preliminary benin arm3 behavior change … · including mass media activities, advocacy, and...

PRELIMINARY BENIN ARM3 BEHAVIOR CHANGE COMMUNICATION STRATEGY

(2012-2016) ACCELERATING THE REDUCTION OF MALARIA MORBIDITY AND MORTALITY (ARM3) IN BENIN

Draft Benin ARM3 BCC and Community Mobilization Strategy

Table of Contents

Executive Summary: ................................................................................................................................... 4

1 BCC and community mobilization (CM) Strategy: Overview ............................................................... 8

2 Situation Analysis ................................................................................................................................ 9

2.1 Malaria in Benin .......................................................................................................................... 9

2.2 Overview of the National Malaria Control Plan and Strategy ................................................... 12

2.3 Organizations supporting malaria communication interventions in Benin ............................... 13

2.4 Communication gaps/Challenges .............................................................................................. 16

2.5 Accelerating the Reduction of Malaria Morbidity and Mortality (ARM3) ................................. 20

3 Communication Strategy .................................................................................................................. 23

3.1 Pathways for malaria prevention and control in Benin ............................................................. 23

3.2 ARM3 BCC Strategic Objectives:................................................................................................ 25

3.3 Audiences and priority behaviors targeted by the ARM3 Communication Strategy ................. 25

3.4 Key Messages ............................................................................................................................ 27

3.5 Communication Channel ........................................................................................................... 33

3.5.1 Mass Media ....................................................................................................................... 33

3.5.2 Interpersonal Communication .......................................................................................... 34

3.5.3 Counseling in Government and Private Health Facilities ................................................... 34

3.6 Communication Materials ......................................................................................................... 35

3.7 Capacity Building ....................................................................................................................... 37

3.8 Gender ...................................................................................................................................... 38

3.9 Monitoring and Evaluation ........................................................................................................ 39


4 Implementation ................................................................................................................................ 53

4.1 Activities.................................................................................................................................... 54

4.1.1 Objective 1: Coordination ................................................................................................. 54

4.1.2 Objective 2: Community mobilization ............................................................................... 56

4.1.3 Objective 3: Social marketing of LLITNs............................................................................. 58

4.1.4 Objective 4: Capacity Building in BCC ................................................................................ 59

4.1.5 Objective 5: Advocacy for increased support for malaria control ..................................... 60

4.1.6 Objective 6: BCC and Community Mobilization materials ................................................. 61

4.1.7 Objective 7: Monitoring and Evaluating the BCC Strategy ................................................ 62

4.2 Scheduling for mass media and community mobilization interventions ................................... 64

4.3 Scheduling for mass media and community mobilization interventions for the remaining three

years (Oct 2013- Sep 2016) ................................................................................................................... 65

5 Annexes ............................................................................................................................................ 68

5.1 Annex A : Terms of Reference for GTTC .................................................................................... 68

5.2 Annex B : Key Messages for Targeted Audiences ...................................................................... 71

5.3 Annex C: Information about Benin ............................................................................................ 74

5.4 Annex D: ARM3 Results and Targets ........................................................................................ 75


Executive Summary:

To achieve the vision of a malaria-free Benin by 2030, the government, through the National Malaria

Control Program (NMCP) and other programs has formulated a National Strategic Plan for malaria to be

implemented by government agencies, international partners, and local civil society organizations. The

ARM3 Behavior Change Communication (BCC) strategy aims to support the National Strategic Plan by

contributing to the development, implementation, monitoring, and evaluation of NMCP initiatives to

influence behaviors and mobilize communities to create long-term normative shifts toward desired

behaviors and to sustain enabling behaviors around the President’s Malaria Initiative (PMI) interventions

in Benin with a focus on those related to ARM3 project objectives. The desired behaviors should result

in: improved adherence to treatment regimens, IPTp during pregnancy (as well as other MIP-related

behaviors); regular LLIN use by the general population, focusing on vulnerable groups to include

pregnant women and children under five; prompt, appropriate treatment with Artemisinin-based

combination therapy (ACTs) for children under five within 24 hours of onset of symptoms; and

community involvement in malaria control.

The strategy is designed to support ARM3 and NMCP malaria prevention and treatment objectives by

promoting improvement in prevention and treatment behaviors. It draws on guidance presented in the

BCC section of the GHI strategy document for Benin, PMI’s communication strategy guidelines, and the

Roll Back Malaria (RBM) Strategic Framework for Malaria Communications at the country level. The

strategy document has benefited from MCDI’s experience in developing national malaria

communication strategies elsewhere in West Africa and draws upon JHU-CCP’s work in developing the

Pathways model of malaria communication.

The ARM3 BCC Strategy has seven main objectives:

O.1. To support BCC interventions by the National Malaria Control Program and ARM3 through:

effective coordination of activities by the BCC Working Group; participation in activities by other

existing working groups [1] ; harmonization of BCC/IECC messages, materials and tools

developed in Benin[2].

O.2. To increase community engagement in /mobilization for malaria prevention and treatment.

O.3. Increase the supply and use of LLINs through social marketing with private sector partners.


O.4. To upgrade BCC skills of health workers from private and public sectors at national and

community levels, and provide supervision in the use of BCC guidelines.

O.5. To advocate for increased support for malaria control, by government authorities and key

partners (reflected in support for coordination, availability of funds, allocation of human

resources and development of public policies that support malaria mortality and morbidity

reduction).

O.6. To develop and disseminate materials supporting BCC and Community Mobilization

O.7. To monitor and evaluate the ARM3 BCC and Community Mobilization Strategy.

BCC supports implementation of activities to ensure that commodities are used effectively and that

healthy practices become normative. IPTp activities will target pregnant women, their partners, and

health providers to encourage the uptake of IPTp at both the provider and the client level. Training

curricula on interpersonal communication (IPC) will be developed to train new cadres of health workers

and nurses in counseling techniques and proper administration of the drug. Pregnant women

frequenting ANC services will be encouraged to seek prompt care when experiencing a febrile episode

and to sleep under an LLIN, and the campaign will promote the role of responsible husbands in their

family's overall health.

LLIN activities will target caregivers and their partners to encourage the use of LLINs among children

under five as well as the general population, and workplace programs will be implemented to promote

malaria prevention in the private sector, including both distribution of LLINs and communication

activities to promote prevention practices.

A special umbrella campaign to support providers will focus on provider-client communication to

support the quality assurance and capacity strengthening strategies of the ARM3 under this project.

Diagnostics activities will target caregivers and their partners to stimulate demand for a malaria test and

at the same time, target health providers and their supervisors to ensure compliance with diagnostic

policies.

Treatment activities will target caregivers and their partners and immediate family members to

stimulate demand for ACTs and to ensure compliance. Improved case management of malaria at

frontline facilities will occur within the IMCI framework thereby also supporting the effective case

management of malaria.


Communication channels to be employed in all intervention areas will include radio, to reach a

maximum number of persons in a cost-effective manner with radio spots, drama programs, and talk

shows. TV spots will also be produced on a limited basis to reinforce key messages and to provide

models of ideal behavior, particularly important for new practices such as net care and repair. Mass

media will be complemented by a strong community mobilization component wherein local leaders,

associations, women's groups, and community health workers will be mobilized to promote malaria

prevention and proper diagnosis and treatment at the grass roots level. By creating and building

stronger social norms via radio and television, and stimulating discussion among clients and providers,

caretakers of children and their families and friends, and boosting training and compliance among

health care workers to government policies, ARM3 intends to improve malaria preventive behaviors

among the population as a whole.

The campaign will be tied together with cohesive visual elements, logo and slogan that will identify

mutually reinforcing components of the strategy and lend credibility to individual activities and

products.

At the advocacy level, coordination with government entities including the PNLP, the TGGC and other

ministry officials will serve to bring partners together around the same goals, reduce bottlenecks and to

develop harmonized work plans for communication on malaria.

This current communication strategy document is intended to provide a framework within which ARM3

malaria communication can occur and remain aligned with the NMCP’s own program. The strategy will

undergo subsequent revisions as deemed appropriate by the BCC Working Group. It is hoped that the

document will serve as a foundation upon which the GFATM -supported initiative managed by Africare

Benin can formulate a National Malaria Communication Strategy.

Monitoring of the communication activities presented in the strategy will focus on program

implementation and input and output indicators. Outcome indicators with a behavioral component will

be employed. Tracking the progress outcome indicators in project intervention areas enables the

success of the communication strategy to be evaluated.


List of Acronyms

ACT Artemisinin-based combination therapy ADB African Development Bank ANC Antenatal care ARM3 Accelerating Reduction of Malaria Morbidity and Mortality CAME Centrale d’Achat des Médicaments Essentiels (Central Medical Stores) CBO Community-based Organization CCM Country Coordinating Mechanism CEBAC-STP Coalition des Entreprises Béninoises contre le sida, la tuberculose et le paludisme CHW Community Health Worker CRS Catholic Relief Services DHS Demographic and Health Survey FY Fiscal Year GFATM The Global Fund to Fight AIDS, Tuberculosis, and Malaria GHI Global Health Initiative GOB Government of Benin GTTC Groupe Technique de Travail en Communication IEC/BCC Information, education, communication/Behavior change communication KAP Knowledge, attitude, practice IMCI Integrated Management of Childhood Illness IPC Interpersonal communication IPTp Intermittent preventive treatment of malaria in pregnancy IRS Indoor residual spraying ITN Insecticide-treated net LLIN Long-lasting insecticide-treated net M&E Monitoring and Evaluation MCH Maternal and child health MOH Ministry of Health NGO Non-governmental Organization NMCP Programme National de Lutte contre le Paludisme (National Malaria Control Program) PISAF Projet Intégré de Santé Familiale (Integrated Family Health Project) PITA Plan intégré de Travail Annuel PMI President’s Malaria Initiative PSI Population Services International URC University Research Co. LLC RBM Roll Back Malaria RDT Rapid diagnostic test SBCC Social and Behavior Change Communication SP Sulfadoxine-pyrimethamine UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization


1 BCC and community mobilization (CM) Strategy: Overview The BCC and CM Strategy is designed to support ARM3 and NMCP malaria prevention and treatment

objectives by promoting improvement in prevention and treatment behaviors. It draws on guidance

presented in the BCC section of the GHI strategy document for Benin, PMI’s communication strategy

document, and the Roll Back M Strategic Framework for malaria communications at the country level.

The strategy document has benefited from MCDI’s experience in developing a national malaria

communication strategy in Equatorial Guinea; it also draws upon JHU/CCP’s work in developing the

Pathways model of malaria communication.

The Strategy is aligned with:

1.1. National Health Development Plan (Plan National de Development Sanitaire) 2009-2018, supporting

its priorities, particularly the ones oriented to the reduction in infant, child and maternal mortality due

malaria and strengthening the capacity of the health systems, the providers and the community,

through the malaria program with participation of the private sector.

1.2. National Malaria Strategic Plan. The National Malaria Strategic plan calls for intensive IEC/BCC,

including mass media activities, advocacy, and social/community mobilization as a core element. (Plan

Strategique de Lutte Contre le Paludisme au Benin 2011-2015)

1.3. Global Health Initiative Benin Country Strategy, oriented to increase inter-agency coordination and

program sustainability, and to harmonize health programs led by US Government under one country

strategy. The GHI is based on seven core principles: focusing on women, girls and gender equality; and

building sustainability through health systems strengthening. It is oriented to support the reduction of

the under-5 mortality rate, improve maternal health and reduce the burden of Malaria, contributing to

the achievement of the Millennium Development Goals in the country.

1.4. The PMI Communication Strategy highlights the role of communication and community

participation to attain sustainable changes in the behavior of individuals and communities, on malaria

treatment and prevention. It provides a path for ARM3 to increase the demand for malaria services and

products, improvement in the adherence to treatment regimens and IPTp during pregnancy, and use of

LLINs, especially among pregnant women and children under five, prompt care-seeking behavior by

caretakers of children under five, and community involvement in malaria control. It also focuses

communication interventions on each target audience, and includes a Monitoring and Evaluation

component, using PMI outcome indicators that allow measurement of changes in behavior.


1.5. JHU- CCP Communication experience.

The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU•CCP)

envisions a world in which communication saves lives, improves health and enhances well-being.

JHU•CCP has extensive experience working in many African countries in malaria behavior change

communication, including the development of the National Strategy for Malaria BCC in Tanzania and the

six-year Communication Initiative for Malaria in Tanzania (COMMIT), the Ghana Behavior Change

Support project, the Stop Malaria Project in Uganda, and activities in Zambia, Senegal, Rwanda, Mali,

Malawi. JHU•CCP has also conducted training of NMCP staff in over 30 countries in malaria BCC through

Alliance for Malaria Prevention and Leadership in Strategic Health Communication workshops in

Bamako, Dakar, Cote d’Ivoire, Nairobi, Abuja and Dar es Salaam.

2 Situation Analysis

2.1 Malaria in Benin Malaria is highly prevalent in all regions of Benin, with virtually 100% of the population at risk. According to the Global Health Initiative’s Benin Country strategy, malaria’s contribution to Benin’s disease burden is significant, affecting both the health and finances of many households. It is the number one killer of children under-five and is a common condition afflicting many mothers and pregnancies each year. It constitutes 40 percent of all out-patient consultations in health facilities, and 22 percent of all hospital admissions. In 2010, The Lancet (375:9730, pp.1969 – 1987) estimated that 9,165 children under-five died of malaria in 2008, representing 23% of all under-five deaths. Malaria transmission is stable but influenced by several factors such as vector species, geography, climate, and hydrography. The primary malaria vector in Benin is Anopheles gambiae s.s.; however, secondary vectors may become important in certain circumstances. For example, the widespread distribution and continuous breeding of An. gambiae results in endemic transmission nationwide, with three distinct regions. In the coastal region of Benin, which has many lakes and lagoons, transmission is heterogeneous because of the presence of both An. melas and An. gambiae. Above the coastal region, malaria is holoendemic. Finally, in northern Benin, malaria is seasonal, with a dry season (November to June) and a rainy season (July to October) during which malaria rates are highest. Current Status of Key Indicators

1. Infant mortality: 73 per 1,000 live births (WHO Global Health Observatory Data Repository 2010) 2. Under five mortality rate: 115 per 1,000 live births (WHO Global Health Observatory Data

Repository 2010) 3. Maternal mortality: 397 per 100,000 births 4. Proportion of households with at least one ITN: 79% (DHS 2011-2012)


5. Proportion of children under five years old who slept under ITN the previous night: 71% (DHS 2011-2012)

6. Proportion of pregnant women who slept under an ITN the previous night: 75.5% (DHS 2011-2012)

7. Proportion of women who received > 2 doses of IPTp during their last pregnancy in the last 2 years: 22.8% (DHS 2011-2012)

8. Proportion of children under five years old with fever in the last two weeks who received treatment with ACTs within 24 hours after onset of fever: 6.7% (DHS 2011-2012)

9. Houses targeted for IRS that have been sprayed: 89% (DHS 2011-2012)

Benin is divided into 12 Departments de Santé (DDS), which are subdivided into 34 Health Zones (HZ). In

addition to the literature review and the results of the workshops conducted jointly with the

Department of Littoral and Atlantic in July 24 to 26 2012, the ARM3 team reviewed other demographic

and epidemiological surveys and reports that shed light on current malarial problems and issues in

Benin. The situation analysis was conducted on the basis of an assessment of current Social and

Behavior Change Communication activities and materials in Benin that address malaria program areas.

The most recent data available to describe the current malaria indicators is the preliminary 2011-2012

DHS survey. Although estimates from the DHS survey are considered representative at national level and

accepted by PMI Benin, it is worth pointing out that these results are preliminary therefore, they should

be used with precaution.

Table 1 Malaria indicators

Malaria indicators 2006 DHS DHS 2011-2012

Proportion of households with at least one ITN 25% 79.8%

Proportion of children under five years old who

slept under an ITN the previous night

20% 71%

Proportion of pregnant women who slept under

an ITN the previous night

20% 75.5%

Proportion of women who have completed the

recommended 2 doses of IPTp during last

pregnancy in the last 2 years

>1% 23%

Proportion of children under five years old with

fever in the two weeks who received treatment

with ACTs within 24 hours of onset of fever

<1% 6.7%

Other sources:


Government health facilities with ACTs available

for treatment of uncomplicated malaria

PMI Health Facility Survey/End Use Verification Survey 2010: artesunate-amodiaquine (3)

17.5% artemether-lumefantrine (6)




36.2%

Number of positive malaria cases among

pregnant women (reported to DDP in 2011)

27,185 (SGSI/DDP/MS, 2011

Annuaire des statistique

sanitaire 2011)

Percentage of uncomplicated malaria case

among children under the age of 5

49% among 0-11 months; and

28. 1 among 1-4 years old

(SGS1/DDP/MS, 2011-

Annuaire des statistiques

sanitaires 2011)

Percentage of ANC visit (in public, private and

religious health centers)

85% (Annuaire des statistiques

sanitaires 2011)

Houses targeted for IRS that have been sprayed 99.3 (2010 RTI

report)

85% (2011 RTI Report)

The sharp increase in ITN use can be attributed in large part to Benin’s free LLIN mass distribution

campaign in 2010, as well as the combined interventions of the President’s Malaria Initiative (PMI),

World Bank Booster Program for Malaria Control in Africa, the Government of Benin, and other

stakeholders. However, the DHS results also show that although antenatal care (ANC) visits are very

high (an estimated 86% of women received prenatal care from a trained health care professional during

their last pregnancy; 61% of women reported having 4 or more visits), only 23% of pregnant women

reported having completed the two doses of SP required during their last pregnancy in the last 2 years.

The reason for this significant gap between the first dose and second doses is one of questions that the

ARM3 formative research (that will be led by JHU-CCP) is planning to answer in year two.

Although malaria can be severe, early and appropriate treatment is very effective. However, in Benin,

care-seeking outside of the home is still limited; in the 2011-2012 DHS survey, only 39% of children who

had fever were taken to health center for treatment. Although home-based care can be effective, it is


essential that caregivers are knowledgeable about proper home treatment, as well as danger signs

requiring medical attention.

2.2 Overview of the National Malaria Control Plan and Strategy

With the support of PMI, WHO, and Roll Back Malaria, the NMCP has developed its new five-year

National Malaria Strategic Plan 2011-2015. The vision behind the new strategy is to continue to

promote universal access to malaria prevention and treatment interventions, implement activities

that encourage positive behavior change, achieve and sustain high coverage levels, thereby

reducing malaria’s burden and achieving near zero deaths by 2015.

The core interventions of the 2011-2015 strategy include:

Universal coverage with ITNs, with a special emphasis on distributing LLINs through mass

distribution campaigns in July 2011 and 2014

Donors and the GOB are continuing to support routine distribution to pregnant women during

ANC visits and to children under five years during routine immunization clinics

Further expanding IRS, which covers all nine communes of the department of Atacora

Universal access to ACTs, as well as improved diagnosis and management of severe malaria

Emphasis on the prevention and treatment of malaria in pregnancy, particularly with IPTp

Intensive IEC/BCC efforts and social mobilization at all levels, especially at the community level

Integration of malaria control activities within the health system with an emphasis on human

resource development

Strong monitoring, evaluation, and operations research to monitor progress, evaluate impact,

and continuously improve interventions

In its 2011-2015 Strategic Plan, the NMCP is seeking to enhance coordination capacity within the

decentralized structures at the departmental level. Under this approach, 12 departmental coordinating

structures will continue to be supported to improve health outcomes through implementation of

policies and strategies defined by the national coordination structures and the GOB such as.

Waiver of user fees for children under five attending health facilities

Increasing capacity of community health cowrkers (CHWs)

Free malaria treatment for children under five and pregnant women


National Malaria BCC Strategy:

The Behavior Change Communication Strategy for NNCP Benin was developed in 2006 as part of

the National Malaria Control Plan and Strategy (2006-2011). This document was desined to be

an integrated communication plan that would standardize messages and tools for all partners

working on malaria in Benin. The NMCP is now planning to develop and implement a new

integrated communication plan that accompanies the new National Malaria Control Plan and

Strategy (2011-2015). The new integrated communication plan will include strategies for

advocacy, BCC and social mobilization.

As part of the National Malaria Control Plan and Strategy, the NMCP has identified the following

target indicators for BCC:

100% of heads of households in urban and rural areas know that LLINs are an effective means of

prevention against malaria

100% of mothers an/or caregivers of children know the treatment for uncomplicated malaria

100% of mothers and/or caregivers of children know that treatment with ACTs requires positive

confirmation with RDTs

100% of mothers and/or caregivers know the signs of malaria

100% of pregnant women in urban and rural areas are aware of IPTp and its advantage

2.3 Organizations supporting malaria communication interventions in Benin

Over the past five years, the Global Fund Round 3 grant to Africare has also supported malaria

messaging at the community level through organized social mobilization campaigns, support to women’s

groups, and training of CHWs in IEC/BCC. The RCC for Round 3 includes a significant communication

component, which will encourage CHWs and women’s groups to promote prompt treatment for febrile

children at the community level, timely referral of severe malaria cases, and use of ANC to increase IPTp

uptake among pregnant women.

UNICEF is the lead for Benin’s health sector partners. They support IMCI, maternal mortality reduction,

and the management of severe child malnutrition in several departments in both the northern and

southern parts of Benin. They are piloting performance-based financing of CHWs through health zones

and communes. UNICEF’s Communication for Development (C4D) approach is referenced in the National

Malaria Strategic Plan’s section on IEC/BCC.


PMI has supported BCC for all malaria interventions, with a particular focus on net hang up and use,

including CHW visits and community mobilization in support of the mass campaign in 2011. PMI also

funds a National Malaria Communications Working Group (Groupe Technique de Travail en

Communication), which receives routine technical assistance from a number of PMI implementing

partners. The group is responsible for reviewing the technical content of all IEC/BCC messages

pertaining to malaria. The NMCP included key IEC/BCC priorities in its 2011 integrated plan, which has

been used to prepare monthly and quarterly plans for all activities. PMI supports BCC related to IRS

activities through RTI in nine communes in the north. PMI also funded a TRAC survey to measure

communication interventions and changes in behaviors and attitudes in 2010.

Roll Back Malaria:

The RBM network is also very active in coordinating and enlisting broad-based participation in scaling up malaria efforts in Benin. This local RBM network is closely linked to the West Africa RBM Network (WARN) and the global RBM Network based in Geneva. In Benin, the NMCP acts as the convener of the RBM network. The NMCP coordinator is the chair and the WHO malaria advisor is the co-chair. Meetings are held monthly and are well attended. All stakeholders present are given the opportunity to report on their malaria activities during the previous month including on behavior change communication and community mobilization.

World Bank

Between 2006 and 2011, the World Bank implemented a $22 million performance-based financing

project to improve maternal and neonatal health in eight health zones in Benin. The World Bank’s

project, Projet d’Appui à la Lutte contre le Paludisme, ends in 2011. USAID and the World Bank’s Project

are collaborating on the universal distribution campaign for bed nets. Although this project’s scope of

work was not directly linked to any malaria communication activities, the impact of their activities had

somehow benefited the national malaria programs.

World Health Organization (WHO)

WHO supports the Government of Benin (GOB) in the development of technical norms, protocols and

service standards in the health sector. For instance, in 2006, the development of the National Malaria Control Plan and Strategy was funded by the WHO. Also, USAID and WHO collaborate on various health topics such as Maternal and Child Health (MCH), or the development of a national policy on the use of RDTs, malaria treatment protocols, routine malaria information system, and most recently on the evaluation of the five-year National Malaria Control Strategy and the development of the next road map for malaria control in Benin. African Development Bank: The ADB was another contributor to the malaria program through its

support to local health committees and Communicty Health Workers and the distribution of bed nets to

pregnant mothers and infants in Zou, Borgou and Donga departments.


Malaria Communications Working Group members (GTTC): In year 2012 ARM3 helped to resume the

GTTC quarterly meetings. Members of the group include the NMCP, USAID/PMI, Research Triangle

Institute, University Research Corporation/PISAF, Africare, CRS, PSI, the World Bank, WHO, UNICEF, and

the Peace Corps. The group met in April and September 2012, to review the existing communication

tools and materials assess their quality and usefulness vis-à-vis the current malaria situation in Benin.

The National Malaria Communications Working Group came to the conclusion that almost all malaria

partners working in Benin have either produced audio, visual or printed materials. Many of them have

also developed messages for their community based-activities.

Along the same lines, the Malaria Communications Working Group members pointed out the need to

update materials and messages during the first meeting on April 24, 2012. They also recognized that

current materials do not include new elements such as net use by all members of the family and malaria

diagnostic. ARM3 has started to develop a new document containing all key information about malaria

prevention and management to replace the old version “Mieux connaitre le paludisme pour l’eviter”,

edited in 2008. However, this document needs to be validated by the NMCP.

During the last working group meeting in September 2012, the National Malaria Communication

Working Group urged the NCMP coordinator to rush for the designing of a new integrated

communication plan in replacement of the previous version, which expired in 2010. This activity will be

funded by Global Fund under a subcontract with Africare.

Several bilateral and multilateral donors, as well as civil society, have also played an important role in

supporting the NMCP malaria communication efforts in Benin. Although some of the donor support

ended in recent years, their impact is still felt on the malaria communication activities, directly or

indirectly. These donors include:

Bilateral: (1) Belgian Cooperation; (2) Chinese Government; (3) the Coopération Française; (4) Japanese

International Cooperation Agency

Multilareral: (1) UNFPA

USG Agencies: Peace Corps

Civil Society and Private Sector: (1) Benin Business Coalition; (2) Gates Foundation;


2.4 Communication gaps/Challenges In Benin, the NMCP is responsible for coordinating the national communication strategy through policy

formation, setting standards and monitoring quality assurance, resource mobilization, capacity

development and technical support, coordination of research, and monitoring and evaluation.

Coordination among communication partners has improved, but challenges remain in providing

integrated communication, harmonizing messages and engaging the community. Several key documents

such MOP 2013, the National Malaria Strategic Plan 2011-2015 identified that obstacles to the success

of communication interventions are socio-cultural, economic and political in nature. They include poort

perception of the magnitur of the malaria burden, poor treatment seeking behaviors of the individuals

and communities, lack of political will and commitment and lack of qualified BCC personnel and all level.

For instance, the National Malaria Strategic Plan for 2011- 2015 identifies five weaknesses to the

implementation of BCC and community mobilization in Benin. These focus on national-level and

management gaps:

o Lack of follow up of community based- outreach activities by the field staff;

o Weak dissemination system of partnership and strategic communication documents

o Lack of qualified personnel in charge of communication and community based-services at

the central and departmental levels

o Under use of the PNLP website

o Lack of audio-visual tools for training

A literature review, site visits, meetings with local partners during a workshop and the access to official

documents helped us to identify additional gaps. In May 2012 ARM3 hired a consultant to conduct an in-

depth literature review to gain an understanding of barriers to IPTp uptake and LLIN use in the country.

Key findings emerging from this literature review include the following:

Table 2 Barriers to Behavior Change

Topic Lit Review Findings Other Sources

Vector control-LLINs

Household level

Persistence of negative

perceptions around mosquito

nets (discomfort, lack of air,

sensation of heat)

Negligence from the care

providers (mothers and fathers)

2010 TRAC/PILP

Self efficacy and motivation

were found to be significant

determinants for LLIN use in

Benin. Many heads of household

and family members do not

sleep in mosquito nets


The perceived burden associated

with hanging the net and taking

it down every morning

Perception that mosquito nets

are not important

Perception that mosquito nets

cause sleep disruption

Doubts about the efficacy of

LLINs

Difficulty associated with

replacement and repair of

damaged mosquito nets

Lack of awareness about the

importance and benefit of LLIN

use among the population

Configuration of the room where

the LLIN will be hung.

Perceived poor quality of care at

health facilities leading to

infrequent attendance.

Confusion about whether ITNs

need to be retreated or not

consistently every night.

Service delivery level: Providers at understaffed

facilities had little time for

counseling on benefits and

appropriate use of ITNs as part

of comprehensive strategy to

prevent malaria

Although many providers

generally spent some time

counseling on the benefits and

appropriate use of ITN as part of

a comprehensive strategy to

prevent malaria, these

conversations were usually

dominated by the providers,

leaving no room for clients to ask

questions or address their

concerns (Source: ARM3 BCC


team site visits)

Malaria and pregnancy

Household level Late ANC attendance of

pregnant women


importance of its use

Some people think that SP is

harmful to pregnant women

Family (men’s involvement) and

economic factors influence

timing of antenatal care

Negative social norms around

IPTp (rumors from friends and

family members)

Taste and size of the SP pills

2010 Africare Report

Pregnant women are not

necessarily aware of what

medications they are given nor

what they are for


benefit of the ANC among users

(pregnant women)

Lack of awareness of the need

for two doses of SP-IPT

Many pregnant women start

ANC attendance late or attend

ANC irregularly

Service delivery level Stock outs of Sulfadoxine-

Pyrimethamine in certain health

centers

Some health service providers do

not follow national directives for

IPTp use

Lack of training for providers on

how to administer SP

Poor quality of client services

Although many providers

generally spent some time on


appropriate use of SP, these

conversations are usually

dominated by the providers,

leaving no room for clients to ask

questions or address their

concerns (Source: ARM3 BCC

team site visits)

Providers may be reluctant to

give SP on an empty stomach

Providers at understaffed

facilities had little time for



appropriate use of SP (Source:

ARM3 BCC team site visits)

Perceived poor quality of

healthcare facilities leading to

infrequent attendance

Malaria Case Management

Household level: Mistrust in results of RDT by

clients

Delays in seeking care from

qualified source

Preference for seeking care from

private and street drug vendors

Malaria not perceived as serious

health problem

Service delivery level: Mistrust in results of RDT by

providers

DDP/Health Zones (Littoral and

Atlantic) reports

Many health providers prefer to

rely on their own judgment

when diagnosing suspect malaria

case

Weak health information system

A more recent study found that net care and repair practices are not widespread in Benin and that nets

are wearing out faster than expected. Following the NMCP 2011 mass LLIN distribution campaign, the

Centre de Recherche Entomologique de Cotonou (CRE-Cotonou) with the support of NMCP, USAID, PMI

and CDC found that deterioration of net fibers was visibly showing after six months of use. The same

study also revealed that almost half the nets had holes and /or tears. In addition the net attrition was

followed by a drastic decrease in the amount of insecticide available at the surface of the nets, possibly

due to excessive washing. The same study revealed that some people used the nets for fishing rather

than protecting against mosquitoes.


Site visits were another source of information. Health centers were visited by the ARM3 BCC team to see

firsthand how clients were being received and what kind of services were provided to them. The team

also met with local community leaders to understand how they use their influence. These site visits

gave some insight into the client-provider relationship within health centers, the provider-community

relationship, as well as how to address some of the communication issues they encounter.

Other barriers to proper diagnosis and treatment of malaria were discussed and addressed during a

three-day workshop in Grand Popo (July 24-26, 2012) with the Atlantic and Littoral Health Department

to develop the two regions’ health zone action plans for year 1 (2012-2013) and for 3 years (2012-2015).

Among the identified barriers were providers’ trust in the accuracy of the RDT results and their

perception of RDTs as a threat to provider’s own ability to make clinical diagnoses based on symptoms,

their training, and medical experience. From the community side, it was believed that the main barrier

to proper diagnosis and treatment is that many households think that malaria is a very common disease

therefore not perceived as a serious health problem.

These findings, along with other existing research and reports, provide the basis for ARM3’s strategic vision and communication strategy. Identified gaps reflect the need for a comprehensive strategy that allows stakeholders to create synergy across programs and use multiple channels of communication to maximize reach and depth. ARM3 proposes a comprehensive, results-oriented communication strategy to address the issues from the central level to the community. Throughout, a BCC capacity building process that engages all malaria partners, including NMCP, is crucial.

2.5 Accelerating the Reduction of Malaria Morbidity and Mortality (ARM3) With funding from the United States Agency for International Development (USAID), a consortium led by

Medical Care Development International (MCDI) as the prime recipient, and Africare, John Hopkins

University - Center for Communications Project (JHU-CCP) and Management Sciences for Health (MSH)

as sub-grantees, in partnership with the National Malaria Control Program (NMCP), is implementing the

Accelerating the Reduction of Malaria Related Morbidity and Mortality (ARM3) Project in Benin. It is a

five year project (October 1, 2011 to September 30, 2016) with a budget of $30 million.

In collaboration with USAID/Benin’s President’s Malaria Initiative (PMI), ARM3 seeks to assist the

Government of Benin (GOB) in improving malaria health outcomes in accordance with the NMCP’s

guidelines and standards. The primary objective of ARM3 is to help the Government of Benin achieve

the PMI target of reducing malaria-associated mortality by 70%, compared to pre-initiative levels in

Benin. In support of this PMI objective, the ARM3 program’s specific goal is to increase coverage and use

of key life-saving malaria interventions in support of Benin’s NMCP Strategy by scaling up malaria

control, accelerating the reduction of morbidity and mortality, and building local capacity for sustained

control. ARM3 will also complement and expand the efforts of other donors (for example the Global


Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), and private sector organizations) to reach the

NMCP’s goal of eliminating malaria as a public health problem in Benin by 2030.

For years 1 and 2, the ARM3 project will cover 12 health zones within the Atlantic and Littoral Health

Department and the Oueme and Plateau Health Department, as well as five former MSH/Basics health

zones in Alibori, Bogou and Donga. As described in the process used in the development of the ARM3

communication strategy section, part of the data used in developing this communication strategy are

from the Littoral and Atlantic Health Department.

The ARM3 BCC strategy aims to support the overall national strategic plan by contributing to the

effective implementation of LLIN distribution in the private sector, promoting use of nets, creating

demand for IPTp and diagnostics, and facilitating positive client-provider interactions to improve malaria

case management and IPTp uptake. The expected results of the ARM3 BCC Strategy are: to empower

individuals to prevent and treat malaria through increasing desired behaviors in target populations

benefited by the project including pregnant women and caretakers of children under five; and improve

desired behaviors in health providers and caretakers at the community level.


ARM3 Results and Sub-Results are as follows:

Table 3 ARM3 Results and Sub-Results Activity

Objective: Assist the Government of Benin to achieve the PMI target of reducing malaria-associated mortality by 70%,

compared to pre-initiative levels

Result 1: Implementation of

malaria prevention programs in

support of the National Malaria

Strategy improved.

Result 2: Malaria diagnosis and

treatment activities in support of the

National Malaria Strategy improved.

Result 3: The national health system’s

capacity to deliver and manage quality

malaria treatment and control interventions

strengthened.

1.1 IPTp uptake increased 2.1 Diagnostic capacity and use of

diagnostic testing improved

3.1 National Malaria Control Program’s

technical capacity to plan, design, manage, and

coordinate a comprehensive malaria control

program enhanced

1.2 Supply and use of LLINs

increased

2.2 Case management of uncomplicated

and severe malaria improved

3.2 MOH capacity to collect, manage and use

malaria health information for monitoring,

evaluation and surveillance improved

3.3 MOH capacity in commodities and supply

chain management improved


3 Communication Strategy

3.1 Pathways for malaria prevention and control in Benin

The communication strategy is informed by the Pathways for Malaria Prevention and Control in Benin, a

framework developed by JHU•CCP that illustrates the ways in which different communication

methodologies can impact outcomes at different levels of society. The model supports the concept that

social and individual behavior change will not happen as a results of one intervention alone or by

focusing on one level or segment of society, but rather through social, individual, and structural change

coming together to produce a supportive society.

ARM3’s strategy describes the way in which media communication is used to influence decision making

of communities and individuals. Advocacy communication is used to promote the support and

adherence to program objectives as well as improve public and private sector partnerships. Community

mobilization communication targets groups and associations to address needs in relation to

malaria prevention and treatment efforts. Interpersonal communication (IPC) will address each behavior

problem individually.

This is based on the analysis of underlying conditions (situational analysis, including partner analysis),

domains of communication (roles, providers, beneficiaries and framework including NMCP), initial

outcomes from the MOP, GHI, PMI and ARM3 proposal; and expected behavioral outcomes based on

the beliefs, actions required, expected behaviors and barrier analysis, towards achieving sustainable

health outcomes targeted by ARM3.


Table 4 ARM3 Pathways for malaria prevention and control


3.2 ARM3 BCC Strategic Objectives:

The strategic objectives of the ARM3 BCC strategy are:

O.1. To support BCC interventions by the National Malaria Control Program and ARM3 through: effective

coordination of activities by the BCC Working Group; participation in activities by other existing working

groups[1] ; harmonization of BCC/IECC messages, materials and tools developed in Benin[2].

O.2. To increase community engagement in /mobilization for malaria prevention and treatment.

O.3. Increase the supply and use of LLINs through social marketing with private sector partners.

O.4. To upgrade BCC skills of health workers from private and public sectors at national and community

levels, and provide supervision in the use of BCC guidelines.

O.5. To advocate for increased support for malaria control, by government authorities and key partners

(reflected in support for coordination, availability of funds, allocation of human resources and

development of public policies that support malaria mortality and morbidity reduction).

O.6. To develop and disseminate materials supporting BCC and Community Mobilization

O.7. To monitor and evaluate the ARM3 BCC and Community Mobilization Strategy.

3.3 Audiences and priority behaviors targeted by the ARM3 Communication Strategy

In addition to the primary target populations, BCC interventions will seek to achieve behavior change in

secondary audiences. Husbands (or other heads of household) often play a key role in the decision by a

pregnant woman or a caretaker of a young child to use an LLIN, seek ANC/IPT, or seek treatment. The

study entitled “Enquête exploratoire sur les perceptions des beneficiaries du future pole d’excellence”1

in Benin stated that all the husbands interviewed think that they can support their wives to attend ANC.

Community leaders (chiefs, kings, religious leaders), relais communautaires and mothers-in-law can also

influence decisions related to preventive measures and care-seeking.

[1] i.e.: (i) Clinical case management, (ii) Supply chain management, (iii) Monitoring &evaluation [2] Includes the alignment of ARM3 Communication Strategy with MOH’s priorities, existing evidence; and to

provide strategic guidance for the articulation of the ICP supported by GFATM (being developed by Africare)


Section ‎0 provides presents these target populations and desired behaviors, together with key message

content and communication channels and approaches.

Table 5 Summary Target Audiences and Key Behaviors by Sub-Result

ARM3 Result Target Audiences Key Behaviors

Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved.

Sub-Result 1.1- IPTp

Uptake Increased

Primary audience: Pregnant Women

Secondary audience: Husbands, “heads of

households in Beninese context), in laws, health

providers, and community.

Tertiary audience: Health policy makers and

Government authorities from other ministries will be

targeted for advocacy.

Receiving and taking 2 or more doses of

SP/Fansidar during their last pregnancy

Encouraging other pregnant women to

receive IPTp at least twice during pregnancy

Support their partners/relatives/friends to

attend ANC

Use their influence to remove or reduce

implementation bottlenecks

Encourage health providers to provide

information and services for malaria control

Promote BCC/IEC activities at community

level to support malaria and pregnancy

Sub-Result 1.2 Supply

and use of LLINs

increased

Primary audience: Caretakers of children under 5

(Fathers and mothers)

Secondary audience: Heads of households, relais

communautaires, community and religious leaders as

well as owners and managers of private companies.


Ensure that all children under the age of 5 in

their care sleep under an LLIN every night of

the year

Sleeping under an LLIN every night

throughout pregnancy and continuing to do

so with the newborn

Support their

partners/relatives/friends/employees to

sleep under LLIN every night









level to support LLINs

Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy

improved.

Sub-Result 1.3. 2.1 Diagnostic capacity and

use of diagnostic

testing improved

From the service supply side:

Primary audience: Health service providers (both

public and private)

Secondary audience: Health service supervisors are in

the position of ensuring compliance with Benin

policies on diagnostics and treatment, providing

supportive supervision and evaluating performance.




Care-seeking at the nearest health facility or

trained provider within 24 hours of the

onset of symptoms

Properly diagnose malaria before

administering treatment, using an RDT or

microscopy.

All individuals diagnosed with malaria are

treated in accordance with the NMCP

treatment protocol.




level to support care seeking practices

2.2 Case management

of uncomplicated and

severe malaria

improved

From the demand side:

Primary audience: As they bear most of the costs and

burden of malaria at home, caregivers (mothers and

fathers) are considered as the other primary audience

for this behavior change communication strategy.

Provide information (especially to mothers

and caretakers of small children) on the

importance of prompt care-seeking when

malaria is suspected



3.4 Key Messages Messages will be engaging, and contain information that is readily understood and actionable. They will

be fully compatible with existing NMCP and USAID guidelines for malaria prevention and control. The

content and format may be adapted to reflect local customs and language. IPT uptake will be promoted

through messages highlighting that SP is free, that all pregnant women should attend ANC and seek IPTp


(highlighting that they should do so even if they feel fine; this is not to treat a sickness, but to prevent it

from happening). Pregnant women will also be advised to sleep under an LLIN every night of the year,

and that they should continue to do so with their baby. Messages directed at health service providers

(primarily through training) will center on the differences between malaria and other febrile illnesses,

how malaria is transmitted, the dangers malaria poses to everyone, especially pregnant women and

small children, provider-patient relations, and the NMCP protocol for malaria diagnosis and treatment.

Although no specific messages were developed during the Grand Popo workshop, the BCC team from

the workshop was able to formulate ideas and key message content that will guide the development of

clear messages for each behavior that needs to be addressed. For treatment, messages will promote

generic ACTs, and for IPTp, generic SP. Since message development is one of the key pillars of an

effective SBCC strategy, ARM3 BCC team will refine each of the messages and propose them to the

NMCP for approval before using them in the field. An activity complementing this activity is already

under way as the ARM3 team has started updating the NMCP “Mieux connaitre le paludisme pour

l’eviter” which included all the important information and key new messages for malaria prevention and

treatment for health providers and partners working in the malaria field.

We have attached in Annex B : Key Messagesa list of existing key messages that the NMCP has approved

from the message inventory collected during the documentary review carried by ARM3. The list is not

exhaustive and additional message development activities are needed and should be adapted to the

cultural context of the program’s main intervention sites. Section ‎0 also includes the complete behavior

analysis and strategic responses, with key audiences, messages and activities.

Messages are oriented to encourage target audiences to take actions supporting certain key behaviors

in the identified audiences. The table below presents illustrative key messages by target audience.

Table 6: Illustrative Key Messages by Target Audience and Sub-Result

Result ARM3 Target Audiences Illustrative Messages (to be finalized with NMCP and

partners)

Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy

improved.

Sub-Result 1.1-

IPTp Uptake

Increased

Primary audience:

Pregnant Women

Pregnant women, attend ANC and take SP at your visit;

you and your baby will be protected from malaria.

Pregnant women, SP is free for you at health centers

during your ANC visit. Go to ANC to find out more about

the benefits for you and your baby.


Pregnant women, SP tablets are effective and safe for you

and your baby. Attend ANC and take the tablets.

SP is used for intermittent preventive treatment of malaria

and protects you and your baby. Take your SP and get your

recommended two doses.

Secondary audience:

Heads of households,

relais

communautaires, or

community health

workers

Men, malaria is dangerous for pregnant women and their

babies. Encourage your spouse to attend ANC to prevent

complications from malaria.

Men, support your spouse when she goes for ANC, since

when men take care of their wives, you will have a healthy

baby and healthy mother.

Men, malaria in pregnant women can lead to anemia,

premature birth, low birth weight. Encourage your spouse

to get two doses of SP during ANC; this will protect them

both from the dangers of malaria.

Secondary audience:

Leaders/managers

Malaria in pregnancy can lead to anemia, premature birth,

low birth weight. Encourage female employees to get their

two doses of SP, this will protect them and their baby from

the dangers of malaria.

Fever during pregnancy is not normal. Your support is

important for women to seek treatment from a qualified

health provider as soon as they get a fever.

Tertiary audience:

Health policy makers

and Government

authorities from other

ministries

Encourage health providers to provide information and

services for malaria prevention

Promote BCC/IEC activities at community level to support

malaria and pregnancy

Sub-Result 1.2

Supply and use of

LLINs increased

Primary audience:

Caretakers of children

under 5 (Fathers and

mothers)

Pregnant women

Pregnant women: LLINs are free at our first ANC visit; be

sure to get one

Once you have your LLIN, hang it up

Use your LLIN every night (women and children)


Take care of your LLIN; repair it if needed and follow

instructions for washing it

Secondary audience:

Heads of households,

relais

communautaires,

Malaria is a serious disease transmitted by mosquitoes

that bite during the night. As head of household, you can

change this situation by encouraging your whole family to

sleep under LLINs every night, all year round.

LLINs are offered free to each child under five in Benin.

Encourage your spouse to go to a health center to get

one.

Secondary audience:

Opinion leaders:

Community and

religious leaders as

well as owners and

managers of private

companies.

For Business leaders: malaria reduces productivity and

increases absenteeism among your employees. You can

change this situation by encouraging staff to sleep under

LLINs every night and all year round.

For community and religious leaders: Malaria harms the

well-being and the quality of life of your communities; tell

community members, especially women and children, to

sleep under LLIN

Tertiary audience:


and Government


ministries


services for malaria prevention


LLINs


improved.

Sub-Result 2.1

Diagnostic

capacity and use

of diagnostic

testing improved

From the service

supply side:

Primary

audience: Health

service providers

(both public and

private)

Consider all cases of malaria in pregnant women to be

severe, and treat them with appropriate drugs to save

lives.

Use new recommended medicine “ACT” to treat malaria

and earn patient confidence

Not all fevers are malaria; RDTs are very useful in making

effective use of antimalarials.

RDTs are very useful in preventing development of drug-


resistance.

RDTs are effective and reliable. You must use an RDT to

each patient with suspected malaria before beginning

treatment in order to save lives.

All fevers should be treated within 24 hours. A child can

die from malaria if he is not treated in time and with the

appropriate drugs.

As soon as danger signs appear, both in children and

adults, go immediately to a health center for appropriate

treatment.

Secondary audience:

Health service

supervisors

Poorly managed malaria in children, adults and pregnant

women can lead to complications and even death. Ensure

compliance with the malaria treatment protocols to save

lives.

All fevers should be treated within 24 hours. A child can

die from malaria if he is not treated in time and with the

appropriate drugs.

Do not provide any treatment without malaria

confirmatory diagnosis

Provide treatment as soon as possible during the first 24

hours and refer severe malaria cases to a level appropriate

for treatment

You must use an RDT to each patient with suspected

malaria before treating them to avoid treatment failure

due to ACT resistance.

.

As model service providers we follow the Ministry of

Health treatment protocols to save lives.

From the demand

side:

Primary audience:

Pregnant women, malaria is dangerous for you and your

baby. Go immediately to a health center for treatment if

you develop symptoms of malaria.


Caregivers (mothers

and fathers), mothers

and in laws

Mothers and caretakers of young children, heads of

household, take your child under five to the CHW if he has

fever for treatment with ACTs, and he will get better

quickly.

Mothers and caretakers of young children take your child

under five to the clinic if he has fever for treatment with

ACTs, and he will get better quickly.

Mothers and caretakers of young children, treat your child

with ACT according to the directions of CHW or health

agents. ACTs are available from CHW or in health centers.


household, all fevers should be treated within 24 hours. A

child can die from malaria if he is not treated in time and

with the appropriate drugs.


household, not all fevers are malaria, so it is important to

quickly to a health center when you suspect malaria.


household, as soon as your child has one of these

symptoms, take them to a health center for a quick

recovery:

· Vomits everything he eats

· Does not nurse or eat

· Doesn’t react or seems asleep

· Has convulsions

· Is more pale than usual; palms and bottoms of the

feet; nails and lips are pale

· is breathing rapidly or with difficulty

Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and

control interventions strengthened.


3.1 National

Malaria Control

Program’s

technical capacity

to plan, design,

manage, and

coordinate a

comprehensive

malaria control

program

enhanced

Primary audience:


and Government


ministries


services for malaria control


care seeking practices

3.5 Communication Channel This document is an important step towards the implementation of a comprehensive and integrated

communications strategy. One of the means for achieving impact through BCC is to combine a number

of approaches to reach the maximum number of beneficiaries. The Consortium’s multi-channeled BCC

program will coordinate with the BCC component of Africare’s Global Fund program so that the reach of

the NMCP’s BCC program is maximized.

3.5.1 Mass Media

Mass media channels have the possibility of reaching large numbers of beneficiaries at a low to moderate cost, and are an excellent means of increasing awareness about the gravity of malaria in Benin, of improving knowledge about transmission, prevention, and treatment, and of modeling positive behaviors. Mass communication channels to be used by the program include radio and television, print media such as billboards, posters, and banners, and special events. In Benin, TV and radio remain the most used and trusted media to date (MIS 2010). Benin has four television stations and more than one hundred radio stations. Radio stations in Benin currently engaged by the World Bank’s Malaria Booster Program have already started broadcasting messages developed by the Consortium and the NMCP. Radio programming may include (based on the results of the consumer research) short programs of music jingles, interviews with opinion leaders (political, religious, social), and skits. Dividing the geographical responsibilities for radio broadcasting between the Consortium and Africare’s Global Fund program will reach a wider audience with more frequency. Women are less likely than men to be regularly exposed to any media in Benin. According to the 2006

DHS survey, only 57% of women listen to radio at least once every week compared to 85% of men.

Television viewership is not widespread, with 35.6% of men reporting that they regularly watch

television vs 25.3% of women. The DHS survey also reported that in Benin, the proportion of people

without any exposure to media is quite high at 38% for women and 13% among men. The proportion of


exposure to newspapers or magazines is almost negligible among Beninese men and women (12.8%

among men and 3.8% among women). The exposure level in urban areas is much higher than in rural

areas. According to the same DHS survey, more than 13% of men in urban areas are exposed to either

TV, radio or print media at least once per week (compared to 4.6% in rural areas). The figure is much

lower among women, only 5.4% of whom are exposed to the three media at least once per week in

urban areas and 0.7% among rural women.

The 2010 final evaluation of PALP project documenti reported that 68% of households possess a radio.

More than 32% of the population also owns a television and 59% possess cellular phones. Knowing

audiences’ exposure to media and preferences is key in designing strategic health communication.

3.5.2 Interpersonal Communication

Effective interpersonal communication is key to achieving positive behavior change. In comparison with

mass media communications, interpersonal activities have the advantage of allowing heads of

household and caregivers to discuss their concerns and doubts about the program’s different

interventions. They also provide an opportunity for communication agents to better understand values

and obstacles to behavior change, so that individual solutions can be devised.

About 39% of Beninese women have no access to any form of media and will require alternative

communication channels. The interpersonal communication component will incorporate community

engagement approaches through games, songs and theater performed at social, cultural, sports, and

market-related events, and through school-based competitions (song, theater). To build social norms

supportive of malaria prevention and prompt treatment, Mobile Video Units and local opinion leaders

and “champions” will be used to promote the Consortium’s messages. The strategy will include home

visits by CHWs to identify pregnant women and motivate them to keep their ANC appointments, to

remind families about the proper use and maintenance of LLINs, and to promote environmental control

of malaria and prompt care-seeking for febrile disease. This component will also provide a voice

whereby the community can influence the quality of care provided, particularly in public facilities. The

Consortium will provide financial and technical assistance to local NGOs/CBOs to implement the

community engagement activities of the BCC program. The NGOs that implemented similar BCC

activities for the World Bank Booster Program will be invited to compete to be selected for this

initiative. Funding for these NGOs will be split between the Consortium and the Global Fund.

3.5.3 Counseling in Government and Private Health Facilities

The Consortium will design and implement a training of trainers program for providers in government

and private health facilities on improved counseling and patient interaction skills to enhance the

patients’ understanding and adherence to treatment regimes. It will be applied during the


implementation of the performance improvement (through quality assurance) approach at hospitals and

health zones. In addition, communications staff in Hospitals, Health Zones and Health Directorates will

be trained to serve as effective spokespersons in conveying the Consortium’s key messages to local

media outlets.

3.6 Communication Materials The communication materials to be developed under the strategy are.

Table 7: List of existing communication materials

ARM3 Result Type of material

(printed/audiovisual)

Name of Material

Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved.

Sub-result 1.1: IPTp

uptake increased

Printed IPT flyer for the general public and pregnant women

T-shirt and hats

Audiovisual IPT radio spots and programs for general public and

pregnant women

IPT radio spots and programs for men

IPT radio spots and programs for community leaders

IPT TV spots for men

IPT TV spots for general public and pregnant women

Sub-Result 1.2

Supply and use of

LLINs increased

Printed LLIN flyers for general public

T-shirts and hats

Audiovisual LLIN radio spots and programs for caregivers and

pregnant women

LLIN radio spots and programs for men

LLIN radio spots and programs for community leaders


LLIN TV spots for men

LLIN TV spots for general public and pregnant women

LLIN TV spots for community leaders


improved.

Sub-Result 2.1

Diagnostic and

treatment improved

Printed Provider-patient IPC job aid

Job aid (aide memoire) on the national new case

management for providers

Flyers on “ACT efficacy”

Audiovisual Diagnostic and treatment radio spots and programs for

caregivers and pregnant women

Diagnostic and treatment radio spots and programs for

men

Diagnostic and treatment radio spots and programs for

community leaders

Integrated materials

Printed LLIN use and repair pamphlet for general public

Malaria key messages booklet for health providers

Booklet on new case management policy for providers

Malaria advocacy pamphlet for community leaders and

managers/supervisors

Malaria advocacy pamphlet for decision makers (local

leaders and other ministries)

Malaria jobaid for health providers/community health

workers and “relais communautaires”


Banners with LLIN and IPTp messages

Audiovisual TV songs with malaria prevention and case

management messages

3.7 Capacity Building

According to MOP 12, the factors impeding the PMI implantation include: the NMCP staff lack of

requisite knowledge and skills to fulfill their job description, weak health information system and health

commodities supply. Within the BCC unit, there are only three staff, each with different background.

One is in charge of social mobilization, and he is seconded by a BCC chief and a program officer. The

unit maintains contacts with implementing partners and provides them with guidance on the

development of strategies in Benin. The unit also has an inventory of produced materials and in some

cases can distribute some materials to partners who express an interest. To allow the unit to be

effective in BCC strategy conception, delivery, implementation and monitoring, it needs to be

strengthened. At the department level, there is a medical doctor focal point and a social assistant who

are in charge of BCC and social mobilization. While they are tasked to develop the BCC interventions in

the department, they face a shortage of skills, which hampers their effectiveness developing strategies

and implementing them. At the zone level, there is no single person in charge of BCC. Within the health

centers, the BCC activities are carried out by different people including birth attendants and nurse

assistants. Mothers are educated during preschool and prenatal care consultation. Unfortunately, it has

been discovered during the site visits that the interpersonal communication between provider and

patient is dominated by the medical model of teaching, where providers talk and patients listen.

Patients are not treated as adults with whom the educator needs to negotiate to obtain an agreement

on what should be done at home. Parents are not given enough time to ask questions and raise their

concerns regarding managing child health or their own health.

Under the supervision of health centers, community health workers do outreach activities to bring ANC

and EPI visits to hard-to-reach areas. Home visits, one-on-one contact or group discussions are the

strategies used to reach the beneficiaries. However, to be effective, CHW need to be well selected,

trained, supervised and motivated.

Capacity building will be a key component to achieve the communication objectives laid out in this

communication strategy. Capacity building activities conducted under the ARM3 will be multi-

dimensional as they focus on building skills, nurturing existing and local values as well as promoting

closer and more effective coordination among all partners implementing SBCC malaria activities. Three

main approaches will be used to ensure capacity building: formal training, learning by doing or on the

job training, and coaching. There are several audience segments at different levels (central,

departmental, zonal, community) for capacity-building activities. These include: (1) at central level:


National Malaria Communications Working Group and local health institutions;(2) at department level:

Departmental BCC Teams that are comprised of people in the department, health zones and health

centers ; and (3) at community level: NGO, CBO, media professionals and community. For the team

from the central and departmental levels, it is important to strengthen their capacity in SBCC skills as

they are the ones who supervise the quality of health providers’ services in health facilities, as well as

the quality of NGOs and associations at the community level. These stakeholders will take part in all

ARM3 planned trainings (from designing the modules to implementing and evaluating them). They will

also take part in strategy and materials design workshops, as well as the Leadership in Strategic Health

Communication course with media professionals, NGOs and CBOs. Through an established cascade

training system, and with support and coaching from the ARM3 team, the core group of master trainers

will then provide training to BCC teams at the department level to ensure that all health providers are

trained on patient-provider counseling and community participation. Through the ARM3 training activity

with the Medical School and Department of Nursing, stakeholders including representatives from the

NMCP and the Medical school will take part in the design and validation of the pre-service training

provider-patient interaction modules and materials. At the community level, Africare will lead training,

supervision and motivating community health workers in ARM3 catchment areas.

Supervisory capacity related to SBCC of the Departmental Malaria teams will also be reinforced. By

conducting regular supervisory visits with the ARM3 BCC team, local partners will benefit from their

experience in coaching as the ARM3 will emphasize the BCC component of the supervisory forms.

Coordination of all BCC activities is also important to achieve the project and NMCP objectives.

Activities such as media production and release of information are the responsibility of the NMCP and

its partners at the central level. All SBCC strategies and materials for Benin will be built upon the

materials and activities produced at the central level. By using existing structures and coordination

mechanisms including those of partners such as PMI, ARM3 will work closely with the NMCP and other

implementing partners to make sure that all communication malaria activities will be coordinated,

messages will be harmonized and disseminated, and capacities within partner institutions are optimally

used to assist others in a “One team” perspective. Other mechanisms such as the Roll Back Malaria

Network, the quarterly program review from the USAID team, will also be used to ensure open sharing

of information and transfer of lessons learned. ARM3 has conducted an inventory of existing SBCC tools

and messages. These tools and messages will then be communicated to Departmental Malaria teams,

which in turn will communicate and disseminate to other implementing partners at zonal and

community levels.

3.8 Gender Effective BCC requires that program managers and media practitioners observe the ways people may be

marginalized because of their gender. This could be their defined social role in society, race, ethnicity or

class. These and other factors might determine how the target audiences respond to BCC intervention.

Research has consistently shown that men play key roles in changing their families’, especially their


wives and children’s behaviors (Cabinet Afrique Conseil’s study, March 2009). In each of the

communication activities we propose, the role of men is a significant part of the strategy because they

have the power to change the current trend of behavior around malaria in Benin. In this strategy gender

will be mainstreamed into the design of interventions at all levels to ensure minority ethnic groups,

women and girls have access to information and services, and are supported by their family members of

both genders.

Effective BCC requires a communications approach that not only responds to the biological and cultural

dynamics of malaria as they relate to men and women; the communication response should also be

underpinned by the principle of equity. In Benin BCC should address the fact that women are

biologically more susceptible, particularly during pregnancy, to malaria infection. At the same time

women are the principle care providers of their families, most importantly of children when they are

most vulnerable to the disease. As such BCC will target women for intermittent preventive treatment of

malaria in pregnancy as well as for desired preventive and curative behaviors. On the other hand,

research shows that men are an underexploited audience for BCC messaging in health. As key decision-

makers in household financial decisions, they play a critical role in the several desired health behaviors

of household members, including use of LLIN and compliance with treatment regimens. BCC activities

will target both men and women to ensure optimal behaviors and equitable access to treatment.

Simultaneously, ARM3 will regularly assess the message efficacy, especially during community events

aimed to educate both males and females in an entertaining way. Doing so will help ARM3 determine

how the conveyed messages are responsive to the needs of women, girls and males in acquiring LLINs

and using them consistently, receiving early diagnostic and care in cases of suspected malaria, in

attending antenatal care and in receiving IPTp and supporting wives. ARM3 will ensure also that all

message content spread through media emphasizes the role of gender in maintaining good health

among family members.

3.9 Monitoring and Evaluation The monitoring and evaluation plan for the communication strategy will complement the overall ARM3

M&E plans. Indicators are divided into two groups: inputs and outputs. Inputs pertain to media

materials produced and disseminated. Outputs pertain to reactions generated by audiences (which

include exposure, recall, and recognition of mass media channels and messages. Under ARM3 M&E plan

the following cross-cutting BCC indicators will be used to measure expected results of the BCC

intervention:

Number and type of BCC materials developed

Number of radio broadcasts performed

Percent of population reached with radio messages

Number of NGOs/CBOs implementing community-based BCC activities


Number of people reached with community based activities

Number of government and private health workers trained on patient counseling

The BCC M&E plan under the ARM3 project will be implemented in partnership with NMCP’s BCC staff

and the National Malaria Communications Working Group. NNCP’s operational plan will be used as a

reference in monitoring and evaluating all BCC activities related to this project. The following logframe

will provide an overall overview of ARM3’s plan to evaluate its BCC activities:


Table 8: Input Indicators:

ARM3 Activity Name of indicator(s) to

measure results

Data source Frequency Expected Results

Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy

improved.

Sub-Result 1.1- IPTp Uptake Increased

Mass media activities on IPTp

Production of

radio

spots/programs

on IPTp

Number of radio

spots/programs on IPTp

produced

Script Quarterly CDs are available

at the radio

stations/partners

Production of

Tv

spots/programs

on IPTp

Number of TV

spots/programs on IPTp

produced

Script Quarterly DVD/VCDs are

available at the TV

stations/partners

Reproduction

of leaflets (, s,

on IPTp

Number of leaflets

reprinted

Receipts for products

delivery

Quarterly Leaflets are

available and

visible in

interventions

areas

Diffusion of

radio

spots/programs

on IPTp and

advocacy

Number of radio

spots/programs aired

Reports, diffusion

plans

Monthly Radio spots and

programs are aired

through national

and community

radio stations

Diffusion of TV

spots/

programs on

IPTp

Number of TV


Reports, diffusion

plans

Monthly TV spots and

programs are aired

through the three

main TV stations

Community-based activities on IPTp

Distribution of Number of visual aids: Activity reports Quarterly Visual aids


leaflets on IPTp

and advocacy

leaflets and advocacy

tool on IPTp distributed

(leaflets on IPTp

and advocacy) are

available and

visible in

interventions

areas

Interpersonal

communication

for BCC on IPTp

Number of house-to

house visits, IPC

conducted by Africare’s

community health

agents/ Peer educators

Activity reports Quarterly Target groups

informed

Sub-Result 1.2 Supply and use of LLINs increased

Production of

radio

spots/programs

on LLIN use

Number of radio

spots/programs on LLIN

use produced


at the radio

stations/partners

Production of

TV

spots/programs

on LLIN use

Number of TV

spots/programs on LLIN

use produced

Script Quarterly DVD/VCDs are

available at the TV

stations/partners

Reproduction

of leaflets on

LLIN and

produce

another for

advocacy

targeting

private sectors

Number of leaflets

reproduced and

produced


delivery

Quarterly Visual aids (,

leaflets) are

available and

visible in

interventions

areas

Diffusion of

radio

spots/programs

on LLIN use

Number of radio


Reports, diffusion

plans


programs are aired

through national

and community

radio stations


Community-based activities on LLIN use

Distribution of

visual aids

(leaflets) on

LLIN use

Number of visual aids

(leaflets) on LLIN use

distributed

Activity reports Quarterly Visual aids

(leaflets) are

available and

visible in

interventions

areas

Interpersonal

communication

for BCC on LLIN

use

Number of house-to

house visits, IPC


community health



informed

Interpersonal

communication

for BCC on LLIN

use

Number IPC

sessions/group

discussion sessions

conducted by private

sectors health agents/

Peer educators


informed


improved.

Sub-Result 2.1 Diagnostic and treatment improved

Activities with health care providers

Training and

refresher

training of

health

providers on

new national

case

management

policy

Number of training

conducted

Training reports Quarterly Health provider

trained and apply

new national case

management

policy


Production of

Job aid (aide

memoire) for

health

providers

Number of job aids (aide

memoire) printed


delivery

Quarterly Job aids (aide

memoire) are

available and

visible in

interventions

areas

Training

Leadership

course

Number of training

conducted

Training report Once Health provider

trained in

Leadership

Advocacy

and/or

supervision

sessions for

health

providers

Number of advocacy

and/or supervision

conducted

Advocacy/supervision

sessions

Quarterly Health provider

convinced on the

importance of

applying the new

national case

management

policy

Community-based activities

Production of

radio

spots/programs

on diagnostic

and treatment

Number of radio

spots/programs on

diagnostic and

treatment produced


at the radio

stations/partners

Diffusion of

radio

spots/programs

on diagnostic

and treatment

Number of radio


Reports, diffusion

plans


programs are aired

through national

and community

radio stations

Reproduction

of visual aids

(leaflets) on

diagnostic and

treatment


(leaflets) printed


delivery

Quarterly Visual aids

(leaflets) are

available and

visible in

interventions

areas


Distribution of

visual aids

(leaflets) on

diagnostic and

treatment


(flipchart, brochures,

leaflets) on LLIN use

distributed

Activity reports Quarterly Visual aids

(flipchart,

brochures,

leaflets) are

available and

visible in

interventions

areas

Interpersonal

communication

for BCC on

diagnostic and

treatment

Number of house-to

house visits, IPC


community health



informed

Interpersonal

communication

for BCC on

diagnostic and

treatment

Number IPC

sessions/group

discussion sessions

conducted by private

sectors health agents/

Peer educators


informed

Organization of

community

events on

malaria control

Number of community

activities conducted by

type, topic, place and

date


informed

Output indicators:

If survey questions are able to be added to the large household surveys on exposure to malaria

messaging, ARM3 will compare exposure to malaria messaging with the outcome indicators to

assess effectiveness and reach of messages. The 2013 Malaria Indicator Survey will include two

new standard questions on exposure to messages and channels.

Table 9 Output indicators:

Key behavior Indicators Sources , Reporting


Frequency

Result 1: Implementation of malaria prevention programs in support of the National Malaria

Strategy improved.

Sub-Result 1.1 IPTp uptake increased

Percent of women who have received 2 + does of a

recommended antimalarial drug treatment during ANC visits for

their last pregnancy in the last 2 years

Source

DHS/MIS 2013/MICS

Frequency

2011,2013,2016

Percent of women who recall hearing messages about IPTp, by

channel

MIS 2013

Sub-result 1.2 : Supply and use of LLINs increased

Percent of households with at least one insecticide-treated net

(ITN)

Percent of population that slept under an ITN the previous night

Percent of children under 5 years old who slept under an ITN the

previous night

Percent of children under 5 years old who slept under an ITN the

previous night or in a house sprayed with IRS in the last 12

months

Percent of pregnant women 15-49 who slept under an ITN the

previous night

Percent of pregnant women 15-49 who slept under an ITN the

previous night or in a house sprayed with IRS in the last 12

months

Source

DHS/MIS 2013/MICS

Frequency

2011,2013,2016

Percent of population who recall hearing messages about

diagnosis or treatment, by channel

MIS 2013



improved.


Among children under 5 years old with fever in the 2 weeks

preceding the survey, percent who received any antimalarial drug

Among children under 5 years old with fever in the 2 weeks

preceding the survey, percent who received any antimalarial drug

the same or next day

Source

DHS/MIS 2013/MICS

Frequency

2011,2013,2016

Percent of population who recall hearing messages about

diagnosis or treatment, by channel

MIS 2013


Table 10: Behavior Analysis and Strategic Responses

Audiences Communication Objectives

Barriers to Behavior changes

Desired Behavior

Key Promise Key Message Content Communication Channels and Approaches

Sub-Result 1.1- IPTp Uptake Increased

Primary audience: Pregnant Women NB:

principally those who do not attend ANC at all and those who attend but not completing the 2 doses of IPT required People who can influence primary audiences’ behavior Husbands, “heads of

- Increase the proportion of pregnant women that:

- Know that IPT is free for pregnant woman in public health centers

- Know the dangers of malaria in pregnancy

- Feel that it is important to attend ANC

- Know how to prevent malaria in pregnancy

- Feel that malaria in pregnancy is dangerous

- Lack of awareness about the importance of the IPTp -- Many do not know that IPT is free in public health centers Do not feel that malaria is a serious problem

-Understand the importance of taking drugs and completing the two does of SP/Fansidar during ANC visits - Receive and complete the 2 doses of SP/Fansidar during ANC visits - Know that IPT is free in public health centers Encourage other pregnant women to come for ANC and to go for IPTp at

IPT for malaria during pregnancy is the gateway of having a healthy child SP/Fansidar is free for pregnant women in public health centers

- SP/Fansidar is free for pregnant women in public health centers

- Pregnant women are more likely to get malaria than women who are not.

- -Any pregnant woman that experiences signs or symptoms of malaria should see a health workers immediately.

- When a pregnant woman has malaria it is very dangerous for both the woman and her baby

- Malaria during pregnancy can cause: - Abortion - Stillbirth - Premature delivery - Low birth weight babies - Maternal and perinatal anemia

- Fortunately, it is very easy to prevent malaria in pregnancy! All pregnant women should: - Go for antenatal visits, starting early in pregnancy; - Get at least two doses of IPT (SP/Fasidar) at ANC; - Many people do not understand why pregnant women have to take drugs when they are not sick. This is because many pregnant women who have malaria will not show any signs,

Advocacy: -Capacity building -Harmonization -Supervision -Coordination Service Quality: -Training of providers Training of providers supervisors -Production of jobaids/tools -Supervision Mass media and community mobilization RADIO: - 45 second radio spots (broadcasted in both national and community radios) - drama (addressed though couple of episodes) -TV - 45 second TV spots addressing the importance of IPT during pregnancy. Broadcasted through the 3 most popular TV channels Community Community Outreach Activities - Community posters on IPTp (designed with those who are illiterate in mind) - Community flyers (to be used by community health workers and “relais communautaires” as part of




Desired Behavior


households in Beninese context), in laws, health providers, and community leaders

least twice during pregnancy

and not know that they have malaria. Therefore, it is very important to prevent malaria before it is too late. - The 1st dose of three tablets of SP/Fansidar should be swallowed during the second trimester, between 4th and 6th month of pregnancy. The 2nd dose of three tablets should be taken during the third trimester, between the 7th and 8th month of pregnancy. This is done at a health facility and is observed by a health professional.

Africare community outreach activities (ie. home visits) - Use immunization outreach sessions opportunities to educate women

Sub-Result 1.2 Supply and use of LLINs increased

Primary audience: Pregnant women, Caretakers of children under 5 (Fathers and mothers)

Increase the proportion of pregnant women and caretakers of children under 5 that: - feel that malaria is a serious problem -state that they can convince their family to sleep under mosquito net (LLIN) every night and all year long - feel that encouraging their family to sleep under nets every night and all year long is their responsibility

Do not feel that malaria is a serious problem Feeling of discomfort (hot, lack of air ) Do not encourage the systematic use of LLIN (every night and all year long)

- Ensure that all children in their care under the age of 5 years and everybody in the households sleep under a net every night and all year long - Talk about family, friends and community members

If you protect your children from malaria, you will be seen as a responsible parents/caregivers, you will increase your family’s productivity If you encourage your family to use mosquito net every night and all year long, you will be seen as a good/parents (father/mother) and good citizen

Prevention: use of LLIN -Sleep under a mosquito net every night, all year long. All nets are safe for the mother and the unborn baby. -The best way to prevent malaria is to sleep under a net every night, every all year long -By encouraging your children and family to sleep under a net every night, all year long, you will not only protect your entire family, but also protect your neighbors and the entire neighborhood and you’ll be seen as a good fathers and good citizen -The long lasting nets are not

Prevention: use of LLIN Mass media and community mobilization - RADIO - 45 second radio spots (promotion of LLIN use broadcasted in both national and community radios) -TV - 45 second TV spots promoting LLIN use (every night, all year long) through 3 most popular TV channels - 45 second TV spots for Malaria Day (final subject/topic will be discussed with NMCP prior to Malaria Day)




Desired Behavior


- think that sleeping under net is comfortable and can save lives

about the advantages of using nets every night and all year long

by your community (building social norm around mosquito net use)

dangerous for people, including babies or children. Some nets contain small amounts of chemicals that kills mosquito, but the amount are not enough to harm humans. The chemicals have been specially tested and approved by the Ministry of Health and the World Health Organization

-

People who can influence primary audiences’ behavior “Heads of households ” (in Beninese context), community leaders Employers/supervisors for the private sectors

Same as above Same as above

Same as above

Same as above Promote nets sales and use through social marketing

Outreach activity - Outreach activities with private sector health committee members - Outreach activities with community health workers and “relais communautaires” as part of Africare community outreach activities (ie. home visits) - Advocacy activity toward employers and community leaders who have influence on primary audience - Advocacy support materials (flyers with LLIN messages) - Social Marketing - Sport events with private sector’s participation (with UAM)


Primary audience: Health providers

- Increase the proportion of health

Despite training

- Properly diagnose

- If you first determine

- Not every fever is malaria - It is important that you first carry

Advocacy: -Capacity building




Desired Behavior


People who can influence primary audiences’ behavior Supervisors

providers who: - Believe that it is

important to properly diagnose fevers as malaria before administering treatment

- State that they are confident and capable of providing proper diagnose to all fevers before administering treatment

many still treat all fevers as malaria

fevers as malaria before administering treatment

whether or not a fever is malaria before treating someone with ACTs, you will be a highly respected health provider in your community

- By providing proper diagnose and treatment to your patients ,you will be saving lives and receive the respected of your community

out the appropriate tests to determine whether or not a patient has malaria before administering treatment

- Treating non-malaria fevers as malaria may lead to resistance to ACTs

-Harmonization -Supervision -Coordination Service Quality: - Training of health providers - Refresher training for HP - Support supervision of HP - Job aids (aide memoire) on the

new National Case Management Policy

- Update existing prevention and case management booklet that reflect the new National case management policy

Information provided should follow the new National case management policy and guidelines

Secondary audience: Caregivers (fathers and mothers) People who can influence primary audiences’ behavior “Heads of households” (in Beninese context) , community and religious leaders

Increase the proportion of caretakers of children under 5 that: - feel that malaria is a serious problem -recognize the signs and symptoms of malaria - Feel that they are able to prevent, seek diagnosis and appropriately treat malaria in their children under 5 - Feel that the

Do not feel that malaria is a serious problem

- Seek appropriate diagnosis and treatment for malaria for children under 5 in their care within 24 hours of onset of malaria symptoms - Talk about family,

If you protect your children from malaria, you will be seen as a responsible parents/caregivers, you will increase your family’s productivity

The burden of Malaria: - Many people do not feel that malaria is a serious problem, but it is the number one cause of death in children and illness in households in Bénin - If you protect your children from malaria, you protect will save resources and have more time to earn money, -If you protect your family from malaria, you will save resources (money) and have more time to earn money, -Although there are mosquitoes around during rainy season, you can

- The burden of Malaria: Advocacy: -Capacity building -Harmonization -Supervision -Coordination Mass media and community mobilization RADIO: - 45 second radio spots (broadcasted in both national and community radios) - drama (addressed though couple




Desired Behavior


prevention, diagnosis and treatment of malaria in children under five is their responsibility

friends and community members about the importance of malaria prevention, diagnosis and treatment

get malaria any time of the year, Diagnosis and Treatment - Malaria is caused only by the bite of female mosquito called anopheles -Not every fever is malaria. Make sure you visit the health center/clinic before you are treated - A child can die of malaria if not treated early and with the proper drug Mothers or caregivers, if your child has any of the following symptoms: - Vomiting everything -Cannot nurse -Cannot eat - No longer reacts and seems to be asleep -Has convulsions - Seems lighter than usual (more pale) - Have trouble breathing or breathing fast Take him/her to the health care immediately; this will allow him/her to receive fast care and to recover quickly

of episodes) Community Outreach Activities - Community posters (designed with those who are illiterate in mind) - Community flyers (to be used by community health workers and “relais communautaires” as part of Africare community outreach activities (ie. home visites) - Advocacy activity regarding the burden of Malaria toward employers and community leaders who have influence on primary audience (UAM campaign) - Diagnosis and treatment advocacy activity toward employers and community leaders who have influence on primary audience (in collaboration with Africare)


4 Implementation

The ARM3 BCC Strategy (2012-2016) aligns to national priorities as articulated in current governmental

malaria strategies and plans. It is a multi-year strategy implemented within Benin’s MOH/NMCP

structure, as well as the Communications Unit, local and regional health systems, and international

partners such as RBM, USAID, Africare, Global Fund, UNICEF, and others. Alignment is ensured through

coordination of annual workplans. Implementation of activities and message dissemination will be

monitored and evaluated under specific frameworks for target audiences.

ARM3 engages with stakeholders to ensure that the support provided on the demand creation side is

matched with strengthening service quality and supply to ensure that malaria quality services and

products such as LLINs IPTs and ACTs are available to meet the demand being generated.

The BCC Strategy supports ARM3’s program activities that will focus on motivating pregnant women to

seek ANC and IPTp, and on training health service providers to consistently provide IPTp during ANC

visits, and to treat their clients with respect. This “Caring Provider” campaign will recognize the

importance of the providers, motivate them to be responsive to the real problems of their clients (i.e. do

not treat all fever as malaria), provide quality services according to the new national case management

policy and guidelines, and model and reinforce provider behaviors. This provider campaign focusing

mostly on provider-client communication will specifically build on and logically follow the

implementation of the quality assurance and capacity strengthening strategies of the ARM3 under this

project.

The campaign will also include messages on the promotion of mosquito net use and repair for pregnant

women and for the households. The concept of the campaign will be built around a social norm for net

use, with an emphasis on the role of a good father figure who can model or encourage others to protect

themselves by starting with himself and his family. By protecting his family, he is protecting his

neighbors and by protecting his neighbors he is protecting the entire community.

A focus on secondary audiences will also be layered in the campaign, especially regarding all activities

related to social marketing. In this component we will emphasize the role of employers, supervisors and

peers who can model and/or encourage others to become champions in using and/or encouraging net

use every day and all year long.

In order to achieve the anticipated results, the key messages and do-able actions must be

communicated to the intended audiences and the audiences need to be supported to implement their

do-able actions.


As they will be playing an important role in supporting the primary target for this project, decision

makers and other government institutions will be targeted with advocacy messages as well. Below is a

list of activities that will facilitate the implementation of the do-able actions to bring about the desired

behaviors and actions.

4.1 Activities

4.1.1 Objective 1: Coordination

Objective 1: To support BCC interventions by the National Malaria Control Program and ARM3

through: effective coordination of activities by the BCC Working Group; participation in activities by

other existing working groups; harmonization of BCC/IEC messages, materials and tools developed in

Benin.

Benin, like other donor-friendly countries, suffers from uncoordinated and overlapping initiatives. What

is needed is a coordinated, strategic advocacy strategy and initiative to be implemented by all malaria

partners. The Leadership for Strategic Health Communication Course (LSHC) will be a key element in

improving the leadership and coordination of the NMCP and its partners. The LSHC workshop integrates

communication theory and experiential learning. The workshop features an easy-to-learn, computer

software program called SCOPE-WEB that guides participants through the steps of designing effective

health communication and strategies. The learning process emphasizes the whole individual and

“learning by doing.” Building institutional capacity at different levels is also critical to effective BCC.

Under ARM3 capacity building activities will be organized for entities at the national, departmental, and

local levels. On the national level particular attention will be given to strengthening coordination

between all parties engaged in BCC as well as in harmonizing messages. This will be achieved by

strengthening the capacity of the National Malaria Communication Working Group, whose members

include the National Malaria Control Program BCC team, UNICEF, WHO, Catholic Relief Service, ARM3,

Africare, Peace Corps, CEBAC, Population Services International (PSI) and representative of health

departments. The Working Group will serve as a forum to coordinate activities in the field, building on

BCC experiences to date, to both harness and share best practices. Appropriate training will also be

used as a tool to build skills and craft messages around local values and norms. Messages will be

informed by quantitative and qualitative research studies under ARM3 on barriers of desired behaviors.

All BCC strategies and materials for Benin will be built upon the materials and activities produced at the

central level. The BCC working group will assist in harmonizing the messages of all implementing

partners and assist in obtaining a “one team” perspective. ARM3 will also collaborate with the Medical

School and Department of Nursing to design and validate pre-service training in provider-patient

interpersonal BCC.


At the departmental level efforts to build capacity will involve Departmental Malaria Teams by use of

the vehicles of formal training, on-the-job-training, and coaching. Special attention will be given to

strengthening the supervisory capacity of these teams to assess the quality of health providers’

interpersonal communication skills with patients in health facilities and community participation. Their

capacity to assess the quality of BCC of NGOs and associations at the community level will also be

reinforced. Some of the mechanisms used will be the design of training in designing BCC modules,

strategy and materials design, workshops on strategy and materials design, and strategic health

communication. Through an established cascade training system, and with the support and coaching

from the ARM3 team, the core group of master trainers will then ensure the training of BCC teams at

the departmental level. Supervisory capacity will also be reinforced by regular supervisory visits with

the ARM3 BCC team that will provide coaching.

Capacity building at the community level will focus on NGOs, community based organizations (CBOs),

media professionals and community groups. ARM3 will provide BCC guidance through an international

NGO under the project that will engage local NGOs, groups and individuals to undertake community

engagement and mobilization.

Activity 1.1: Support the coordination meetings of the National Malaria Communication Working

Group and coordination with other working groups under ARM3, including: (i) Clinical case

management, (ii) Supply chain management, (iii) Monitoring &evaluation.

Activity 1.2: Promote MOH coordination with other ministries, promoting a cross-sectoral

approach.

Activity 1.3: Harmonize tools, materials, messages and broadcast among the working group

members (avoiding conflicting messages, avoiding duplication and saturation, and providing

message reinforcement).

Activity 1.4: Develop guidelines and tools for ARM3, on: BCC, community mobilization, and

capacity building.

Activity 1.5: Hold a workshop to review/update existing community mobilization tools in use by

contracted NGOs (2013)

Activity 1.6: Organize a strategic meeting with Africare to align all community-based activities

with the preliminary ARM3 BCC strategy

Activity 1.7: Support Africare’s community activities for BCC and community mobilization.


Activity 1.8: Develop an integrated toolkit that includes community mobilization tools and

materials developed in Benin, as a result of the harmonization

Activity 1.9: Conduct research to identify barriers to IPTp use (2013)

4.1.2 Objective 2: Community mobilization

Objective 2: to increase community engagement in /mobilization for malaria prevention and

treatment.

Community mobilization activities will greatly complement the advocacy activities and training of

providers under this strategy. These activities are important ensuring that messages reach those who do

not have access to or listen to TV or radio, as well as to complement the messages broadcast through

mass media. As more than a third of Beninese women have no access to any form of media, alternative

channels that target women’s associations’ meetings or dialogues in the local language are needed.

Community mobilization activities spark discussions that continue long after the activity itself has ended.

Community mobilization activities will focus on malaria interventions at health facility level. Following

the recommendation made by participants during the Grand Popo workshop, ARM3 will support social

mobilization events. To do so, it will facilitate the development of social mobilization teams made up of

staff within the health zones and community assets such as the chefs d’arrondissement, neighborhood

chiefs, traditional leaders, women leaders and community health workers. All these opinion leaders will

have the responsibility to mobilize people and continually remind them about ways to prevent malaria.

ARM3 BCC team will work closely with Africare to make sure that Africare and its NGO partners’

community mobilization strategy is in line with ARM3. Community mobilization activities will take into

account traditional and popular channels such as songs, games, sports, caravans and market-related

events.

Home visits are an important BCC strategy that can be operationalized within the short term plan.

Africare is one of the key partners implementing home visit activities in collaboration with a network of

local NGOs supporting a large number of community health workers. ARM3 activities will reorient

Africare’s current activities so that they are aligned with the key behaviors and strategy for malaria

control. ARM3 will review with Africare its communication strategy and materials for health for its

home visit sessions.

As soccer is one of the Beninese’s favorite sports, the ARM3 program will capitalize on this opportunity

to mobilize audiences, especially men, and to promote key malaria preventative behavior including

appropriate use of LLINs, increased participation in IPTp, prompt care, and adherence to treatment in


malaria campaign. This activity will be reinforced with messages through mass media and interpersonal

communication.

To implement this strategy, the following key activities will be carried out:

Activity 2.1: Organize and support local leaders (private sector, community teams).

Activity 2.2: Organize strategic meeting with Africare to align all community-based activities with

the ARM3 preliminary BCC strategy

Activity 2.3: Facilitate community advocacy/outreach activities, including: (i) advocacy activities

in workplaces, communities to improve LLIN use and good care seeking behavior, (ii) partners

sensitization meetings for opinion leaders that address at community level issues related to

LLIN, IPT use and good care seeking behavior (woman leaders campaign Abomey-

2013), (iii) mass community outreach or health education sessions at village/community events

to provide information and messages on LLINs, case management, malaria in pregnancy (5 CCM

events in 5 BASIC HZs-2013)( Prompt care seeking mass media campaign -2013), (iv) household

visits by CHW to counsel families on ITN use, IPTp and good care seeking behavior in

partnership with Africare, (v) programmed IPC activities by CHW to counsel families on IPTp ,

ITN use and good care seeking behavior in partnership with Africare, (vii) public-private-

community sector dialogues(including Under Mango-Tree radio programs) to facilitate private

sector support and subsidies for relevant malaria control interventions.

Activity 2.4: Organize strategic activities supporting prevention and treatment, as: (i) Organize

“special events” for World Malaria Day, (ii) Promote key malaria preventive behavior at soccer

games and other sports events[3],[4] (This activity will be reinforced with messages through mass

media and interpersonal communication), (iii) Implement campaigns, (iv) caravans, (v) market-

related events..

Activity 2.5: Develop and provide print materials on LLINs, case management, malaria in

pregnancy and vector control for household distribution

Activity 2.7: Organize “special event” for World Malaria Day and other community events

Activity 2.6: Carry out an NGO/Community Facilitator training on community engagement and

advocacy strategies

[3]

Promotion of malaria in soccer games incudes: appropriate use of LLINs, increased participation in IPTp, prompt care-seeking, and adherence to treatment [4]

Soccer is one of the Beninese’s favorite sports. The ARM3 program will seize this opportunity to mobilize audiences, especially men


4.1.3 Objective 3: Social marketing of LLITNs

Objective 3: Increase the supply and use of LLITNs through social marketing with private sector

partners.

ARM3 will conduct social marketing with the private sector to ensure LLIN coverage and continued

distribution through sales of subsidized LLINs via employee programs based on the Malaria-Safe model.

The approach has two advantages, first, to educate the target audience to buy their own LLINs and to

inform them where to get quality LLINs when they need them. To achieve the objective 3 of ARM3

program the following activities will be implemented:

Activity 3.1: Review and coordinate the implementation of the Strategy and Plan for social

marketing of LLITNs with CEBAC-STP (meetings, 2 day workshop), including the creation of a

logo for the social marketing distribution of LLIN and a tagline to increase action and product

visibility. As the social marketing of LLINs will primarily be handled by CEBAC-STP, the BCC team

proposes to hold an initial meeting with its members involved in the distribution campaign. This

is essentially a single coordinated meeting to bring CEBAC-STP management personnel on board

and in line with ARM project’s strategy to implement LLIN distribution campaign. At the same

time, the project will take the opportunity to meet with the CEBAC-STP Health Committee

members to orient them on their anticipated responsibilities during the LLIN social marketing

and distribution campaign. Part of the social marketing strategy will be implemented at the

workplace. The ARM3 team proposes a 2-day workshop to lay out the groundwork for the

CEBAC-STP campaign.

Activity 3.2: Launch the social marketing campaign (event, key participants, media coverage).

After this initial coordination and orientation meetings have successfully been completed the

ARM3 BCC team will officially launch the LLIN distribution campaign through the engagement of

a promotion agency identified through a call for proposals. To further work toward achieving

the ARM3 target of increasing the use of LLINs, the BCC team will create a project specific LLIN

logo and tagline to increase action and product visibility.

Activity 3.3: Facilitate public-private-community sectors dialogues to make possible private

sector support and subsidy for relevant malaria control interventions: LLIN promotion activities.

By following the biding process, ARM3 will work with the best advertisement agency in Benin to

create state of the art materials for the LLIN promotion. These materials will range from

promotional video/radio spots to gadgets such as flyers, T-Shirts, flyers and banners.


4.1.4 Objective 4: Capacity Building in BCC

Objective 4: to upgrade BCC skills of health workers from private and public sectors at national and

community levels, and provide supervision in the use of BCC guidelines.

Building the capacity of health providers to provide quality counseling to patients is important.

Communication strategies designed for providers will emphasize the idea that “Caring Providers” are

those who:

Believe that it is important to properly diagnose fevers as malaria before administering

treatment

Feel confident and capable of providing proper diagnosis to all fevers before

administering treatment

This strategy should motivate providers to be responsive to the real problems of their clients (not to

treat all fevers as malaria) and feel good about their actions. For this program, training of health

providers on client-patient communication will be crucial in improving service quality. ARM3 will design

and implement a training of trainers program for health providers in government and private health

facilities on improved counseling and patient interaction skills to enhance the patient’s understanding

and adherence to treatment regimes. Two curriculums will be designed and used during training with

health providers.

Interpersonal Communication (IPC):

Linking health providers with communities through interactive IPC sessions will increase the likelihood of

quality IPC and trust between providers and clients. Entertainment education programs that support

providers and recognize them for their good work will provide motivation for them to do their job well.

ARM3’s other focus will also be in providing effective patient-provider communication tools, including

production of training materials and job aids. The provision of these tools to health providers will help

them to guide their clients during field visits or visits to the health center for IPTp, LLIN and RDT. The

following activities will be performed by partners to support audiences to achieve do-able actions.

Activity 4.1: Develop and validate an assessment instrument

Activity 4.2: Supervise compliance with guidelines under the M&E component of this strategy

Activity 4.3: Develop/adapt and produce BCC materials/Job aids for health workers on Malaria

Control

Activity 4.4: Develop curriculum, training modules-materials, and identify trainers. As a sub

activity , include the development and validation of an in-service training module on patient-

provider communications


Activity 5: Conduct the following courses and trainings: (i) Client-provider training in

communication skills for service providers, (ii) Patient counseling training and supervision for

public/private health professionals-2013), (iii) Interpersonal Communication training for

providers and MOH personnel, (iv) Training of trainers training (ToT) on patient-provider

communication (create a Center of Excellence) (2013), (v) Strategic Communication course for

the NMCP, MOH and extended staff (2013), (vi) Pre-service training scheme for health

professionals in malaria prevention, diagnosis, and case management (2013), and (vii) In-service

Malaria in Pregnancy training for health professionals (to include IPC) (2013),

Activity 4.5: Develop indicators for the capacity building plan, under the M&E section

Activity 4.6: Periodic monitoring and supervision of the CB Plan, including the following key sub-

activities: (i) Supervision of midwives on promotion and use of IPTp (2013), and (ii) Supervision

to enhance patients’ understanding of, and adherence to, treatment regimes.

4.1.5 Objective 5: Advocacy for increased support for malaria control

Objective 5: To advocate for increased support for malaria control, by government authorities and key

partners (reflected in support for coordination, availability of funds, allocation of human resources

and development of public policies that support malaria mortality and morbidity reduction).

Advocacy can be carried out at national and subnational level, but always focuses on motivating

decision-makers to use their influence to improve implementation of interventions and eliminate

bottlenecks that impede progress towards healthy behaviors. Advocacy includes capacity building and

coordination, media advocacy, and supervisory activities. These will be carried out at the appropriate

level among government personnel in charge of supervising health providers (from the Ministry Health

structure2) at department zone and community level, community and business leaders. The Malaria-Safe

advocacy package ( in annex E) will be used when engaging in dialogue with community leaders,

business leaders, and service providers to foster desirable commitment and support for increased

resources and effective management of resources for malaria control. To reach the above objective, the

following activities will be carried out:

Activity 5.1: Identify target audiences for the advocacy component at the governmental level to

support the implementation of the BCC and Community Mobilization Strategy, including key

behaviors and desired behavior changes for these audiences, as a result of the advocacy

efforts.

2 At national level (NMCP BCC team), at departmental level (BCC focal points: doctors and social assistant in charge of BCC and

social mobilization and zone level (currently lacking personnel n charge of the BCC)


Activity 5.2: In collaboration with the NMCWG, develop advocacy guidelines and tools to guide

the NMCP’s advocacy activities for Malaria control

Activity 5.3: Collect and harmonize advocacy tools and materials being used to for Malaria

Control

Activity 5.4: Conduct advocacy activities directed at high-level government authorities,

managers and workers at workplaces, and communities to obtain the desired behavior change.

Activity 5.5: Promote advocacy activity through media and facilitate public-community-private

sector’s dialogue to enhance private sector participation and engagement

Activity 5.6: Monitor the results of advocacy under the M&E section, based on assumption of

the expected behavior.

4.1.6 Objective 6: BCC and Community Mobilization materials

Objective 6: To develop and disseminate materials supporting BCC and Community Mobilization

Like the IPC approach, mass media communication interventions will cut across all the program areas.

As reflected in the audience preference analysis, radio and TV remain the most used media

communication in Benin although exposure is not as high as in other countries. Since 1 in 3 households

has a TV or radio, this program will focus on radio and TV to get messages across our audiences. In

addition Benin has witnessed rapid growth in information communication technology (ICT). Although

cellular phones have reached the rural areas of Benin, coverage is not high enough to rely upon this

channel exclusively. A partnership with the mobile phone company will be explored through the “United

Against Malaria Campaign.” ARM3 will pilot a program that uses SMS to get malaria messages to

audiences (MTN users) for year 2. Strategy and contents will be discussed with MTN. ARM3 will

therefore use these channels to get messages across and to maximize reach and frequency of exposure

through a cost-effective selection of media channels. Spots, magazines and reality programming will be

the main programs to be produced and broadcast through community radio stations. ARM3 has

identified the main local radio stations covering the following departments: Littoral, Atlantique, Oueme

Plateau and Parakou. In addition, to avoid conflicting programs and saturation of messages to target

audiences, ARM3 is currently working closely with Africare and other partners to identify existing radio

spots and programs that can be still be used, to coordinate radio broadcast in intervention zones and

dividing geographical responsibilities for radio broadcasting. The use of three radio programs came

from JHU-CCP’s many years of experience in designing and implementing radio programs. The radio

spots and magazines will be specifically designed to improve malaria knowledge. The reality radio

program will be designed with the direct participation of target audiences. One of these radio

programs, for example, will be designed to break the provider-client barrier by gathering community

members and recording their interactions regarding malaria issues for later broadcast. This platform will


allow providers and the community direct interaction, but most importantly it will allow radio listeners

to learn what can be expected at the health facilities or clinics, and what can expected from health

providers.

All activities related to all BCC and community mobilization materials development and dissemination

will be planned, coordinated and implemented in collaboration with the National Malaria

Communications Working Group.

Activity 6.1: Develop and integrate messages and materials on LLINs, case management, malaria

in pregnancy (IPTp) and treatment, and vector control, for household distribution

Activity 6.2: Develop/adapt and air TV and radio spots, TV and radio programs related to LLIN,

IPT use and care- seeking behavior

Activity 6.3: Make a cost-effective selection of media channels and program types (e.g., spots,

magazines and reality programming) in the departments of Littoral, Atlantique, Oueme Plateau

and Parakou).

Activity 6.4: Coordinate radio and TV dissemination with all program implementers, to maximize

reach and frequency of exposure to messages.

Activity 6.5: Provide mass media communication support to program components, including

advocacy, community mobilization, bed net distribution and others through radio and TV

(dialogues between patients and health providers through community dialogue or radio

program i.e.: “Under the Mango Tree” radio show)

Activity 6.6: Conduct a malaria in pregnancy mass media campaign (2013)

4.1.7 Objective 7: Monitoring and Evaluating the BCC Strategy

Objective 7: To monitor and evaluate the ARM3 BCC and Community Mobilization Strategy.

Monitoring and evaluation of the ARM3 BCC and community mobilization strategy are based on the

indicators presented in the project logframe and will be carried out through regular reporting, site visits,

and research results. Monitoring of ARM3 activities will focus on program implementation and process

and output indicators. It will help to assess whether program activities are on track, how close they are

to meeting the projected timeline and budget, and whether staff members perform their roles correctly.

The evaluation component on the other hand will measure the success of communication activities by

tracking progress toward outcome indicators in program areas. Among key activities to be carried out

during the project life cycle are:

Activity 7.1: Conduct monthly/quarterly monitoring of the indicators under this strategy

Activity 7.2: Develop monthly/quarterly reports


Activity 7.3: Develop BCC and community mobilization material inventory

Activity 7.4: Develop television and radio logs that show when programs are aired

Activity 7.5: Conduct periodic supervision visits with the NMCP to assess ARM3 BCC and

community mobilization activities

Activity 7.6: Conduct regular spot checks of BCC and community mobilization materials

distribution at representative points in the field

Activity 7.7: Hold focus group discussion between rounds or after campaign, including questions

on community mobilization and communication messages

Activity 7.8: Disseminate reports and other pertinent information.


4.2 Scheduling for mass media and community mobilization interventions Table 11: Year 2 mass media and community interventions Plan

Scheduling for mass media and community mobilization interventions: (Oct 2012-Sep 2013)

Quarter I (Oct-Dec 2012)

Quarter II (Jan-Mar 2013)

Quarter III (Apr-Jun 2013)

Quarter IV (July-Sep 2013)

Scheduling for IPTp uptake Campaign

Encourage women to attend ANC and complete two doses of IPT

Television (national level)

Radio (national and community level)

IPC (client-provider and community)

Home visit (community level)

Posters and Prints (community level)

Other community events

Scheduling for LLIN use and supply Campaign




Home visit (community)

Posters and Prints (community)


Scheduling for diagnostic and treatment improvement Campaign








4.3 Scheduling for mass media and community mobilization interventions for the remaining three years (Oct 2013-

Sep 2016) Bellow’s implementation chart is a tabular expression of the mass media and community mobilization interventions (development, pre-test,

diffusion and/or implementation) to be carried out by ARM3 from October 2013 until the end of the project to support audiences to achieve do-

able actions, as listed above under the detailed strategic framework.

Table 12: Year 3-5 mass media and community mobilization interventions Plan

Scheduling for mass media and community mobilization interventions: (Oct 2013-Sep 2016)

Year 3 (Oct- 2013 –Sep 2014)

Year 4 (Oct- 2014 –Sep 2015)

Year 5 (Oct- 2015 –Sep 2016)

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Scheduling for IPTp uptake Campaign

Encourage women to attend ANC and complete two doses of IPT








Scheduling for LLIN use and supply Campaign







Scheduling for diagnostic and treatment improvement Campaign







5 Annexes

5.1 Annex A : Terms of Reference for GTTC

TERMES DE REFERENCE DU GROUPE DE TRAVAIL TECHNIQUE EN COMMUNICATION

TERMES DE REFERENCE DU GROUPE DE TRAVAIL TECHNIQUE EN COMMUNICATION

-----&&&---

Dans le cadre de la lutte contre le paludisme, plusieurs interventions ont été mises en œuvre. En

matière de communication pour un changement de comportement, certains supports ont été réalisés

par le Programme National de Lutte contre le Paludisme(PNLP), les partenaires sociaux et les

Organisations non gouvernementales.

Dans son rôle de coordonnateur, le PNLP a mis en place une organisation ou tout le monde de

la communication et de la mobilisation sociale se retrouve. Ce creuset dénommé le Groupe Technique

de Travail en Communication (GTTC) bénéficie de l’appui financier et technique du PMI à travers PSI. Il

permet d’échanger et d’assurer la mise en œuvre du volet communication dans le cadre de la lutte

contre le paludisme.

Ce groupe une fois mis en place, a pour rôle de coordonner, organiser les échanges, partager

toutes les interventions de mettre en commun leur capacité et les moyens de lutter efficacement

contre le paludisme.

Ce système d’organisation au Bénin a fait l’objet d’une admiration à l’étranger notamment par

l’Alliance pour la Prévention du Paludisme (APP) à BAMAKO en 2010 qui a demandé aux autres pays de

prendre l’exemple. Il s’agit la d’une expérience à ne pas laisser tomber car elle se vent déjà.

Par ailleurs le lancement de la prise en charge gratuite du paludisme chez les enfants de moins

de cinq ans et chez les femmes enceintes depuis le 04/10/2011 par le gouvernement du Bénin est une

occasion pour planifier un certain nombre d’actions prévues dans ce cadre.

OBJECTIF GENERAL

Créer un cadre de concertation pour la mise en commun des expériences et des moyens

d’IEC/CCC et la mobilisation sociale dans le cadre de la lutte contre le paludisme ;

OBJECTIFS SPECIFIQUES


Revoir et approuver le matériel conçu par les partenaires y compris les documents écrits,

les messages á diffuser á la radio ou á la TV.

Partager les meilleures pratiques en communication sur le changement des

comportements et mobilisation sociale tirées des expériences sur le terrain.

Conseiller sur l’appui pouvant être apporté á tout événement communautaire visant la

promotion des comportements sur la prévention et la prise en charge du paludisme

Faire le point du matériel mis à la disposition de la communication et de la mobilisation

sociale au Bénin

Faire le répertoire des supports disponibles qu’on peut utiliser dans le cadre de la mise en

application de la prise en charge gratuite du paludisme chez les enfants de moins de cinq

ans et chez les femmes enceintes.

Faire le rapport et planifier les activités trimestrielles.

CIBLES

Partenaires techniques intervenant dans la lutte contre le paludisme au Bénin en matière de

CCC et de la mobilisation sociale.

RESULTATS ATTENDUS

Les réunions du GTTC ont repris ;

Tous les Partenaires ont été atteints ;

Tous les supports et éléments intervenant dans la CCC et la mobilisation sociale ont été

mis en commun afin de réussir la mise en application de la prise en charge gratuite des

soins du paludisme chez les enfants de moins de cinq ans et chez les femmes

enceintes.

Les supports complémentaires ont été identifiés.

Chaque Partenaire a fait le point de ses activités sur le terrain sur la CCC et sur la

mobilisation sociale.

METHODOLOGIE

La méthodologie est essentiellement faite de présentations suivies de débats.

MATERIELS

Un tableau flip-chart

Un ordinateur portable

Un projecteur Power Point


Vingt cinq kits de participants

LISTE DES INSTITUTIONS DONT LES CHARGES DE COMMUNICATION

ET/ OU DE MOBILISATION SOCIALE SONT CONCERNES

RTI-INTERNATIONAL

OMS

CRS/BENIN

UNICEF

PSI/BENIN

URC/PISAF

AFRICARE

CARITAS/BENIN

ARM3

USAID

Corps de la Paix

Plan/Bénin

CEBAC

Directions Départementales de la Santé


5.2 Annex B : Key Messages for Targeted Audiences Les messages clé tirés de la boite à image éditée par le programme National de Lutte contre le

paludisme (2010)

1. Paludisme chez les femmes enceintes

Audience Comportements clés Messages clés

Femme enceinte

Les femmes enceintes dorment sous

moustiquaire imprégnées

d’insecticide chaque nuit

La plupart des femmes enceintes

reçoivent leurs doses complètes de

SP au cours de CPN

Femme enceinte, dors sous moustiquaire imprégnée à longue durée d’action toutes les fois ; ainsi tu seras protégée et tu protégeras aussi l’enfant que tu portes contre le paludisme. Femme enceinte, va en consultation prénatale, et prends les comprimés de SP devant l’agent de santé ; ainsi l’enfant que tu portes et toi-même serez protégés contre le paludisme. Femme enceinte, le paludisme est dangereux pour toi et l’enfant que tu portes. Va immédiatement au centre de santé dès que tu sens les signes du paludisme pour ta prise en charge.

2. Prise en charge


Les

personnes

en charge

des enfants,

mères,

personnel

de santé,

chefs de

ménage

Les membres de la communauté, les

patients se rendent au centre de

santé (le plus proche) dès les

premiers signes de fièvre

Mère ou gardienne d’enfant, chef de ménage, des que ton enfant a le corps chaud, fais-lui un enveloppement humide. Ceci permettra de faire la fièvre en attendant de l’emmener très rapidement chez un relais communautaire ou dans un centre de santé. Mère ou gardienne d’enfant, chef de ménage, tu peux emmener ton


enfant de six mois a cinq ans qui a le corps chaux chez le relais communautaires proche de chez toi pour le traiter du paludisme simple avec les CTA et il guérira vite. Mère ou gardienne d’enfant, ton enfant de moins de 6 mois qui a le corps chaud doit être pris en charge par un agent de santé. Emmène-le directement dans un centre de santé et il guérira vite. Mère ou gardienne d’enfant, chef de ménage, traite ton enfant qui est malade ou a le corps chaud avec les CTA (Combinaison Thérapeutique à Base d’Artemesinine) en suivant strictement les indications du relais communautaires ou l’agent de santé. Les CTA sont disponibles auprès des relais communautaires et dans les centres de santé. Mère ou gardienne d’enfant, chef de ménage, des que ton enfant présente l’un des signes suivants :

Vomit tout ce qu’il mange

N’arrive pas à téter N’arrive pas à manger Ne réagit plus et

semble endormi Fais des convulsions Parait plus clair que

d’habitude (plus pale) : le paumes de ses mains et ses pieds, ses ongles et ses lèvres sont plus clairs que d’habitude

Commence à respirer très rapidement et difficilement

Emmène-le


immédiatement au centre de santé ; ainsi il sera vite pris en charge et guérira vite.

Le paludisme se transmet par la piqure de la femelle d’un moustique appelé anophèle. Pendant la nuit, ce moustique pique une personne malade et prend le microbe. Le même moustique va piquer une autre personne qui n’est pas malade et lui donne le microbe qui provoque la maladie.

3. Lutte anti vectorielle -LLIN


Les personnes

en charge des

enfants, parents

(mère et père)

La plupart des mères et les

personnes en charge des enfants

font dormir leurs enfants de moins

de 5 ans sous une moustiquaire

imprégnée d’insecticide

Mère ou gardienne d’enfants de moins de cinq ans, le paludisme est plus dangereux pour ton enfant. Fais-le dormir toutes les nuits sous moustiquaire imprégnée à longue durée d’action ; cela lui évitera le paludisme.

4. Lutte anti vectorielle- IRS


Les personnes

en charge des

enfants, parents

(mère et père),

femmes

enceintes, chefs

de ménage

Les mères et gardiennes d’enfants, et

chefs de ménage couvrent avec un

couvercle touts objets creux pouvant

contenir de l’eau dans la cour de la

maison

Les membres de la

famille/communauté ne salissent ou

cultivent plus à l’intérieur et aux

alentours des maisons

Mère ou gardienne d’enfants, femmes enceinte, chef du ménage, les objets creux pouvant contenir de l’eau dans la cour de la maison favorisent la multiplication des moustiques. Enlève-les de ta maison pour protéger et protéger ta famille contre le paludisme Mère ou gardienne d’enfants, femmes enceinte, chef du ménage, nettoie toujours ton milieu d’habitation et garde-le toujours propre. Tu éviteras ainsi la multiplication des moustiques qui piquent et donnent le paludisme.


La pulvérisation intra domiciliaire est une stratégie de prévention du paludisme qui complète l’utilisation des moustiquaires imprégnées à longue durée d’action. Elle nécessite certaines précautions pour éviter les risques qui y sont liés.

5.3 Annex C: Information about Benin

Based on the 2002 census, the 2011 projected population of Benin is 9,067,076 with more than 1/3 of

the population (42.4%) living in urban areas. iiThe total surface area of Benin is 114,763 sq. km, and the

country is bordered by the Atlantic Ocean in the south, Togo in the west, Burkina Faso and Niger in the

north and Nigeria in the east. There are 12 Departments (Alibori, Atacora, Atlantique, Borgou, Collines,

Couffo, Donga, Littoral, Mono, Oueme, Plateau and Zou), and 77 communes, three of which have

particular status such as Cotonou, Porto-Novo and Parakou. The 77 communes are divided into 546

arrondissements and 3,743 villages. The population growth rate is 2.8 3percent (WHO, 2012 estimation).

The country has almost 10 ethnic groups. The Fon (46.2%), Adia (15.6%), Yourouba (12%), and Bariba

(8.6%) are the major ethnic groups. Other ethnic groups include Peulh, Betamaribe Yoa, Lokoa and

Dendi. Language barriers between health providers and patients are frequent in Benin, especially in

rural areas. For those rural people, the major barriers in accessing health facility is compounded by their

low level of education and income.

In 2008, there was an estimated one physician per 7,511 inhabitants, one nurse per 2,245 inhabitants,

one midwife per 1,345 women of child-bearing age, and a total of 343 laboratory technicians working in

Benin’s public health system. For the country as a whole, there are an estimated 442 arrondisement-

level health centers, 75 commune-level health centers, and 305 licensed private health facilities iii(HMIS,

2006). The private health sector consists of unlicensed traditional practitioners, private hospitals and

facilities, unlicensed health providers, and unlicensed drug vendors. Unauthorized health providers are

an important source of care for the poor. Although there is a slight improvement in health systems in

general, the country still lack of qualified health staff at the district level and their distribution is uneven.

The health system decentralization is still ongoing. The free Malaria treatment and free mosquitos nets

initiatives for pregnant women and children under 5 years was launched to scaling up of health

interventions and enhance access to health service. Unfortunately, many of the intended target of

these initiatives still don’t know that malaria treatment are free or charge for pregnant women and

children under five in Benin.

3 Source: WHO Country statistics, 2012


5.4 Annex D: ARM3 Results and Targets

RESULT 1: Implementation of malaria prevention programs in support of the National Malaria

Strategy improved.

Sub-Result 1.1 IPTp uptake increased.

ARM3 Target 1: Women who receive two or more doses of SP during the last pregnancy within the last

two years in intervention areas will be 85%

Sub-Result 1.2 Supply and use of LLINs increased.

ARM3 Target 1: Proportion of pregnant women who slept under an LLIN the previous night in

intervention area will reach 85%

ARM3 Target 2: Proportion of children under-five who slept under an LLIN the previous night in

intervention areas will reach 85%

ARM3 Target 3: Proportion of households with a pregnant women and/or children under five which own

at least one LLIN will reach more than 90 %

Sub-Result 1.2.1 Strengthen the current efforts for social marketing for LLINs.

RESULT 2: Malaria diagnosis and treatment activities in support of the national malaria strategy

improved

Sub-Result 2.1 Diagnostic capacity and use of diagnostic testing improved.

ARM3 Target 1: 85% of health centers will be able to perform RDT or microscopy.

ARM3 Target 2: 95% of patients (all ages) who tested positive (via microscopy or RDT) will receive an

effective anti-malarial.


ARM3 Target 3: Supervision is provided to at least 90% of health workers nationwide with malaria-

related responsibilities at least once every three months (this target is also applicable to Sub-result 2.2)

Sub-Result 2.1.1 Consortium’s role in policy formulation and in training of government and private

health facilities to improve malaria diagnostics.

Sub-Result 2.1.2 Consortium’s role in the design and implementation of enhanced supportive

supervision (OTSS) to government and private health facilities.

Sub-Result 2.2 Case management of uncomplicated and severe malaria improved.

ARM3 Target 1: Proportion of under-five children with fever in the past two weeks tested for malaria will

be 85%.

ARM3 Target 2: Proportion of under-five children with a positive result treated with ACT’s will be 85%.

RESULT 3: The national health system’s capacity to deliver and manage quality malaria

treatment and control interventions strengthened.

Sub-Result 3.1 National Malaria Control Program’s technical capacity to plan, design, manage, and

coordinate a comprehensive malaria control program enhanced.

ARM3 Target: The NMCP technical working groups (monitoring and evaluation, supply chain,

communication, and case management) are meeting regularly as planned.

Sub-Result 3.2 MoH capacity to collect, manage and use malaria health information for monitoring,

evaluation and surveillance improved.

ARM3 Target 1 The national Routine Malaria Information System and sentinel surveillance sites are

providing high-quality information on a regular and timely basis for decision-making.

Sub-Result 3.3 MOH capacity in commodities and supply chain management improved.

ARM3 Target 1: The national malaria commodity supply chain is functioning with a Logistics

Management Information System (LMIS) providing quarterly and annual reports.

ARM3 Target 2: 85% of PMI-supported health facilities report no stock-outs of malaria commodities in

the last three months.

ARM3 Target 3: Complete implementation of reforms initiated in CAME so as to improve governance and

transparency of its operations.


ARM3 Target 4: Results from the quarterly End-Use Verification Surveys are analyzed and used to identify

management and operational issues in the commodity supply chain system.

Sub-Result 3.3.1 Technical Assistance to CAME.

Sub-Result 3.3.2 Strengthening of the Health Zone’s malaria supply chain management.

Sub-Result 3.3.3 Strengthening of the Logistics Management Information System (LMIS).

Sub-Result 3.3.4 Support to End-User Verification Surveys.

i Evaluation finale du Projet d’Appuis à la Lutte contre le Paludisme par la méthode MIS. 2010

ii CIA World Factbook, 2012 iii Système National d’Information et de Gestion Sanitaires --Health Management Information System, 2006


5.5 Annex E: Malaria Safe Guide

preliminary benin arm3 behavior change … · including mass media activities, advocacy, and...

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