Promote harnessing and integration of existing and currently under-utilised distribution channels, such as community-based health workers, and potential strategic points of entry, such as the workplace and networks of PLHIV, into the advocacy and communication strategy, which also draws on more conventional methods


16

• Develop and coordinate a monitoring strategy, drawing wherever possible on existing monitoring channels to prevent replication, to inform on the impact of the advocacy and communication strategy and facilitate refinement of implementation modalities.

Role of Stakeholders and Partners:

• Support roll out of the advocacy and communication strategy and the adoption of the new WHO guidelines for ART, PMTCT and infant feeding in Zimbabwe

• Engage and consult MoHCW during the implementation of activities which are associated with ART, PMTCT or infant feeding, or that may have an impact on the activities to be implemented as part of this communication and advocacy strategy

• Support and complement Government strategies and priorities

• Resource mobilisation

• Ensure sustainability of the roll out.


17

6. Eighteen Month Implementation Plan

Implementation of the Advocacy and Communication Strategy has been divided into three broad phases, according to initial priority. Phases will be rolled out in line with available funding and need. Implementation of the plan is expected to be conducted over an eighteen month period beginning in January 2011. Ideally, each phase represents a period of approximately six months during the 18 month total implementation period, but this is heavily dependent on the availability of funding:

Phase 1: priority sensitisation of service providers and policy makers, in preparation for initial roll out of revised treatment guidelines. Phase one has been further divided into phase 1A and phase 1B, each representing aproximately a three month period. Phase 1A represents activities to be implemented with funds which have already been secured. Phase 1B represents high priority activities for which funds have not yet been secured.

Phase 2: sensitisation of communities, PLHIV, potential patients, beneficiaries and media on the new guidelines to manage response.

Phase 3: promotion of services to scale up demand and increase uptake of improved HIV treatment, PMTCT and infant feeding strategies and services, contributing to reduced HIV transmission and enhanced quality of life for PLHIV.

Figure 3 details the proposed implementation plan, in line with the phased approach.


18

Fig

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lets

dev

elop

ed

and

appr

oved

3 Pr

int a

ppro

val f

orm

s si

gned

by

MoH

6.4

Tran

slat

ion

of

each

leaf

let i

nto

both

Sh

ona

and

Ndeb

ele

xTr

ansl

atio

n30

0.00

618

00.0

03

leaf

lets

tran

slat

ed

into

Sho

na

3 le

afle

ts tr

ansl

ated

in

to N

debe

le

6.5

Prin

ting

of le

afle

tsx

Prin

ting

0.25

3000

00.0

075

000.

0010

0,00

0 co

pies

of

each

of t

he 3

leaf

lets

pr

inte

d (3

00,0

00

copi

es in

tota

l)


24

Act

ivity

Sub

-Act

ivity

Tim

e lin

eB

udge

tE

xpec

ted

outp

utP

hase

1AP

hase

1B

Pha

se

2P

hase 3

Item

Uni

t C

ost

Qua

ntity

Tota

l C

ost

7Pr

oduc

tion

and

airin

g of

TV

pro

gram

me

– Po

sitiv

e Ta

lk a

nd T

V sp

ots

7.1

TV p

roga

mm

e pr

oduc

ed (2

x 13

epi

sode

s)

xPr

oduc

tion

cost

s

Prof

essi

onal

fees

Prom

os

3000

.00

450.

00

500.

00

26 6 40

7800

0.00

2700

.00

2000

0.00

2 x 1

3-ep

isod

e TV

pr

ogra

mm

es p

rodu

ced

7.2

TV p

rogr

amm

e ai

red

(2 x

13

epis

odes

)

x (13

epis

odes

in

P2)

x (13

epis

odes

in

P3)

Airin

g co

sts

2500

.00

2665

000.

002

x 13-

epis

ode

TV

prog

ram

mes

aire

d

8Pr

oduc

tion

and

airin

g of

radi

o pr

ogra

mm

e –

Posit

ive

Talk

and

spo

ts

8.1

Radi

o pr

ogam

me

prod

uced

(2 x

13 e

piso

des)

xPr

oduc

tion

cost

s

Prof

essi

onal

fees

Prom

os

2000

.00

450.

00

500.

00

26 6 40

5200

0.00

2700

.00

2000

0.00

2 x 1

3-ep

isod

e ra

dio

prog

ram

mes

pro

duce

d

8.2

Radi

o pr

ogra

mm

e ai

red

(2x 1

3 ep

isod

es)

x (13

epis

odes

in

P2)

x (13

epis

odes

in

P3)

Airin

g co

sts

1500

.00

2639

000.

002

x 13-

epis

ode

radi

o pr

ogra

mm

es a

ired

9De

velo

pmen

t and

pla

cing

of

a we

ekly

new

spap

er c

olum

n9.

1 Id

entif

icat

ion

of

suita

ble

news

pape

r to

prin

t col

umn

and

‘doc

tor’

to

write

the

colu

mn

xn/

an/

an/

an/

aSu

itabl

e ne

wspa

per

iden

tifie

d

9.2

Colu

mn

cont

ent

deve

lopm

ent

xx

Cont

ent

deve

lopm

ent

– ho

nora

ria fo

r ‘c

olum

n do

ctor

’

100.

0052

5200

.00

Cont

ent f

or 5

2 ne

wspa

per c

olum

ns

deve

lope

d

9.3

Plac

ing

of c

olum

n in

ne

wspa

per (

once

pe

r wee

k)

x (26

colu

mns

pl

aced

in

P2)

x (26

colu

mns

pl

aced

in P

3)

Plac

ing

of c

olum

n20

0.00

5210

400.

00W

eekl

y co

lum

n fe

atur

ing

in a

ne

wspa

per


25

Act

ivity

Sub

-Act

ivity

Tim

e lin

eB

udge

tE

xpec

ted

outp

utP

hase

1AP

hase

1B

Pha

se

2P

hase 3

Item

Uni

t C

ost

Qua

ntity

Tota

l C

ost

10

Sens

itisa

tion

of m

edia

pe

rson

nel o

n th

e ne

w gu

idel

ines

as

well

as th

e im

porta

nce

of a

ccur

ate

and

sens

itive

repo

rting

ar

ound

the

new

guid

elin

es

– ga

in m

edia

buy

-in

10.1

Fac

ilita

tion

of

3 m

edia

brie

fings

(e

ach

for 5

0 jo

urna

lists

and

m

edia

per

sonn

el):

• Ha

rare

• Bu

lawa

yo

• M

utar

e

x (3 m

edia

br

iefin

gs

in P

2)

Prof

essi

onal

fees

Tran

spor

t

Venu

e hi

re

Conf

eren

ce p

acka

ge

Acco

mm

odat

ion

Tran

spor

t re

imbu

rsem

ents

Stat

ione

ry

Equi

pmen

t hire

(P

roje

ctor

, PA

syst

em)

Pres

ente

r ho

nora

rium

s

450.

00

0.10

200.

00

30.0

0

120.

00

50.0

0

250.

00

250.

00

100.

00

3

1500 3

150 75 75 3 3 6

1350

.00

150.

00

600.

00

4500

.00

9000

.00

3750

.00

750.

00

750.

00

200.

00

150

med

ia p

erso

nnel

br

iefe

d on

revi

sed

treat

men

t gui

delin

es

M&

E to

ols

(regi

stra

tion

form

s,

feed

back

form

s,

etc)

com

plet

ed

10.2

Dev

elop

men

t of

eve

nt re

ports

xPr

ofes

sion

al fe

es45

0.00

313

50.0

03

med

ia b

riefin

g re

ports

dev

elop

ed

10Up

datin

g of

trai

ned

jour

nalis

ts a

nd m

edia

pe

rson

nel t

hrou

gh

regu

lar p

ostin

g of

med

ia

flash

es th

roug

h m

edia

re

sour

ce d

esk

(MRD

)

10.3

Pos

ting

of a

t le

ast o

ne fl

ash

per

mon

th fo

llowi

ng th

e m

edia

brie

fings

x (6 m

edia

fla

shes

po

sted

in

P2)

x (6 m

edia

fla

shes

po

sted

in P

3)

Prof

essi

onal

fees

450.

003

1350

.00

At le

ast 1

med

ia

flash

pos

ted

per

mon

th fo

llowi

ng th

e m

edia

brie

fings


26

Act

ivity

Sub

-Act

ivity

Tim

e lin

eB

udge

tE

xpec

ted

outp

utP

hase

1AP

hase

1B

Pha

se

2P

hase 3

Item

Uni

t C

ost

Qua

ntity

Tota

l C

ost

11Se

nsiti

satio

n of

pop

ular

pu

blic

figu

res

and

opin

ion

lead

ers

such

as

Good

W

ill A

mba

ssad

ors

11.1

Fac

ilita

tion

of 1

bre

akfa

st

mee

ting

for 5

0 pe

ople

per

qua

rter

x (2 b

/fast

m

eetin

gs

in P

2)

x (2 b

/fast

m

eetin

gs

in P

2)

Prof

essi

onal

fees

Venu

e hi

re

Conf

eren

ce p

acka

ge

Acco

mm

odat

ion

Tran

spor

t re

imbu

rsem

ents

Stat

ione

ry

Equi

pmen

t hire

(P

roje

ctor

, PA

syst

em)

Pres

ente

r ho

nora

rium

s

450.

00

200.

00

30.0

0

120.

00

50.0

0

250.

00

250.

00

100.

00

4 4

200

100

100 4 4 8

1800

.00

800

.00

6000

.00

1200

0.00

5750

.00

1000

.00

1000

.00

800

.00

4 br

eakf

ast m

eetin

gs

cond

ucte

d, 1

per

qu

arte

r, wi

th 5

0 pe

ople

atte

ndin

g ea

ch m

eetin

g

M&

E to

ols

(regi

stra

tion

form

s,

feed

back

form

s,

etc)

com

plet

ed

11.2

Dev

elop

men

t of

eve

nt re

ports

xx

Prof

essi

onal

fees

450.

004

1800

.00

4 br

eakf

ast m

eetin

g re

ports

dev

elop

ed

12De

velo

pmen

t of p

oste

rs

on th

e 3

key

them

atic

ar

eas

(ART

, PM

TCT

and

infa

nt fe

edin

g) to

pr

omot

e ne

w gu

idel

ines

an

d in

crea

se u

ptak

e

xCo

nten

t de

velo

pmen

t

Editi

ng &

pro

ofin

g

Desi

gn &

layo

ut

Prof

essi

onal

fees

450.

00

450.

00

450.

00

450.

00

6 3 6 6

2700

.00

1350

.00

2700

.00

2700

.00

3 dr

afte

d po

ster

s de

velo

ped


27

Act

ivity

Sub

-Act

ivity

Tim

e lin

eB

udge

tE

xpec

ted

outp

utP

hase

1AP

hase

1B

Pha

se

2P

hase 3

Item

Uni

t C

ost

Qua

ntity

Tota

l C

ost

12De

velo

pmen

t of p

oste

rs

on k

ey th

emat

ic a

reas

(A

RT, P

MTC

T an

d in

fant

fe

edin

g) to

pro

mot

e ne

w gu

idel

ines

and

incr

ease

up

take

(con

tinue

d)

12.2

Rev

iew

of c

onte

nt b

y ad

apta

tion

com

mitt

ee a

nd o

ther

ke

y st

akeh

olde

rs

xn/

a*

*Dra

ft po

ster

s to

be

subm

itted

el

ectro

nica

lly;

revi

ew p

roce

sses

to

be

cond

ucte

d du

ring

exis

ting

foru

ms

n/a

n/a

n/a

3 po

ster

s re

view

ed

Feed

back

form

s su

bmitt

ed fo

r 3

post

ers

12.3

Fin

alis

atio

n an

d ap

prov

al o

f co

nten

t for

3 p

oste

rs

xPr

ofes

sion

al fe

es45

0.00

313

50.0

03

prin

t-rea

dy

post

ers

deve

lope

d an

d ap

prov

ed

3 pr

int a

ppro

val f

orm

s si

gned

by

MoH

12.4

Tran

slat

ion

of

each

pos

ter i

nto

both

Sh

ona

and

Ndeb

ele

xTr

ansl

atio

n10

0.00

660

0.00

3 po

ster

s tra

nsla

ted

into

Sho

na

3 po

ster

s tra

nsla

ted

into

Nde

bele

12.5

Prin

ting

of p

oste

rsx

Prin

ting

0.50

6000

030

000.

0020

,000

cop

ies

of

each

of t

he 3

pos

ters

pr

inte

d (6

0,00

0 co

pies

in to

tal)


28

Act

ivity

Sub

-Act

ivity

Tim

e lin

eB

udge

tE

xpec

ted

outp

utP

hase

1AP

hase

1B

Pha

se

2P

hase 3

Item

Uni

t C

ost

Qua

ntity

Tota

l C

ost

13Su

blim

inal

mes

sagi

ng

(‘inf

o-by

tes’

) to

prom

ote

revi

sed

heal

th p

rom

otio

n st

rate

gies

to g

roup

s wh

o te

nd to

be

less

incl

ined

to

seek

hea

lth in

form

atio

n

13.1

Iden

tific

atio

n of

wid

ely

dist

ribut

ed

prod

ucts

to b

e pr

inte

d wi

th

subl

imin

al m

essa

ges

(3 p

rodu

cts

to

be id

entif

ied

for s

ublim

inal

m

essa

ging

)

xn/

an/

an/

an/

a3

prod

ucts

to b

e pr

inte

d wi

th s

ublim

inal

m

essa

ging

iden

tifie

d

13.2

Sig

ning

of

MOU

s wi

th

man

ufac

ture

rs o

f id

entif

ied

prod

ucts

xn/

an/

an/

an/

aM

OUs

sign

ed w

ith 3

pr

oduc

t man

ufac

ture

rs

13.3

Mes

sage

de

velo

pmen

t and

de

sign

of m

essa

ge

/ bra

ndin

g

xPr

ofes

sion

al fe

es45

0.00

313

50.0

0Su

itabl

e an

d re

leva

nt

mes

sage

s id

entif

ied

13.4

Prin

ting

of g

oods

with

m

essa

ges

xPr

intin

g0.

0520

0000

010

0000

3 pr

oduc

ts p

rinte

d wi

th s

ublim

inal

m

essa

ges

– 2,

000,

000

prod

ucts

prin

ted

13.5

Dis

sem

inat

ion

of p

rodu

cts

– th

roug

h ex

istin

g ch

anne

ls

xn/

an/

an/

an/

a2,

000,

000

prod

ucts

in

circ

ulat

ion

bear

ing

the

deve

lope

d m

essa

ges

14Di

ssem

inat

ion

of

all m

ater

ials

14.1

Dis

tribu

tion

of IE

C m

ater

ials

de

velo

ped

xx

xx

xx

xDi

strib

utio

n

*Dis

sem

inat

ion

will

prim

arily

be

thro

ugh

prov

inci

al,

dist

rict,

ward

an

d c

omm

unity

se

nsiti

sers

as

well

as V

HWs,

CB

O, C

BVs,

etc

to

redu

ce c

osts

0.01

*

4000

0040

00.0

0Di

strib

utio

n pl

ans

for a

ll m

ater

ials

de

velo

ped

in p

lace


29

Act

ivity

Sub

-Act

ivity

Tim

e lin

eB

udge

tE

xpec

ted

outp

utP

hase

1AP

hase

1B

Pha

se

2P

hase 3

Item

Uni

t C

ost

Qua

ntity

Tota

l C

ost

15Ha

rnes

sing

of e

xistin

g in

form

atio

n di

ssem

inat

ion

chan

nels

to e

nhan

ce a

nd

com

plem

ent t

he s

trate

gy

(e-fo

ra; n

ewsl

ette

rs, e

tc)

15.1

Dis

sem

inat

ion

of in

form

atio

n on

the

revi

sed

guid

elin

es u

sing

ex

istin

g ne

wsle

tters

, e-

foru

ms

and

othe

r cha

nnel

s an

d pl

atfo

rms

xx

xx

xx

n/a

n/a

n/a

n/a

Info

rmat

ion

rega

rdin

g th

e ne

w tre

atm

ent g

uide

lines

di

ssem

inat

ed th

roug

h ex

istin

g ch

anne

ls

16Im

plem

enta

tion

of

the

Advo

cacy

and

Co

mm

unic

atio

n St

rate

gy to

Su

ppor

t the

Impl

emen

tatio

n of

Rev

ised

ART

Gui

delin

es

in Z

imba

bwe

16.1

Pur

chas

e of

re

quire

d eq

uipm

ent

Digi

tal C

amer

a

Trip

od

2000

.00

500.

00

1 1

2000

.00

500.

00

1 di

gita

l cam

era

purc

hase

d

1 tri

pod

purc

hase

d

Subt

otal

1384

00.0

017

2400

.00

2223

00.0

017

9950

.00

7130

50.0

0

Adm

inis

trativ

e co

sts

(10%

)13

840.

0017

240.

0022

230.

0017

995.

0071

305.

00

Tota

l15

2240

.00

1896

40.0

024

4530

.00

1979

45.0

078

4355

.00

MINISTRY OF HEALTH ANDCHILD WELFARE, AIDS AND TB UNIT:

P.O. Box CY 1122, Causeway, Harare, Zimbabwe

Tel: +263-4-702446, +263-4-792981

Tel/Fax: +263-4-795191

SAfAIDS17 Beveridge Road, Avondale, Harare, Zimbabwe.

Tel: +263-4-336193/4 Fax: +263-4-336195

E-mail: [email protected]

Website: www.safaids.net

advocacy and communication strategy to support …...advocacy and communication strategy to support...

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