1. Prepared by:
Mr. Sajid Ali
District Behavior change communication coordinator
Merlin-Bannu
February, 2015
SOCIAL &BEHAVIOR CHANGE COMMUNICATION
STRATEGYFORMERLIN-BANNUPROGRAM

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CONTENTS
INTRODUCTION.............................................................................................................................................3
BRIEF OVERVIEW OF HEALTH SITUATION.....................................................................................................4
MAIN OBSTACLES AT COMMUNITY LEVEL..................................................................................................10
COMMON BARRIERS TO BEHAVIOR CHANGE.............................................................................................10
ANALYSIS OF TARGET AUDIENCES ..............................................................................................................12
TARGET AUDIENCE FOR BEHAVIOR CHANGE..............................................................................................12
KEY COMMUNICATION STRATEGIES FOR EACH PRIORITY BEHAVIOR........................................................14
MASS MEDIA MATERIALS............................................................................................................................16
PRINT MATERIAL.........................................................................................................................................16
SOCIAL AND BEHAVIOR CHANGE COMMUNICATION STRATEGY ...............................................................16
MONITORING & EVALUATION ....................................................................................................................16
REFERENCES AND RESOURCES....................................................................................................................18

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INTRODUCTION
The Pak Army enduringskirmishagainst terrorism in North Waziristan Agency banisheda
hefty portion of local population from their inborn homes and forced them to either reside
in Bakakhel IDP Camp or live in hosting UCs of District Bannu, hencethwartingthe provision
of health care services.Merlin is currently retorting to North Waziristan Agency IDPs via an
assimilated approach by supporting primary health care, nutrition and WASH amenities at
the health facilities and community level through 16 static BHUs and one health facility in
consultation with Khyber Pakhtunkhwa Healthcare (KPH) and Department of Health (DoH)
Bannu. Merlin has been providing services in sixteen static BHUs at district Bannu in alliance
with DSU- PPHI Bannu, DHO-office Bannu, ECHO, DoH KPK, WFP, WHO and UNICEF.As per
anticipated plan Merlin will providing life saving, emergency health, nutrition and WASH
services to the conflict affected internally displaced population living with host
communities at district Bannu from October, 2014 to March, 2015.
The project will servethe below aims and objectives during the above 6 months period:
1. To prevent/reduce excess morbidities and mortalities through provision of life
saving emergency health, nutrition and WASH services by supporting the public
health care system of district Bannu hosting the bulk of the NWA IDPs.
2. Quality CMAM services are obtainable to IDPs and Host communities through 08
static health facilities for the timely identification and treatment of acute
malnourished children and PLW.
3. Access to safe drinking water, safe sanitation and hygiene improved for the target
population.
The purpose of this document is to place out foundational elements of Merlin’s emergency
response to NWA IDPs social and behavior change communication (SBCC) strategy to catalyze
demand generation around PHC, nutrition services and behaviors. Merlin SBCC efforts will be
accorded with supply side efforts to expand access to services and to train and equip service
providers (Govt. staff) in order to meet increased demand for PHC and nutrition services at
District Bannu. With these links, women and families in the target communities will be
encouraged and more likely to respond positively to health communication messages.
Merlin SBCC strategy aims to change key approaches, rehearses and social norms among target
communities. Knowledge-practice and coverage profile of priority maternal & child lifecycle
survey and WASH interventions (conducted by Merlin through consultant at the month of
December, 2014) informed the strategy development process, as well as a review of previous
SBCC experience in FATA and KP, and recent data from the Pakistan Demographic Health Survey
(PDHS) (2012-2013) were also used as base line data for the document.Effective social behavior
change communication (SBCC) is essential to arm the public with tools and knowledge forapt
response to health related issues and malnutrition. It is therefore imperative to ensure that the
Merlin program has an effective communication strategy at Bannu that will not only guide the
implementing team in their daily interactions with the communities but to concoct them for
effective engagement of target communities for promotion of sustainable social behavior
change at the target area.

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High impact behavior change communication catalyzes behavior change, it galvanizes
communities into action provoking them to espouse healthy lifestyles by captivating the
necessary changes and processes to prevent diseases or practices leading to the birth of
diseases e.g. adopting a regular hand washing with soap behavior, disposing feaces safely or
using a latrine, handling and drinking safe water, consulting doctor on the onset of defined
diseases signs, exclusive breast feeding to protect the new born from complications and
malnutrition and many more.
To have an impact, the Merlin SBCC strategy content will be appropriate and should follow the
criteria below.
Accuracy Message should be valid without errors of judgment, there should be
no room for misinterpretation
Availability Should be available where the targeted audience can access it whether
visually or audio. This can vary from place to place e.g. messages can
be placed in health centers, on billboards, public kiosks and schools etc.
Balance Only where appropriate, provide the risks and benefits of the actions
you are promoting e.g. using a latrine will keep the women in your
household safe from harassment, save you money through disease
prevention and will bring dignity to your household. Risk –
harassment, disease: Benefits: economic, dignity, reduced burden of
disease.
Consistency Messages should remain consistent over time. Other sources of
information also giving the same message. Where messages of similar
subjects are not standardized, the risk of inconsistency is high.
Culturally
appropriate
Important to understand the culture of the target population;
language, behavior etc.
Evidence based Research provides the evidence to make messages credible.
Reach Should reach as many people as possible
Reliable The source of the content should be credible and content should be
kept up to date. Use the most credible sources of information in the
target area.
Repetition Repeat message over time to reinforce the impact and reach new
people
BRIEF OVERVIEW OF HEALTH SITUATION AT KP/FATA
Pakistan’s National Health Policy 2009 seeks to improve health by delivering a set of basic
health services for all, improving health manpower, gathering and using reliable health
information to guide program effectiveness, and by designing and using strategically emerging
technologies. It also aims to improve health by achieving policy objectives of enhancing
coverage and access of essential health services, measurable reduction in the burden of
diseases and protecting the poor and under privileged population against risk factors. However,
key maternal, newborn and child health indicators for FATA and KP show this task may prove

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extremely challenging. Spread over seven tribal agencies and six tribal areas known as Frontier
Regions, FATA has witnessed turmoil and instability over the last three decades, severely
disrupting the delivery of public health, education, water and sanitation services. In KP, the
health sector also faces multiple challenges due to instability in law and order, capacity
constraints, budgetary issues, and a host of communicable and non-communicable diseases.
Fertility & Family Planning
The most recent PDHS (2012-2013) reports a total fertility rate (TFR) of 3.8 children per woman
for the three-year period preceding the survey. Fertility is considerably higher in rural areas (4.2
births per woman) than in urban areas (3.2 births per woman). The estimated TFR in the 2006-
2007 PDHS was 4.1 children, and thus the decrease in the TFR over the past six years is only 0.3
births. The continuing disparity in fertility between urban and rural women is most likely due to
factors related to urbanization, such as better education, higher status of women, better access
to health and family planning information and services, and later marriage. On the whole, peak
fertility occurs between the ages of 25 and 29, a pattern evident in rural areas as well as urban
areas. The contraceptive prevalence rate (CPR) is usually defined as the percentage of currently
married women who are using a method of contraception. Thirty-five percent of currently
married Pakistani women are using some method of contraception; 26% use modern methods,
and 9% use traditionalmethods (PDHS 2012-2013). Of the modern methods, condoms and
female sterilization are used most often (9% each). Among traditional methods, withdrawal is
the most popular, used by 9% of currently married women. Use of withdrawal more than
doubled from 4% in 2006-2007 to 9% in 2012-2013. KP has a CPR of 28.1% for all methods, of
which 8.1% reported using withdrawal. Total unmet need for family planning in KP is 25.5%
(16.5% for limiting, 9% for spacing), which is higher than the national figure of 20% due to
higher unmet need for limiting versus spacing. The highest unmet need for family planning is in
rural KP, where unmet need for limiting exceeds 17% (PDHS 2012-2013). Although knowledge
of family planning methods is high, 63% of Women of Reproductive Age in rural KP have never
visited an outlet that provides FP services. More than 71% of rural KP women cited a lack of
need to visit the center as the reason why they have not visited. An underlying reason for high
fertility rates in KP and FATA is son preference. Gender discrimination and gender inequities
deeply impact all aspects of health.
Maternal Health
Nationally, a little over half (52%) of births take place with the assistance of a skilled health
provider (doctor, nurse, midwife, or Lady Health Visitor (LHV)). Traditional birth attendants
(TBA) assist with less than half (41%) of all deliveries, while friends and relatives assist with 6%
of deliveries. Less than 1% of births are delivered with no assistance. Skilled health providers
are more likely to deliver births to women less than age 20 and first-order births (55% and 68%,
respectively) than to deliver births to older women (age 35-49) and higher order births (44%
and 36%, respectively). Births in urban areas are much more likely to be assisted by a skilled
health provider (71%) than births in rural areas (44%). PDHS 2012-2013 data on deliveries
shows that overall 48.3% of deliveries are assisted by a skilled provider. However, the most
frequently reported assistant at delivery for rural women in KP was a relative (29%).

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Additionally, women in rural KP reported delivery with a doctor (26.6%), nurse midwife/LHV
(17.5%), or traditional birth attendant (24.2%).
Child health and nutrition
Key findings from the PDHS 2012-2013 related to child health and nutrition include:
• A slow improvement in the percentage of fully immunized children age 12-23 months, from
47% in 2006-2007 to 54% in 2012-2013. For KP the percentage is 52.7%.
• Sixteen percent of children under age five showed symptoms of acute respiratory infection
(ARI) in the two weeks before the survey; 64% of these children were taken to a health facility
or care provider for advice or treatment, and 42% received antibiotics. KP had the highest
proportion of children under five who showed ARI symptoms in the past two weeks (23.4%),
but only 29% of these children were taken to a health facility or care provider for treatment.
• Nationally about 38% of children under age five had a fever in the two weeks before the
survey, and 65% of them were taken to a health facility or care provider for advice or
treatment. Again, KP had the highest proportion of children with fever in the past 2 weeks
(44.4%) and the lowest rate of care-seeking (only 6.5%).
• Twenty-three percent of children under age five in KP had diarrhea in the two weeks before
the survey.
• The proportion of children with diarrhea taken to a health care provider for advice or
treatment has increased substantially over the previous decade, from 48% in 1990-1991 to 61%
in 2012-2013. The proportion taken for advice or treatment in KP was much lower than all
other provinces at 23%.
• The use of oral rehydration solution (ORS) among children with diarrhea is not popular; only
38% of children who had diarrhea in the two weeks preceding the survey received ORS.
• Forty-five percent of children under age five are stunted, 11% are wasted, and 30% are
underweight. In KP, the proportion of stunted children is 42%.
• Thirty-eight percent of children less than six months of age are exclusively breastfed. The
median duration of exclusive breastfeeding is less than one month. KP has the highest median
duration of exclusive breastfeeding at 3.3 months, with predominant breastfeeding through 4.9
months.
• Overall, only 15% of children ages 6-23 months are fed appropriately based on recommended
infant and young child feeding (IYCF) practices.
• Fourteen percent of women are undernourished (BMI <18.5), and 40% are overweight or
obese (BMI ≥25.0)
Situation at Bannu
The above situational analysis of FATA/KP health situation are more likely the situation at
distirct bannu and is generalized to suplement Merlin SBCC strategy for Bannu. As per
Merlin conducted survey of Knowledge-practice and coverage profile of priority maternal &
child lifecycle survey and WASH interventions (conducted by Merlin through consultant

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atthe month of December, 2014) following are the main findings (selective) regarding
knowledge, practice and coverage prevailing at the area. Table.1.
0% 20% 40% 60%
Maternal knowledge of correct effects for receiving TT
vaccination
Maternal knowledge of child spacing between two
pregnancies (two years or more)
Maternal knowledge of two or more risks associated with
frequent pregnancies
Maternal knowledge of two or more methods of modern
contraceptives
Maternal knowledge of Exclusive breast feeding
Maternal knowledge of the correct number of vaccination
sessions required to fully immunized a child
Maternal knowledge of two or more valid danger signs in a
sick child suffering from ARI
Maternal knowledge of at least three critical moments of
hand washing with soap
Maternal knowledge of two or more hazards associated
with open defecation
Maternal knowledge of two or more risks associated with
taking unsafe water
26%
48%
35%
60%
38%
12%
60%
43%
44%
54%
BANNU DISTRICT PROFILE OF HEALTH/NUTRITION AND WASH
(Knowledge level)

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0% 10% 20% 30% 40% 50% 60% 70%
First Bath of the New-born: Percentage of children 0-23
months that were bathed after 2nd day of birth
Eye Care: Percentage of children 0-23 months who were
given eye ointments or drops within first hour after birth
Immediate breastfeeding of new-borns: Percentage of new-
borns who were put to the breast within one hour of
delivery
Exclusive breastfeeding: Percentage of children age 0-5
months who were exclusively given breast milk the day
prior to the interview
Increased fluid intake during diarrheal episode: Percentage
of children age 0-23 months with diarrhoea in the last two
weeks who were offered more fluids during the illness
Increased breastfeeding during diarrheal episode:
Percentage of children age 0-23 months with diarrhoea in
the last two weeks who were offered more breastfeed
during the illness
Increased feeding during diarrheal episode: Percentage of
children age 0-23 months with diarrhoea in the last two
weeks who were offered more food during the illness
Drinking water treatment: Proportion of HHs who used a
water treatment method to make water safer to drink
65%
26%
37%
15%
31%
26%
21%
45%
BANNU DISTRICT PROFILE OF HEALTH/NUTRITION AND WASH (Practices)

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0% 5% 10% 15% 20% 25% 30% 35% 40%
ANC4 Coverage (Covering All Aspects of Birth Preparedness):
Percentage of mothers of children age 0-23 months who had four or
more antenatal visits when they were pregnant with the youngest…
Maternal TT Vaccination: Tetanus toxoid coverage based on card and
recall (two or more doses)
Post-natal visit to check on mother health within 42 days: Percentage
of two or more PPC visits within 42 days of delivery by trained
attendant
Vitamin A Coverage for Mothers After Delivery: Percentage of
mothers receiving Vitamin A after delivery
Active Management of the third stage of labour: Percentage of
mothers of children age 0-23 months who received injection in the
arm during the birth of her youngest child to prevent bleeding
Current Contraceptive Use Among Mothers of Young Children:
Percentage of mothers of children age 0-23 months who are using a
modern contraceptive method
Child Screening for Malnutrition: Percentage of children aged 6-23
months who were screened for malnutrition in the last 6 months at
the time of survey
Deworming: Percentage of children age 6-23 months who were
screened for intestinal worms infestation and given de-worming
treatment
Vitamin A Coverage for Children: Percentage of children age 6-23
months who were given Vitamin A in the last 6 months
Fully Immunization Coverage: Percentage of children aged 12-23
months who received measles along with all other vaccines according
to the vaccination card or mother’s recall by the time of the survey…
Access to immunization services: Percentage of children aged 3-23
months who received Pentavalent1 according to the vaccination card
or mother’s recall by the time of the survey
Health System Performance regarding Immunization services:
Percentage of children age 6-23 months who received Pentavalent3
according to the vaccination card or mother’s recall by the time of…
Therapeutic Zinc: Percentage of children age 0-23 months with
diarrhoea in the last two weeks who were treated with zinc
supplements
21%
26%
19%
22%
40%
26%
2%
35%
26%
13%
28%
40%
33%
33%
BANNU DISTRICT PROFILE OF HEALTH/NUTRITION AND WASH (Coverage)

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MAIN OBSTACLES AT COMMUNITY LEVEL
1.2.1. Family Roles and Communication
Elder family members are responsible for taking care of health issues. People generally visit the
hospital or the nearest health center for consultation and check-up. After marriage, women are
dependent on their husbands and mothers-in-law for assistance with visiting the health
facilities. Doctors and Lady Health Workers (LHW) advising them during pregnancy to take
proper care and avoid any hard physical work. Husbands and mothers-in-law also recognized
the need for additional rest during pregnancy.
1.2.2. Role of Lady Health Workers
At some areas of District Bannu especially at remote areas LHWs/LHVs only visit their
communities during polio of other campaigns contributing to low health profiles of that
area due to unavailability of early treatment and advice/guidance through qualified health
staff at their door step.
1.2.3. Sources of Health/hygiene information
For women, mothers-in-law appear to be a main source of information, followed by LHWs
and midwives. Mothers and married elder sisters were also the source of information about
health and pregnancy. Lack of access to main communication channels is an obstacle at the
area.
1.2.4. Role of nearest health facilities
At some villages people are unaware from the existence or functionality of nearest health
facility. As per fallouts of FGDs conducted by Merlin at the month of December, 2014 most
of the people at community are unaware of the existence or fucntionality of their nearest
BHU.Because during their last visit either the doctor was not availabe or their were no
medicines at the BHU, so still they are with the concept to avoid visiting their or going to
Bannu city for availing health services and treatment.
1.2.5. Low literacy rate/religious minds and lack of access to basic communication
channels
Low literacy rate and religious thoughts like Pardah/veil is one of the major factors creating
gap between community and health facilities. Jirga system is the main and highly respected
group in making major decisions and ethical norms of the area does not allow females to
visit health facility and consult male doctor when female medical officers are not appointed
there or on leave.
COMMON BARRIERS TO BEHAVIOR CHANGE
1.3.1 Socio-Cultural Barriers
 Gender discrimination as women had less access to information sources.
 Norms of early child bearing/early; in case of change it is strongly resisted.

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 Norms around newborn care due to low level of education
 Norms around dietary patterns mostly religious.
1.3.2. Access Barriers
 Lack of regular outreach services at village level especially at remote villages.
 Health provider attitude and low motivation levels due to low salaries of hiring of
untrained and unprofessional staff.
 Lack of trust on staff for their presence in public sector facilities
 Lack of emergency transport, especially at night due to security threats and remoteness of
the areas.
 Low mobility of women (must be accompanied by a male or female family members and in
absence of company they must to wait and sometimes that delay is proved detrimental).
1.3.3. Socio-Economic and Infrastructure Barriers
 No funds for transport and for medicinesdue to poor economic status
 Households located in insecure areas or indulged in enmity with other families at villages.
 Lack of female health services providers due to security reasons, unacceptability or some
other reasons.
1.3.4. Lack of Strategic Behavior Change Communication Services
 Too much focus on generalized/traditional awareness creation leading communities to
boredom and the activities are just served as formality for donor agencies.
 Low literacy levels, especially among women and community elders who are the decision
makers of family.
 Low penetration of community-based SBCC (Interpersonal communication [IPC], group
meetings, community events) due to human resource shortages/gaps (e.g. no LHWs in
some areas)
 Uncoordinated, poor quality mass media campaigns leading to bad image of campaigns
hence the areas are no more to be touched for even effective campaigns.

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 Limited BCC design and planning skills within KP and Pakistan.
ANALYSIS OF TARGET AUDIENCES
As per field staff feedback; the target communities are of diverse nature from open minded
and well educated to illiterate, conservative and religious minds with zero tolerance for
NGOs at some areas. At some villages like Gul Akram Merlin field staff was even pushed
back from houses by not allowing them for screening of children and conducting awareness
sessions with their females. The main reason behind the position is lack of education,
misunderstanding about NGOs and myths of religious minds at the area. While in areas
where education level is high and NGOs have good acceptability the problem is attributed
by low level of income and remoteness of the village. At some areas Government structures
are just exists by name where no medical or less medical staff is present with no medicines
leading to lack of trust of community on Govt. structures.
TARGET AUDIENCE FOR BEHAVIOR CHANGE
1.1.1. Staff capacity building
This aspect of programming cannot be over emphasized, only a competent team will
result to improved program quality. Merlin and PPHI Staff capacities will be raised
up to level forgaining the trust of public over health staff and facilities with no
spacefor misconception of staff about their roles and responsibilities with technical
strength during their day to day field activities. Staff capacities will be raised and the
process will be continue throughout the project life at Bannu.
1.1.2. Govt. stakeholders
Options to overcome these challenges
1. Mother tongue should be used in health communication and hygiene promotion
2. Audience knowledge should be assessed before developing communication
interventions.
3. The person (staff) responsible for communication should know the cultural and
traditional values and be well-trained in communication skills.
4. Programs should work with Govt. departments, influential community members
and religious scholars/Ulema.
5. Mass media campaigns and PSAs should be used.
6. Effective awareness sessions/campaigns/communication through well trained and
dedicated staff with maximum coverage.
7. The point of making communities as partners instead of recipients to be addressed
at designing stages of programs.

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Merlin will synergistically with Government health departments and other
organizations working on health at the same area to mitigate security risks and gain
public confidence and acceptability of religious people at the area. It will contribute
to reach maximum coverage with effective implementation in the absence of
threats.
1.1.3. Target audience in community
Keeping in mind the social set ups of the area a husband is a strong influencer for
most household-level decisions and he is a gatekeeper for information in the
household. He has sanction power if he wishes to make a decision about his wife
and children. However, childbirth and pregnancy are considered to be women’s
affairs and a husband who is perceived as overly involved in pregnancy and
childbirth may be perceived as “unmanly” in the community. Thus, men are
constrained in knowing much about PHC and pregnancy because of social taboos;
greater use of contraception and better reproductive health could potentially be
achieved if men faced less social barriers to this type of knowledge.
Mothers-in-law:The mother-in-law is the decision-maker for all MNCH/PHC and
nutrition related issues as she is more experienced and is considered as the most
senior in the family (culturally). She is the gatekeeper for women to access health
services. Her key decision-making criteria are: personal childbearing experience
(when the health services were less advanced or as easily available) and tradition
(her desire to project herself and her daughters-in-law as respectful of traditions,
culture and age-old practices). Even among those who have information regarding
the health services and advantages thereof, there is a hesitation to change the
practice. Mother in law is the key person can instruct to her to breast feed her
young baby sometimes the mothers in law and other females ate home advising her
for Gudka feeding by convincing her in the light of different myths and traditions.
Women of reproductive age:Overall, female adolescents and women are in much
greater need of information regarding their dietary needs, reproductive health and
ways to access healthcare, particularly in light of the finding that boys have more
knowledge than girls about puberty, pregnancy, family planning and sexually
transmitted diseases. The pregnant woman is often aware that she can access the
health center for better care, treatment and advice. However, if the mother-in-law
disapproves, the pregnant woman may not insist. This is so because her relationship
with her husband and her position with her mother-in- law are often her most
important relationships. She does not share minor health complaints with her
family. She would seek care for herself at a health facility, but she likely does not
want to go alone, she might have difficulty managing transportation for the long
distance, and she may have no money to pay for treatment or medicines. Getting
permission for the trip may also be a problem, but it is less often mentioned than
the others. Apart from this her nutritional needs may be addressed only if her family
members are known to her nutritional needs during pregnancy.
Community leaders: Community leaders play a vital role in improving MNCH
behaviors and practices in Pakistan. As respected bearers of advice, information and
skills, they are role models for others. When strong local leaders are identified and

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empowered with accurate information, skills and resources, these leaders act as
catalysts to improve health outcomes in their village, union council or district.
Ulema (i.e., religious leaders): The traditional religious institutions of mosques and
ulema, or religious leaders, have a strong influence in Pakistan. They play an
important daily role in the lives of a majority of the population who refer to religious
leaders for guidance on various issues, including factors concerning their health and
well-being. In remote areas, the mosque is sometimes the only medium of
communication with the communities. Ulema and mosques have played a
significant role in the success of polio campaigns in the past by supporting the
immunization teams and can be leaders on MNCH issues as well.
KEY COMMUNICATION STRATEGIES FOR EACH PRIORITY BEHAVIOR
Channel and
Message Strategies:
Priority Behavior
Target Audience Core Message Communication Channel
4 ANC visits during Pregnant women Four ANC checkups
starting from one in
1st,
IPC with LHW
pregnancy Mothers-in-law
Husbands
one in 2nd and two
in 3rd trimester
Group counseling
session/Support Groups
Mass media
Seeking care during
complication in
pregnancy
Pregnant women
Mothers-in-law
Husbands
Danger signs and
specific action to be
taken if any one of
these appear should
be conveyed
IPC with LHW
Group counseling session
Mass media
Seeking care if
complications
appear during
delivery
Birth attendant
Mothers-in-law
Husbands
3 danger signs
during labor and
specific actions to
be taken if any of
these appears
Training for LHWs/LHVs
IPC with LHW
Group counseling session (SGs)
Mass media
Skilled birth
attendance
Mothers-in-law
Husbands
Birth should be
assisted by Doctor,
nurse, midwife, LHV,
or CMW
IPC
Group counseling session (SG)
Mass media
Bathing of baby
after no sooner
than 24 hours after
birth
Birth attendant
Mothers-in-law
Delayed bathing is
advised to avoid
hypothermia and
keep the protection
of vernix intact
IPC
Group counseling session (SG)
Mass media
Exclusive
breastfeeding for
six months
Mothers
Mothers-in-law
Families should
know that even
water deprives the
IPC
Group counseling session

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child from
advantages of
breastfeeding
Preparation of
complementary
food
Pregnant women
Mother in law
Families should
know how to
prepare
complementary
food at home from
local materials
Cooking demonstration
IYCF sessions
Danger signs in the
newborn
Mothers
Fathers
Mothers-in-law
Family should know
and be able to
recognize 5 danger
signs in the neonate
and know where
specifically to go for
care
IPC
Group counseling session
Healthy timing and
spacing of
pregnancies and
births
Husbands
Mothers
Mothers-in-law
Optimal birth
spacing should be
known to couples
IPC
Group counseling session
Infant and Young
Child Feeding
Practices
Mothers
Mothers-in-law
Additional food to
be given to babies
after six months,
including frequency
and variety, as well
as continued
breastfeeding
IPC
Group counseling session
Hand washing with
soap after
attending toilet
Children
Mothers
Hand must be
washed before and
after attending the
bath room to avoid
illness
Group counseling sessions
IEC materials
IPC
Critical hand
washing timings
Children
Pregnant women
Aged persons
Critical hand
washing times may
be known to them
IEC materials
Awareness sessions
IPC
Proper use of
latrine
Children
Pregnant women
Elders
Use of proper
latrine to avoid
open defecation
IEC materials
Awareness sessions
IPC
Personal &
environmental
hygiene
Children
All family members
They must know
about personal and
environmental
hygiene and its
importance
IEC materials
Hygiene promotion session

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MASS MEDIA MATERIALS
Merlin will adopt and print counseling cards for LHWs/BFCs/IYCF supervisors to be used for
group and individual counseling during household visits and group counseling sessions.
In addition, Merlin will design and print posters containing key messages regarding
PHC/Nutrition and WASH and will disseminate to C.O.S/C.OW/H.P for display at various health
facilities for general public awareness.
PRINT MATERIAL
• Pictorial flip charts containing priority behaviors on PHC/Nutrition and hygiene.
• Pictorial pamphlets containing priority messages for broader dissemination at community
level
• Posters containing key behaviors and messages on PHC/Nutrition and hygiene promotion.
SOCIAL AND BEHAVIOR CHANGE COMMUNICATION STRATEGY FRAMEWORK
MONITORING & EVALUATION
Merlin’s routine monitoring system will ensure that all activities are implemented on a regular
basis as planned and at the desired quality standard. There will be a three tier system for
monitoring community-based interventions. Community outreach supervisor/IYCF supervisor
will randomly monitor group counseling sessions conducted by LHVs/COWs/BFCs and Health
promoters in their catchment population using a checklist. Each month DBCC/DNC/PMC will
review COS records to determine the total number of sessions that have conducted in the
coverage population, the number of attendees at each session and CHCs meeting
(disaggregated by sex). Merlin field-based other staff will also report on these activities
Key SBCC
Inputs
• Project and PPHI staff capacity building
• Preparation and dessimination of IEC materials on key messages
• Community awareness through awareness sessions/IPC and group counseling
• Formatiom and training of mothers support groups and Community health committees
Initial
outcome
• Presence of skilled staff at BHUs
• Mass awarness in target communities
• Rebuilding of public trust on existing health structures
• Basic knowledge about common illness signs, malnutrition, WASH and clarification for
how and where to consult or adapt behaviors to mitigate or avoid the problem.
Sustainable
results
• Decrease in morbidity and mortility rates at the area
• Provision of counseling to communities by mother support groups and CHCs for long time
• Availability of quality health services through well trained PPHI/DoH staff for long time.

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monthly. The management staff will also occasionally conduct un-announced spot checks to
observe and provide feedback on these activities.

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REFERENCES AND RESOURCES
 Social and Behavior Change Communication Strategy for USAID FATA-KP Health
Program, Save the Children March 2014.
 Health communication strategies by Unite for Sight, available at
http://www.uniteforsight.org/health-communication-course/module1#_ftn4
 Developing behavior change communication interventions for population, health and
environment projects. Available at
https://www.k4health.org/sites/default/files/PHE%20IEC%20workshop_Facilitators%20
Guide_508.pdf
 Introducing participatory approaches, methods and tools by FAO, available at
http://www.fao.org/docrep/006/ad424e/ad424e03.htm
 Behaviour change communication in emergencies by UNICEF, available at
http://www.unicef.org/ceecis/BCC_full_pdf.pdf
 FGD survey conducted by Merlin at Bannu onDecember 3, 2014.
 KNOWLEDGE-PRACTICE-COVERAGE PROFILE OF PRIORITY MATERNAL & CHILD
LIFECYCLE and WASH INTERVENTIONS, December, 2014.