THE OFFICIAL GUIDE TO PRIDE’S BEHAVIOR CHANGE COMMUNICATION PORTFOLIO

Health informationat your fingertips

Thumbs Up!

Rebuildingwith

PRIDEHealth system recovery

post earthquake

The health situationin Bagh & Mansehra

The DramaQueenCreating a powerful

mass media character

JULY, 2010

Behavior ChangeCommunicationMaterial CD

The PRIDE Project (Primary healthcare Revitalization, Integration and

Decentralization in Earthquake-affected areas) is a part of the United

States Agency for International Development’s Pakistan Earthquake

Reconstruction and Recovery Program launched in 2006.

The project was designed to revitalize the primary health care systems

of Bagh District (Azad Jammu & Kashmir) and Mansehra District (Khyber

Pakhtoonkhwa) through improved health systems, improved health

services and increased community participation. Implemented by the

International Rescue Committee in partnership with Management

Sciences for Health (MSH) and Jhpiego (an affiliate of Johns Hopkins

University).

PRIDE acknowledges the resilience and determination of the people

affected by the October 8, 2005 earthquake and their commitment

to better health. Whatever success has been achieved reflects the

strong partnerships the project had with government departments

and local communities.

DISCLAIMER

This report is made possible by the generous support of the American people through the

United States Agency for International Development (USAID). The contents are the responsibility

of the PRIDE Project and do not necessarily reflect the views of USAID or the United States

Government.

CONTENTS

5From the Editor’s Desk

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The Beauty and the Beast

Rebuilding with PRIDE

2 Million Faces2 Million Smiles 12

A Journey into Hearts

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Balancing Supply and

Demand

Radio Ga Ga19222324 Thumbs Up!

Radio’s Voice26

Face to Face with Ammaji

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Up for Grabs!

How to Train your Dragon

18The Drama Queen

Better EducationHealthier Decisions

Behind the Scenes

The business of better health

ThumbsUp!

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Rebuildingwith PRIDE

6The Beauty

and the Beast!

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In the wake of the devastation wrought by October 2005’s 7.6 magnitude earthquake that shook the mountains in northern Pakistan, crumbling buildings and burying lives in the rubble, the U.S. government was on the forefront of relief and reconstruction efforts. The U.S. Agency for International Development (USAID)’s $200 million, five-year Earthquake Reconstruction Program has been rebuilding destroyed schools and health facilities, reviving and improving education and healthcare services, and restoring livelihoods with expanded economic opportunities.

As part of the recovery of the healthcare system in the most affected areas in the Bagh and Mansehra districts, the USAID-funded Primary Healthcare Revitalization, Integration and Decentralization in Earthquake-affected areas (PRIDE) project has focused on improving the performance of public health systems, expanding access to services and encouraging institutionalized community participation and healthy behaviors.

Amid the hundreds of donor-funded activities underway and big stories, this portfolio tells a smaller tale. It shines a light on just one aspect of the PRIDE project, albeit a vital one - its communication component. Specifically, the following pages reveal the way innovative Behavior Change Communication (BCC) and social marketing principles were used to create demand for improved maternal and child health practices, ensure a quality supply of services to meet the increased need and drive traffic to the freshly rehabilitated - and newly branded - government healthcare clinics.

The PRIDE team, in consultation with the Ministry of Health, partnered creatively with international health communication experts Howard Delafield International (HDI), top local firms and the advertising agency Spectrum Communications to create the content, colors and character of the campaign. We offer you a snapshot of some of the reasons for using BCC, theories behind the campaign design, the creative methods used and their outcomes. We hope it will serve the dual

purpose of informing and entertaining - and give you a reason to further explore the power and potential of media, communication technologies and marketing tools towards better health.

From the

Editor’sDesk

05

“Allah! Allah!” she was screaming, between sobs and gasps, crying out in pain. The older woman’s agony was evident, as she held her daughter-in-law’s thrashing body against her own. The limp body of the younger woman was sweat stained, her dress clinging to her swollen arms, her torso vehemently held in place by her mother-in-law. The young woman’s husband paced outside the room, frustrated, anxious and afraid. The elderly female birth attendant angrily admonished him,“She had a cyst last time, she could have died. You should have gone to a health center...” The husband mumbled something about everyone in the village saying that the home is where a birth should take place.

A beauty tarnishedThe districts of Bagh and Mansehra in northern Pakistan, home to nearly 2 million people, are blessed with breathtaking natural beauty, lush green mountains and valleys, diverse flora and fauana - and a rich and

diverse cultural heritage. This picture-perfect scenery is spoiled by some of the same things that make it so beautiful - its rough terrain, age-old traditions and poor infrastructure - factors that lead to very high levels of maternal and child mortality. Here, women are victims of a two-fold desire: they want to have children and live to be mothers. It is a somber reflection of the region’s primary healthcare and obstetric care services that many of them are unable to do either.

Dying to give birth Every year around 60,000 babies are born here. Unfortunately, two-thirds of their mothers do not receive adequate antenatal care during pregnancy, and a similar proportion deliver their babies at home without the assistance of a skilled birth attendant. Only one in five mothers and their newborns receive basic postnatal care. It is not surprising that each year in these two districts, approximately 1,500 babies die within 24 hours of birth and another 2,100 newborns die within the first month. Each year, nearly 6,000 children (81 per 1,000 live births) do not live to their first birthday, mostly due to preventable factors.

More children die of preventable diseases every year than died during the 2005 earthquake.

06T H E B C C P O RT F O L I O

Shaken and stirredOn top of this ongoing tragedy, these districts were among the areas most affected by the massive earthquake in October 2005 - Pakistan’s greatest natural disaster. About 80 percent of the primary healthcare infrastructure was damaged - compounding the challenge of improving some of the worst maternal, newborn and child health indicators in the South Asia region.

In 2006, in response to this crisis, the Primary healthcare Revitalization, Integration and Decentralization in Earthquake affected areas (PRIDE) project, funded by the United States Agency for International Development (USAID) was launched to improve primary health care services and health outcomes in Bagh and Mansehra. After four years, major strides have been made in the effort to save lives of mothers and newborns.

07O F P R I D E P R O J E C T

When Tragedy Struck...The 7.6 magnitude earthquake of 2005 devastated not only family and community life in Bagh and Mansehra, but also debilitated the already inadequate health care system in the region. Although a survey of Basic Health Units and Rural Health Centers a few months after the quake found most functioning in some way, only one of twelve was adequately staffed and most were short of medicines.

...a response was neededThe need for an effective response was urgent and dramatic.The Primary healthcare Revitalization, Integration and Decentralization in Earthquake affected areas (PRIDE) project adopted a 360o approach to health systems recovery where first the supply of and then the demand for quality health services were addressed.

Since August 2006, PRIDE has worked with national and district health managers, healthcare service providers and organizations and individuals in the affected communities with the following priorities:

1. Improving the performance of public health services and management systems (including improved planning and budgeting, human resources, data use and supply and storage of drugs);

2. Access to and quality of primary health care services (including improved performance against standards, delivery services and referrals); and

3. Healthier behaviors and institutionalized community participation in public health services through implementing a multi-media and multi-level behavior change communication and health center branding campaigns.

“Much of the focus and public attention on the earthquake-affected areas had been about new schools and health facilities, but what happens inthose schools and health facilities is also vital. PRIDE is playing a key role in providing the training and management tools needed to improve the quality and efficiency of heath care services”.

USAID Mission Director Jonathon Addleton Press Release, March 14, 2007

PRIDEREBUILDINGWITHREBUILDINGWITH

08T H E B C C P O RT F O L I O

PRIDE adopted a 360o approach to health systems recovery where first the supply of and then the

demand for quality health services were addressed.

PRIDE is playing a key role in providing the training and management tools needed to improve the quality and efficiency of health care services.

09O F P R I D E P R O J E C T

T H E B C C P O RT F O L I O

PRIDE’s BCC initiative is nothing short of a journey– one intended to touch the heartsof the people of Bagh andMansehra and inspire betterhealth-seeking behaviors andbetter use of the qualityhealth services available tothem.

journeyaintohearts

Putting People First

The starting point of thePRIDE’s strategydevelopment process is‘“people”’ (as opposed tothe program) thus ensuringthat the program interventionsare need driven and cohesive,holistic and synergistic from the targetgroups’ perspective. This approach helps inbridging the gap between “‘what people want’”and “‘what the program offers’”. The PRIDEstrategy utilizes communication as a bridge thatconnects the maternal and child health servicesand products with the target groups orbeneficiaries of the program. Metaphorically, toaccess the services, the bridge has to be crossedby the target groups necessitating a client-centric approach.

This remarkable approach is based not onlyon sound behavior change and social sciencetheories but on practical and proven marketingapproaches.

To develop atruly unique

communicationapproach, PRIDE

contracted HowardDelafield International

(HDI ) to help facilitate thedevelopment of a sound BCC strategyand to help build internal capacity withinPRIDE. HDI and the team analyzed baselinedata and other formative assessment data onknowledge, attitudes and practices, behavioral trends,as well as enabling and disabling factors in Bagh and Mansehra,to best understand how women of childbearing age, husbandsand mothers-in-law felt about various primary healthcare andemergency obstetric care services. Then collaborative sessionswere helped to develop the BCC strategy.

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So, in a nutshell, how was the BCC strategy developed?

Asim Malik: Right from the inception of the PRIDE project,we knew that BCC would play a critical role in increasing

demand for the improved health infrastructure.We were battling a series of hurdles that

needed to be addressed - the tarnishedimage of the Government health

system, traditional attitudes andpractices that did not support

regular visits to health facilities,a further slide in the status

of health as a family priorityafter the earthquakes,

and so on. All theseneeded to beaddressed throughinnovative andgroundbreakingcommunication.

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11O F P R I D E P R O J E C T

Could you tellus about the

innovations you justreferred to?

Asim Malik: The first thingwe wanted to do differently

was to not tread the beatenpath of depending on mass

media to reach the targetgroups. A wide variety of newapproaches have beenimplemented both in terms ofcreative executions, use of mediachannels and private sectorpartnerships.

What would you say is the cornerstone of your strategy?

Asim Malik: PRIDE’s BCC strategy is based on anunderstanding that communication is about people, notjust programs. Hence, a creative and media strategy isdesigned to help communication become part of people’slives. Several innovations have resulted through this approachresulting in three core components: (1) branding healthfacilities to help overcome negative associations and createa positive driving force; (2) a mother and child health campaign,using media and technology to help people prioritize healthissues and change key behaviors; and (3) support to enhancethe quality of health education in households and communities.

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Here we talk to Mr. Asim Malik,PRIDE’s Branding and MarketingDirector, about how the BCCstrategy was developed andimplemented.

Theseinnovations range from

developing a mother-in-lawcharacter to anchor the communicationcampaign efforts, designing a weekly radiodrama serial, using short, high-frequencyradio spots (known as “time-check spots”)to launch a health service brand called

Hifazat and starting a mobile phone- based Interactive Voice

Response (IVR) service incollaboration with

Telenor, Pakistan.

Hifazat Milestones:

Partnered with international and national communications firms

Studied target audience lifestyles and health behavior

Developed brand concepts, images and materials

Pretested concepts, images and materials with target audiences

Engaged health department, service providers and communities

Finalized brand identity and designed materials

Promoted first group of 8 branded facilities

Reviewed materials and audience responses

Extended brand to differentiate service levels

Promoted second group of 10 branded facilities

Launched radio drama

Trained health education trainers

Promoted a third group of 18 branded facilities

Supported trainers and health educators

Launched pre-recorded health information service

Reviewed results

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Mother-in-lawslead decisionsaboutmother andchild care

Thetwomillionresidents ofBagh andMansehra lost all

reason to smile after theearthquake devastated their livesOctober 2005. Amid the flurry of reconstruction activities,the PRIDE Project was tasked with not only helping theHealth Department to revive the health system, but to buildpublic trust in the services offered – to give Bagh and Mansehraresidents something to smile about.

Building hope and trust is arguably even more challengingand time consuming than constructing health facilities. Aftertwo years of PRIDE-supported service quality improvementefforts, health facilities were still not being used to their fullpotential. A fresh communication strategy was required toconvert this investment in better services into visible results– happy faces.

When designing the communication strategy, it was criticalto understand how decisions about mother and child healthand health care are made in this context. The communicationshould focus on the most influential people and personalitiesto ensure the highest potential for bringing back the smiles.

Studies explored this further and looked at the values,interests and lifestyles of those special people whoshape the health of women and children.

In Mansehra and Bagh districts, even though womenof reproductive age are most intended to benefit frommaternal and child health services, they are often

restricted in their ability to seek timely and quality carefor themselves and their children. While there are many

obstacles, socio-cultural norms and practices are oftencritical in preventing women from using available services.

Those who influence women most in this context – theirmothers-in-law and husbands – may not value governmenthealth services and therefore require the most education andpersuasion. Therefore they become the highest priorities interms of communication investment, followed by the womenthemselves, service providers and community leaders.

Building on these insights, an exercise calledpsychographic profiling helped to best appreciatehow these audiences make health decisionsand where. Understanding their values,lifestyles, activities and interests helpedto identify opportunities, locationsand mediums for communication.Creating these descriptive profilesmade each target group come aliveas if individuals. This allowed thecommunications to focus on theirgoal – two million faces with 2million smiles.

Million FacesMillion Smiles

Quality servicesare not used totheir full potential

12T H E B C C P O RT F O L I O

in

Mothers do notmake health caredecisions alone

Men feel unsureof how best toensure care for theirfamilies

Mothers do notmake health caredecisions alone

Men feel unsureof how best toensure care for theirfamilies

Husbands are typicallyexpected to providetransport and money

Quality servicesare not used totheir full potential

13O F P R I D E P R O J E C T

A critical mother and child health situation needsa dramatic response. To rise to the occasion,quality primary health care services – such asantenatal care, Emergency Obstetric Care(EmOC), postnatal care, and immunization – notonly need to be available, but they must also bewell used. How can improvements in the qualityand availability of services be matched withincreased awareness and better health-seekingbehavior? The world of business economics offerssome guidance.The fundamental principle of equilibrium betweensupply and demand applies not only tocommercial businesses, but also to public health.Every business or communication expert would

agree that merely creating supply (such as thesupply of condoms or health facilities) is notsufficient for ensuring these products or servicesare used as intended – you may build it but theymay not come. Similarly, packaging and promotinga product or service that is sub-standard canturn consumers off – they may come but notfind what they were promised. So an over-emphasis on supply may waste valuable resourceson the one hand, and on the other hand pushingup demands alone can feed mistrust amongconsumers. Both scenarios can ultimately beharmful and potentially life-threatening, preventingaccess to much needed care for mothers andchildren.

The business of better health

BALANCINGSUPPLY ANDDEMAND

BALANCINGSUPPLY ANDDEMAND

14T H E B C C P O RT F O L I O

Service brandingand marketing

Three interrelated communication componentswere implemented:

1. Branding and marketing of quality assured health services

Including indoor and outdoor signage andmaterials, launch events and local advertizing

2. A mother and child health campaign,using media and technology

Including pre-recorded motherand child health phone information service and an entertaining radio drama

3. Strengthened community andhousehold level health education

Focusing on helping Lady Health Workers to better share critical health information in their communities

These components worked synergistically towardsincreasing the appropriate use of services. Onlya year after this initiative started, a 3,000-householdsurvey revealed that one in three women wereaware of the government health service brand.Among these, two in three women felt theseoffered better quality services, particularly betteravailability of staff, cleanliness and mother and

child health services.

Community representatives,government managers and service

providers continue to rise tothe challenge of balancing

supply and demandtowards better health.

With this in mind, the PRIDE communicationstrategy is designed to find a balance betweentwo synergistic and inherently linked components– supply and demand. The project had made asubstantial investment in helping the HealthDepartment to improve its service managementand delivery, yet the services remainedunderutilized. This meant that creative

communication strategies were needed to attractand satisfy more potential clients. The first stepwas to build an understanding of both, whatquality services were on offer and what intendedclients want from a mother and child-focusedhealth service. The middle ground betweensupply and demand became the foundation forPRIDE’s communication strategy.

DEMANDWhat the

clientwants

SUPPLYWhat theserviceoffers

Communityeducation

MediaCampaign

Service brandingand marketing

15O F P R I D E P R O J E C T

Creating a quality public sector health servicebrand was central to the PRIDE communicationand marketing strategy. This is an innovative wayof building a bond of trust between services andintended clients.

Branding and marketing are often treated as“dragons” in public health and social sectors –feared and respected at the same time. Mostapproach these dragons with caution andskepticism, doubting their ability to tame them,let alone train them. It is important to understandwhy PRIDE took the branding route and whythat was such a critical decision.

From a public health provider’s perspective,quality is seen as a set of standards and protocols.From the consumer perspective, though, qualityis less tangible and more emotional – such asfeelings of being cared for, respected and treatedwithout judgment. These emotions can be

representedthrough abrand, whichcan heightenconsumerperception ofvalue and connectto their needs andpriorities.

In Bagh and Mansehra districts,people had lost faith in the public healthsystem long before the earthquake furtherdamaged buildings and services. Despitethe steady efforts to improve health services,their reputation for quality care needed tobe rehabilitated in communities. PRIDEworked with the Health Department tocreate the Hifazat brand to positively alterthe image of key government health facilitiesand renew demand among intended clients.

Building the ‘Hifazat’ brand

Howto TRAINYourDragon

“A brand is aperson’s gut

feeling about aproduct, serviceor organization.”

MartyNeumeier

16T H E B C C P O RT F O L I O

TheHifazat

brand,representedby a colorfulrainbow andsun logo, is theresult ofextensive

research,pretesting and

inputs frominternational communication and

branding experts – Howard DelafieldInternational (HDI). Hifazat is a wordassociated with protection – whether it beprotection of health, happiness, wealth orreputation. The tagline that accompaniesthe logo “Kyonki Zindagi Kimti Hai...”(“Because life is precious…) captures thevalue of better maternal and child health,and covers a wide spectrum of things thatpeople prioritize in their lives.

In March 2009, eight Hifazat-branded governmenthealth facilities were launched with signs, healtheducation posters and pamphlets, radioadvertising, announcement vans and communityevents. The changes promoted by the new brandincluded availability of skilled service providersand essential medicines, high standards of careand collaboration between communities,representatives and government staff to ensurebetter health.

Since this kick-off, another fourteen brandedfacilities were launched in phases, further growingthe commitment to quality and the demand forservices. Promotional radio spots, includingtestimonials from satisfied clients, were developedto remind listeners and viewers of the brand’spromise. Brand maintenance workshops withhealth management committees have helped toreinforce efforts to maintain the positivemomentum built while training the dragon.

Building the ‘Hifazat’ brand

“A brand is aperson’s gut

feeling about aproduct, serviceor organization.”

MartyNeumeier

“Hifazat represents a promise of quality

healthcare and protection from the government

and facility staff to their community.” Dr. Abdul

Aziz Dar, District Health Officer, Bagh AJK

17O F P R I D E P R O J E C T

Creating a sympathetic character in Ammaji

DramaThe

Queen

ConflictThe people of Bagh and Mansehra have their own sets of conflicts. Theirlives are riddled with contradictions that often restrict their abilities tomake decisions that best serve their needs. For example, while mothers-in-law are responsible for the health of the women and children in theirhouseholds, they are also the protectors of tradition within the familyand often consider health centers unnecessary. Similarly, husbands havethe authority to take care of their family’s health but traditionally theyare not responsible for it. A pregnant woman wants to provide thebest possible care for her unborn or newborn child but often doesnot have the authority to make decisions that affect her and her child’slife.

ResolutionThe creative strategy of the PRIDE BCC campaign used thisfundamental understanding and insight -- that people live with innerconflict - to create a powerful character: Ammaji. A lovable, thoughself-righteous and argumentative mother-in-law character, Ammajiwas created as a vehicle for showcasing dilemmas between traditionalvalues, messages and practices officially approved by the NationalProgram for Family Planning and Primary Health Care in a non-threatening, non-dogmatic manner. The use of this characterallowed the PRIDE BCC campaign to communicate with people

of all age groups and both genders without offending theirdignity, intelligence or sense of tradition. The

idea of Ammaji’s inner conflict, depictedthrough the creative use of an alter ego,allows target groups to identify and resolve

their own doubts and dilemmas.

The Ammaji character has been featuredin posters, radio spots and an ongoing radio

drama.

T H E B C C P O RT F O L I O O F P R I D E P R O J E C T

Every drama, whether on television, radio or in real life, is based on conflict -conflict between people, conflict between opinions, conflict of interest andoften, a conflict in one’s own mind. Conflict fuels debate, discussions andleads to changes in attitudes and behavior.

18T H E B C C P O RT F O L I O

Several family members excitedly gatheringaround the radio, giggling and awaiting theirfavorite program is a more common occurrencein the Bagh and Mansehra districts these days,now that the engaging radio soap opera Rishtoonki vadiyan Anha ki pahar (whose title means “ABattle between Love and Pride”) is beingbroadcast to their remote and inaccessiblelocations. The PRIDE project chose to developa drama for radio because about 70 percent ofhouseholds in Bagh and 40 percent in Mansehrahave access to radio, it is less costly than televisionand requires no electricity. Radio is more likelyto reach women with low levels of literacy. It isalso an ideal medium to raise and address sensitivehealth and socio-cultural issues in an entertaining

fashion.

The 30-episode weekly 20-minutedrama, which debuted inJanuary 2010, focuses on thecentral role of the mother-in-law in making healthcaredecisions for the womenand children in theirhousehold. It develops theAmmaji character andbuilds a story around herlife, her inner struggles and

the resolution of conflictsbetween her immediateand extended familyand local healthcareproviders. These

providers include a

hardworkingthoughdiscouraged LadyHealth Workerand a TraditionalBirth Attendant(or dai) who hasa change of heartabout hospitals.

Giving Ammaji a larger voice

During each episode, Ammaji’s inner dialoguecan be heard. She listens to her favorite call-inradio program - one that challenges her traditionalbeliefs - and muttering at the advice given by theshow’s host who symbolically functions asAmmaji’s alter ego or inner conscience.

Creating engagement

This drama covers a wide range of issues likematernal nutrition, breastfeeding, birthpreparedness, skilled birth attendance, birthspacing and immunizations.

A quiz contest at the end of every other episodeallows the audience to participate in a meaningfuleducational experience and be rewarded. With5,000 text messages sent in by the end of thefirst season, listeners are begging for more!

T H E B C C P O RT F O L I O O F P R I D E P R O J E C T

Using radio entertainment to educate and promote dialogue

DRAMA ON RADIO

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Ammaji: Hey look Gulnar Chachi,two health workers under one roof!Lady Health Worker Dilshaad andDai Rozina together...

Dai Rozina: Haven't you heard? I'm no longer good enoughto deliver babies!

Dilshaad: The truth is, Gulnar Chachi (Ammaji's sister)has not had a good experience with dais. That's whyshe....

Dai Rozina: What was wrong with her experience?Life and death are a gift from God. If God decidesto take the life, neither the dai nor the hospitalcan do anything about it. Your Gulnar Chachi is attackingthe dais for no reason. Does she think that no one ever dies in hospital?I've delivered healthy babies after twenty hours of labor. In the hospital theycut everyone open! In the old days there were no hospitals and every baby wasdelivered by a dai. Have you forgotten the name of Dai Haleema? Who are youto forget the women whose hands brought you into the world?

Dilshaad: Madam Rozina, you have experienced so much. Thank God for yourwisdom and experience. But look, as the country develops, many things get better.Change comes. In the old days we used to travel by camel, but now we don'tany more, do we? There have also been advances in medicine. God inspires peopleto better their world. In Tahira's case, she's a long way from giving birth. Wejust want to take her to the hospital so that we know for sure whether sheis pregnant or not. That’s why Gulnar Chachi called me.

Excerpt fromEpisode

5

“My name is Arbab. I’m 22 and I live in a small village with my three brothers, two sisters, mother andgrandmother... Our village is in a very rural remote area. It takes a very long time to reach the nearesthospital as the roads are so bad. Taxis are expensive and hard to come by. Often,women have to be carried on a bed and sometimes they die before theyreach the hospital. I like this radio program because it’s the first source ofinformation that I’ve heard of, which tells women what they should do toprepare for a birth by saving money and things like that”.

In the radio drama, what key role do youplay to help understand and build up thecharacter?Zaheen Tahira: The character projected bythe author is basically taken from a real lifescenario. I try to find a similar character in oursociety and, based on the role that I am given,adapt to the character’s body language and wayof talking. To understand the character more indetail, the writer and director can be quite helpful.

Which character in the radio drama helpedtraditional “Ammaji” understand the needsand values of society today?Zaheen Tahira: The character that helped bringabout change in Ammaji’s character was AzraKhala. Through the radio, Azra Khala communicateswith Ammaji and during their conversation, theyhave disputes. Azra Khala’s character helpedAmmaji change her values and belief, becausewhatever she used to say was right.

The objective of “Hifazat” is that bothmother and child should be healthy. Basedon your experience, please share your views.Zaheen Tahira: A mother is one of a kind andcan sacrifice her happiness for the well being ofher child. I admire those who work for theprotection of mother and child’s health. I hopeGod gives us all more guidance to do more formaternal and child health.

Is there anything you would like to say tomothers in Bagh and Mansehra?Zaheen Tahira: First of all, I would like to thankthe mothers in Bagh and Mansehra for showinginterest in the drama and Ammaji’s character, bylistening to it and acting upon its advice as well.A mother’s status carries a lot of respect, yet shefaces a lot of problems. The mothers at Bagh andMansehra are of more value because they had

faced a lot of difficulties taking care of theirchildren for quite sometime. But with the helpof Hifazat, there has been a lot of improvement.I pray to God, that the mothers of Bagh andMansehra make use of the excellent facilities thathave been provided to them.

Would you like to say anything to theuntrained birth attendants in Bagh &Mansehra?Zaheen Tahira: Just as I had mentioned earlier,it is good to stick to our cultural norms andvalues, but it is also important to know whatcultural aspects should be rejected for our ownbetterment. There’s nothing more important thangood health. Work opportunities are in the handsof God, as they come and go. If one door closesit doesn’t mean that opportunities are over. Tenother doors might be waiting for you. The worldis progressing and adapting to different methodsfor a better quality of life. We should say goodbyeto our older methods and move on. This couldprove beneficial for both life and good health.

Is there anything you would like to say forthe Hifazat BCC Portfolio?Zaheen Tahira: Hifazat and my associationwith it came into being because of this drama“Rishton ki vadiyan, ana kay pahar”. I would liketo say something in this regard that working ina drama is not new for me. I have worked inmany dramas and every drama had someobjective or the other. Entertaining people is notthe real objective, but to actually communicatethe right message to the audience. The feelingwas different when I performed for this drama;I not only entertained people, but also providedthem with essential information along with itwhich proved to be helpful. Today, I feel over-whelmed at being part of such a good cause. Iwould like to thank God and the Hifazat teamfor having me on this project.

Face to Facewith Ammaji

(Zaheen Tahira)Voice over artist

22T H E B C C P O RT F O L I O

Bettereducation

Naseem Aktar is a Lady Health Worker in Dharevillage in Bagh district. She visits between five andseven houses a day, making sure that women inher village go to the Rural Health Center (RHC)Chatter 2, the nearby health facility, for at leastfour antenatal checkups and for the delivery oftheir babies.

In Bagh and nearby Mansehra districts, awarenessof basic health and hygiene - including theimportance of hand-washing, immunization,nutrition and antenatal care, is very poor. Whereasurban populations learn about health at schoolor through the media, illiterate women in remoteareas lack such opportunities. In addition, culturalvalues prevent women from leaving the homeand discussion of women's health is consideredtaboo.

Such limitations mean that Lady Health Workersplay a key role in promoting maternal and childhealth. They are known and respected withintheir communities and have access to people'shomes.

In December 2009, PRIDE Project launched ahealth education initiative to train mastertrainers and Lady Health Workers to providehigh quality, accurate and effective healtheducation on maternal and child health issues.

At the Rural Health Center Chatter 2 in Baghdistrict, Naseem Aktar and eighteen other LadyHealth Workers were trained by a PRIDE staffmember and Nasreen Bibi, the Lady Health Visitorat RHC Chatter 2 in May 2010. Naseem Aktarsays that ‘‘It was an excellent opportunity. Ourprimary responsibility is to convey healthmessages, but earlier it was always a bit of a 'one-man show' or a lecture. Now I have a guidebookand I've learnt different approaches, like how touse picture cards, real life examples and role playsto engage the participants. I learnt how importantdetails like seating arrangements, discussing theobjectives of the sessions, the use of simplelanguage and giving feedback to participants canbe to the success of a health education session.”

These new skills are already showing results. Oneof Naseem’s patients, Shazia Iqbal, delivered herprevious baby at home with a traditional birthattendant, but had such a bad experience thatshe was terrified of giving birth again. Naseemwas able to use her new skills to convince Shaziaof the advantages of going to the health facility.

Shazia says, “I was really scared when I went intolabour as I had such a bad experience when mydaughter was born. This time though, things weremuch better. Naseem came with me to the healthfacility. She helped me find a taxi and phonedahead so the facility staff would be ready whenwe arrived. Nasreen Bibi, the Lady Health Visitor,was so kind and made me feel much calmer. Shetalked to me as though I was her own daughter.”Shazia's baby girl Sanam was born on 2 June2010.

LHW Naseem Aktar with Shazia Iqbal and baby Sanam

Healthierdecisions

23O F P R I D E P R O J E C T

ThumbsUP!

A uniqueinnovation

fromPRIDE

now putsthe power toget maternal

and childhealth

informationat your

fingertips.

Hi...I’m Dr. Shaista Wahidi!Welcome to the ‘Hifazat’ line.

I am here to give you tipsrelated to maternal &child health.

In early 2010, as part of its media andtechnology campaign, PRIDE introduced

the first ever health-related, mobilephone-based Interactive VoiceResponse (IVR) service in Pakistan.This unique program wasimplemented in collaboration withTelenor -- one of the country’s leadingtelecommunication companies. Bydialing one simple number, the serviceis designed to put the power of MNCHinformation in the hands of every cell

phone user in Bagh and Mansehra andbeyond. The dialer is greeted by thepleasant and welcoming voice of Shaista

Wahidi, a well-known doctor and mediapersonality. After the introduction, the caller

is then guided through a set of simple menus to find theinformation that he or she is looking for.

Given the high penetration of mobile phones, which is more widespreadthan health service coverage, this intervention has the potential tohave the country’s highest reach and lowest cost-per reach ever forsuch a campaign. Usually with mass media or inter-personalcommunication efforts, the cost of reaching one individual (or costper reach) is fairly high. But the use of mobile technology and costsharing with the actual mobile users has made it possible to provideinformation on a wide range of topics at a significantly lower cost andwith higher efficiency.

Call Hifazat Sehat Number 0345-555-55-20 and try themenu now: Press 1: For information related to pregnancyPress 2: For information related to delivery and laborPress 3: For information on postnatal care and mother’shealth after delivery Press 4: For neonatal and child healthPress 5: For family responsibilities during a woman’spregnancy.

24T H E B C C P O RT F O L I O

Hi...I’m Dr. Shaista Wahidi!Welcome to the ‘Hifazat’ line.

I am here to give you tipsrelated to maternal &child health.

25O F P R I D E P R O J E C T

Our radio messages were catalyticin building people’s trust in Hifazatand its services. To find out howwe did it... read on!

We’re all in it togetherHow do you get through to people who live ina community with strong traditional beliefs thatmake them pretty much set in their ways? Evenmore so, how do you talk to them about asubject that has ‘taboo’ written all over it?

They say a message gets through loud and clearwhen it’s given by someone you trust or feel asense of familiarity with – so that’s exactly theapproach we took!

We used familiar ‘characters of the community’to educate the people of Bagh and Mansehraabout taking cautionary measures for smoothpregnancies, and to teach them the importanceof child birth in a health care centre as opposedto at home.

These characters were the ones they hold inhigh esteem (e.g. health workers, doctors, nurses)and also the ones that they can relate to on apersonal level, whom they meet everyday andare friends or neighbors with (e.g. grocery storeowner, head mistress, farmer, etc.).

Simple analogies were used to hold people’sinterest, like a taxi driver delivering the messageof ‘being prepared’ by juxtaposing the idea ofkeeping an extra tire in the car in case of anunexpected puncture, to pre-arranging cash andtransport in case of early labor pains.

These testimonial and informative messages weresuccessful in reaching out to thousands of peoplein Bagh and Mansehra, telling them the value ofnurturing a mother and child relationship andthe importance of breastfeeding a newborn baby.Similarly, many other significant issues were alsoraised – namely, looking out for physical symptomsduring pregnancy that require immediate medicalattention; getting regular check-ups and giving atleast a three-year break between pregnancies.

Messages were also used to focus on child care,such as, vaccinations for diseases like polio, measles,etc. and medical care in case of breathingproblems, fever, vomiting, etc.

It was the straightforward and ‘keeping it real’approach that led so many people in these areasto Hifazat health care centers. Knowing thatsomeone like you could be sharing your problems,not only makes it acceptable to have them, butalso encourages open discussion.

It’s health check timeNever miss an opportunity to be heard is whatwe believe, which is why we even used on-the-hour time checks to reach out to our audiences.These were also informative and testimonialmessages, mixed with quiz-style spots, used tofurther reinforce the benefits of the Hifazat healthcare centers.

Blood donation campsOne way of bringing a community together, is toteach its people to be there for each other intimes of need. For this, radio messages weremade to clear medical misconceptions, whichpeople tend to have. One of them was the ideathat donating blood adversely affects one’s health.The radio message was used to take away thesefalse impressions and encourage people to donateblood at the Hifazat blood donation camporganized by PRIDE at DHQ Bagh on 14 and15 December 2009.

RADIO’S VOICE

26T H E B C C P O RT F O L I O

To promote the Hifazat brand and healthier behaviors,

an attractive range of giveaways were designed and produced. These included gifts prizes for

mums and their newborns, such as baby bags and blankets, and other handy items such as

wall clocks, key chains and umbrellas. Each item was designed with a specific context and set

of behaviors in mind. Using giveaways helped to strengthen the hype and sense of involvement

that is an essential ingredient to Hifazat’s success.

Up for grabs!

Key chains:For members of the community

Badges:For members of the community

Shopping bags:For Lady Health Workersand Lady Health Visitors

Wall clocks:Distributed to Health facilities

Certificates:Distributed to Health Management

Committee members

Baby hats:For newborns in Hifazat’s Emergency

Obstetric Care facilities

Hifazat chaddar/shawl:For mothers

Hifazat mother and baby care kit/pack:For newborns in Hifazat’s Emergency

Obstetric Care facilities

Baby blanket:For members of the community White coats:

For Health Facility staff

Hifazat umbrellas:Distributed to

Lady Health Workersand Lady Health Visitors

27O F P R I D E P R O J E C T

Baby item:For members of the community

BEHIND THE SCENES

Siddhartha SwarupSr. Strategy and Creative Advisor,Howard Delafield International

Asim Malik

Director Bran

ding

and Communicati

ons, PRIDE

Syed Ali HussainSocial Marketing Manager,

PRIDE

Helen SeegerCommunicationsManager, PRIDE

Sharifa MirHealth Education Manager,

PRIDE Rahat Yasmeen

Communications Officer,

PRIDEUsman Rafique

Sr.Admin & Logistic

s

Officer, PRIDE

28T H E B C C P O RT F O L I O

BEHIND THE SCENES

Sheldon Allen

Director Monitoring

& Evaluation, PRIDE

Ghazala Ahmed,Director,

Social Marketing

Spectrum Y&RTeam Leader

Imran Akhtar AsimGeneral Manager,Spectrum Y&R

Farham EbrahimCreative Manager,Spectrum Y&R

Aijaz Haider

Creative Manager,

Spectrum Y&R

Rumman AbbasiCreative Manager,Spectrum Y&R

Kamal Jafri

Account Manager,

Spectrum Y&R

29O F P R I D E P R O J E C T

sp

ectr

um

yr.c

om

A reason to smileTwo million people in Bagh and Mansehra districts lost all reason to smile after the

earthquake hit their lives on October 8, 2005. USAID’s response was to assemble a high

impact recovery program to bring back the smiles. One such project – PRIDE (Primary

healthcare, Revitalization, Integration and Decentralization in Earthquake-affected areas)

focused on helping the Health Department and communities to improve their health

services and achieve better health.This document outlines one aspect of the PRIDE Project – its Behavior Change

Communication (BCC) strategy – designed to improve the critical health behaviors that

influence the health of mothers and children and increase the demand for public health

services.Save paper. Make every page engaging.

PRIDE’s communication strategy is based on understanding people – insights to create

communication that is effective, engaging and wherever possible, entertaining. We have

used the same approach in designing this BCC portfolio. We understand that most readers

are busy and most reports are boring – resulting in thousands of printed pages going into

the garbage can. The mission we gave our BCC team included a simple guideline: save

paper by making every page engaging and entertaining. I think they’ve done a fine job!

Sharing our story in this magazine style is the culmination of the tremendous hard work

and creative energy of many people over the past three years. We are confident that there

is something here for anyone interested in innovative ways to help improve the lives of

mothers, newborns and children.I hope you enjoy it!

Bruce RasmussenPRIDE Project DirectorPS: As part of this package you will also find a CD that contains copies of all the creative

work produced for the various campaign components PRIDE Project has undertaken.

SPECTRUM