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Final APR communicaiton strategy master copy (002)

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INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION
STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’
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Integrated A...
INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION
STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’
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INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION
STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’
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Final APR communicaiton strategy master copy (002)

  1. 1. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 1 Integrated Advocacy, Social Mobilization and Communication Strategy & Action Plan for ‘A Promise Renewed’ Led by - Sheeba Afghani, Communication for Development (C4D) Specialist Supported by – Miriam Lwanga Communication for Development (C4D) Officer
  2. 2. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 2 Contents Executive Summary.................................................................................................................................4 List of Acronym .......................................................................................................................................5 Key terms ................................................................................................................................................6 CHAPTER I................................................................................................................................................7 INTRODUCTION, RATIONALE AND PROCESS...............................................................................................7 1.1 Background:..........................................................................................................................................7 1.2. Rationale for Communication framework and structure......................................................................8 1.3. Development process..........................................................................................................................9 CHAPTER II ............................................................................................................................................10 OVERALL FRAMEWORK FOR THE INTEGRATED STRATEGY.....................................................................10 2.1 Communication Framework................................................................................................................10 2.2. The Package:.....................................................................................................................................10 2.3. Communication Goal, objectives (Roadmap Materanal & Neonatal Mortality & Morbidity).............11 2.4. Target audience and behavioral analysis..........................................................................................12 Chapter III..............................................................................................................................................18 STRATEGIC COMMUNICATION INTERVENTIONS.......................................................................................18 3.1. Communication Strategies.................................................................................................................18 3.2. Behavior Change Communication (BCC)..........................................................................................18 3.3. Social mobilization with specific focus on the hard to reach............................................................20 3.4. Advocacy:..........................................................................................................................................22 Chapter IV .............................................................................................................................................24 SPECIAL STRATEGIES - MALE INVOLVEMENT, HEALHT WORKERS MOTIVATION, HARD TO REACH...24 4.1. Male Involvement...............................................................................................................................24 4.2. Health Workers Motivation.................................................................................................................26 4.2. Specific activities for Hard to reach:..................................................................................................27 4.3. Collaboration and Networking: ..........................................................................................................28 CHAPTER V ............................................................................................................................................29
  3. 3. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 3 TRAINING AND CAPACITY BUILDING..........................................................................................................29 5.1. Training and capacity building;.........................................................................................................29 5.2. Training of Trainers (TOT):.................................................................................................................29 5.3. Training of District Health Management Teams (District Health Educator, District Health Inspector and District Health Visitor):........................................................................................................................29 5.4. VHTs, LC1s, Chiefs, religious leaders, teachers, TBAs and health assistants:................................29 Appendices............................................................................................................................................35 Annex 1: INTEGRATED ACTION PLAN 2014-2015.......................................................................................35 Annex 1: Stages of Behavir change...............................................................................................................42 Annex 2: Social ecological model..................................................................................................................43 Annex 5: Matrix for assessing Demand side barriers (adapted)...................................................................44
  4. 4. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 4 Executive Summary The integrated Advocacy, Social Mobilization and Communication Plan aims to support the new priorities highlighted in the ‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health Sharpened Plan For Uganda (2013)’ and other priorities outlined in ‘Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’ and ‘National Child Survival Strategy (2009 -2015).’ The communication strategy takes an integrated approach to maternal and child health and focuses on the critical time period on the continuum of care, consistent with the priorities underlined in the Sharpened Plan. Building on the ‘Stages of Change’ and ‘Social Ecological Model for Behavioral Change’, the Strategy gives clear strategic direction on achieving key behavioral objectives. Although formative research has not yet been conducted, target audiences and barriers have been identified after a comprehensive research of secondary sources and the best practices documented in various toolkits developed by partners. The behavioral analysis and the resulting behavioral objectives are presented for key target audiences; Primary, Secondary and Tertiary. This analysis gives a robust way forward on priority strategies, activities and messages to reach main stakeholder groups for RMNCH. The ‘Strategy’ also aims to optimize the use of innovations in communication technologies like mtrac, VRS, edutrac, in support of RMNCH, with specific focus on real time data collection and utilization for monitoring purposes. The key strategies include behavior change communication, social mobilization and Advocacy. The strategy also prioritizes male involvement and health workers motivation as key strategies to improve RMNCH outcomes. Gender transformative and gender sensitive communication approaches are envisaged to improve adoption of key behaviors among the target audiences. The roll out of this integrated communication strategy will also entail a robust capacity building and training component with specific focus on building capacity at the district and community levels.
  5. 5. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 5 List of Acronym ANC Antenatal Care APR BCC C4D A Promised Renewed Behavior Change Communication Communication for Development DHT District Health Team DMHT District Management Health Team HMIS Health Management Information System EPI Expanded Programme on Immunization FBO Faith Based Organizations IEC IMR Information Education and Communication Infant Mortality Rate IPC Interpersonal communication MDG Millennium Development Goals MMR Maternal Mortality Ratio MOH Ministry of Health M&E Monitoring and Evaluation MCH Maternal and Child Health PSA Public Service Announcement RNMCH SM Reproductive New-born Maternal Child Health Social Mobilization UDHS Uganda Demographic Health Survey VHT Village Health Team WASH Water Sanitation And Hygiene
  6. 6. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 6 Key terms 1.1. Communication for Development: refers to a planned, evidence-based strategic process for promoting positive and measurable individual behavior and social change that is an integral part of development programmes, policy, advocacy and humanitarian work. This process is crucial for social transformation and operates through three main strategies namely; advocacy for raising resources, political and social leadership commitment, social mobilization for wider participation and ownership and programme communication for bringing about changes in knowledge, attitudes and practices among specific participants in programmes (UNICEF, 2001). 1.2. Programme Communication/ Behavior Change Communications (BCC): Is designed to achieve measurable objectives. It shifts the emphasis from making people aware to bringing about new attitudes and practices. It is a process that uses various strategies, communication processes, and media to persuade people to increase their knowledge and change risky behavior (UNICEF, 1999b). It uses an appropriate mix of interpersonal, group and mass media channels including participatory methods. 1.3. Community Mobilization: Uses deliberate participatory processes to involve local institutions, local leaders, community groups, and members of the community to organize for collective action toward a common purpose (CEDPA,2000). 1.4. Social Mobilization: Aims to muster national and local support for a general goal or programme, in order to create an enabling environment and effect positive behavior and social change (Mckee, 1992). It also refers to a process of bringing together all feasible intersectoral social partners and allies to identify needs and raise awareness of, and demand for, a particular development objective. It involves enlisting the participation of such actors (including institutions, groups, networks and communities) in identifying, raising and managing human and material resources, thereby increasing and strengthening self-reliance and sustainability of achievements made. (UNICEF, 1992). 1.5. Advocacy: Is a process that involves a series of actions conducted by organized citizens in order to transform power relations. The purpose of advocacy is to achieve specific policy changes, or allocation of resources that benefit the population involved in the process (CEDPA, 2000 ). 1.6. Empowerment: is a process of facilitating and enabling people to acquire skills, knowledge and confidence to make responsible choices and implement them.(UNICEF, 1992)
  7. 7. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 7 CHAPTER I INTRODUCTION, RATIONALE AND PROCESS 1.1 Background: As the global community rolls out action plans to improve maternal, newborn and child survival, Uganda has developed its own strategy entitled ‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health Sharpened Plan for Uganda (2013)’. The ‘Sharpened plan’ is not meant to replace the existing ‘Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’ or the ‘National Child Survival Strategy (2009 -2015)’ but to catalyze them. The Sharpened Plan has identified five strategic shifts to avoid business as usual; 1. Focus Geographically 2. High burden populations 3. High impact solutions 4. Education Empowerment, Economy, Environment and 5. Mutual accountability. The Sharpened Plan places a strong emphasis on accountability and monitoring mechanisms and partnerships for social mobilization. Over the past 15 years Uganda has made modest progress in improving health and development indicators. However, maternal and infant mortality and morbidity remain unacceptably high and as a result Uganda is not on track to achieve MGD 4&5. Nationally, maternal mortality is estimated at 438 deaths per 100,000 live births. This MMR translates to 6000 women dying every year from pregnancy related causes. Uganda’s under- five mortality also remains high at 90, while it’s infant and newborn mortality 54 and 27 deaths per 1,000 live births, respectively (UDHS 2011). Therefore, Uganda’s maternal mortality ratio (MMR) and under five mortality rate still remains well off track the MDG 5 and MDG 4 targets of 131 deaths per 100,000 live births and 56 deaths per 1,000 live births respectively by 2015. Key challenges experienced in the health system and barriers to Uganda’s path to achieving the MDGs include inadequate skilled birth attendants which leaves many pregnant women dying at home due to lack of access to health care, prompt decision making, difficulties in transportation and lack of emergency obstetric care services at the referral level. Other key challenges in maternal, newborn and child health include lack of health personnel, poor health service delivery, low VHT (Village Health Team) coverage, as well as frequent stock out of essential drugs in remote and difficult to reach areas. On the demand side several barriers exist to the utilization of RMNCH service. Women often lack knowledge and decision making power to avail critical
  8. 8. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 8 RMNCH services before during and after delivery. Women who may face complications often are not part of the decision regarding the potential course of action1. In addition, several religious and cultural practices exist in many parts of Uganda that threaten maternal and neonatal survival2; Ingestion of herbs to quicken labor, refusing caesarian section on the pretext that women need to deliver normally to prove woman hood and culture of silence/non expression of pain3. Evidence based communication strategies to increase knowledge and change attitude, behavior norms at individual, community and societal level are essential to eliminate key demand side barriers. However, in the past communication initiatives have focused on individual and household level behavior change leading to strategies that provided only short term, fragmented and limited behavior change. 1.2. Rationale for Communication framework and structure The rationale for this framework is to;  Support the new priorities highlighted in the ‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health Sharpened Plan For Uganda (2013)’ and other priorites outlined in ‘Roadmap for accelarating the reduction of Maternla and Neonatal Mortality and morbiditity in Uganda (2007-2015)’ and ‘National Child Survival Strategy (2009 -2015)’  To build strong partnerships in support of RMNCH program across different levels; national, district and communities and highlight exisiting resources and structures within and outside the health system that can be mobilized in support of an integraed RMNCH Program.  To highlight and address key cultural and socio economic barriers impacting women’s abiliity to access RMNCH services. Specific focus 1 Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’, page 13 2 Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’, page 13 3 Kyomuhendo GB 2000, Ndyomugyenyi 1998)
  9. 9. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 9 on the three delay model and involving communities in planning and management of RMNCH activities.  To Support the roll out of key innovations in communication technologies in support of RMNCH program; mtrac, VRS, edutrac and U Report.  Show case special strategies for engaging with the male populations by highlighting gender transformative communication strategies  To focus on capacity building of community based VHTs in interpersonal communication in support of RMNCH  To facilitate resource generation for communication actvities in support of integarted RMNCH program. 1.3. Development process The draft strategy has been developed in-house by UNICEF ALIVE section to guide the communication support for ‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health Sharpened Plan for Uganda (2013)’ and the ALIVE Program as a whole. The draft will be shared broadly with partners for review and revision; MOH, development partners, parliamentarians, district and sub county stakeholders. A series of consultative workshops from the national to the district and sub district level are envisaged for the roll out of this strategy. The feedback will further inform the implementation down to the community level.
  10. 10. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 10 CHAPTER II OVERALL FRAMEWORK FOR THE INTEGRATED STRATEGY 2.1 Communication Framework The communication strategy is based on the theories of ‘Stages of Behavior Change’ and Social Ecological Model. The Stages of Behavior Change theory views behavior change as a process rather than an event. The main tenet of this Model is that an individual (or a stakeholder group) goes through several stages from non-practice to practicing or adopting a desired behavior. These stages including Knowledge, Approval, Intention, Practice, and Advocacy are so strongly associated with the new behavior that he or she becomes an advocate). This model helps to explain where the individual or a stakeholder group is in relation to a specific behavior and in relation to other stakeholder groups and gives direction on the types of strategies to move them along the ladder to the desired behavior (See Annex 1). The Social Ecological Models explain the link between the individual behavior and the enabling environment. In the past, development approaches focused on individual behavior change. But since then we have learnt that individuals often do not or cannot change behavior without support from the environment around them; Parents, spouses, peers, friends, community and religious leaders etc. Factors such as family pressure, community norms, and the larger policy and legal environment can affect the health related behaviors an individual engages in. Thus an individual’s behavioral choices should be seen in the larger context of his or her environment. Hence, interventions are needed at different levels of the environment to facilitate behavior change (See Annex 2). 2.2. The Package: The communication strategy takes an integrated approach to Reproductive Maternal, Newborn and Child Health and focuses on the critical time periods on the continuum of care. The target audience information needs will include messaging on the following; Table 1 Life stage priority area for Programming Health priority area linked to RMNCH New born, Infant and Child - New Born Care - Early initiation of breastfeeding - Exclusive breastfeeding - Acute Respiratory Tract infections - Diarrhea
  11. 11. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 11 - Immunization - Vitamin A deficiency - Growth monitoring - Infant and young child feeding practices - Under -utilization of health services - High reliance on traditional practices Adolescent - Nutrition - Health care counselling and services Life skills - Spacing of children and planning a manageable family - STDs/HIV AIDS, - Complications due to unsafe abortions - Pregnant Women; Delivering; Postnatal Care - High fertility Rate - Low contraceptive prevalence rate - Early initiation of breastfeeding - Exclusive breastfeeding - Birth preparedness - PPH – Post Partum Hemorrhage - Under Utilization of RMNCH services during ANC, Delivery and PNC - Nutrition and iron for pregnant and lactating women - Stop Smoking and tobacco use - Malaria prevention in endemic areas (Importance of IPT) - Sexually transmitted infections/HIV AIDS - Complications due to unsafe abortions - Gender based discrimination; work burden, harmful social norms, limited decision making, gender based violence 2.3. Communication goal, objectives and overall strategic focus Goal: To promote, support and ensure adoption of appropriate health seeking behavior among pregnant and lactating women, their families and communities4. Strategic Objective: Create Demand for Quality RMNCH services at the community level to ensure continuum of care. Communication Objective: 90% Pregnant & Women of CBA and Men adopt key RMNCH behaviors (time frame sharpened plan) 4 ‘Roadmap for accelerating the reduction of Maternal and Neonatal Mortality and morbidity in Uganda (2007-2015)’, page 7
  12. 12. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 12 Indicators o % Pregnant & Women of CBA who adopt key RMNCH behaviors o % of Men who adopt key RMNCH behaviors Overall Strategic Approach: Mobilize and Empower key decision makers and communities across sectors to ensure a continuum of care between the household and heath facility and create demand for RNMCH services in line with the APR priorities; 1. Roll out a National advocacy movement for Reproductive, Maternal, Newborn & Child health across all sectors; Health, education, agriculture, gender, private, finance, local government), cultural &religious leaders, development partners, private sector, media 2. Review and harmonize integrated RMNCH IEC tool kit for all health facilities, community health workers, communities and key stakeholders 4. Build proactive and sustainable partnerships with key stakeholders at national, district, sub county and parish levels in support of RMNCH 5. Use Gender Transformative communication approaches and messages to address child marriage, educating girls and women, women’s decision making with specific focus male involvement in RMNCH 6. Engage mothers and communities to utilize innovative platforms (mTrac, Mobile VRS, U report, Mother Reminder) for collection and use of real time data to promote accountabilities at all levels. 2.4. Target audience and behavioral analysis Although formative research has not yet been conducted, the following target audiences and barriers have been identified after a comprehensive research of secondary sources and the best practices documented in various toolkits developed by the partners. Generally, the following target audiences were identified: Primary  Household level: Women (Caretakers, married/stable relationships, adolescents, Husbands/Spouses.  Community Level: LCs, Religious leaders, VHTs, Teachers and TBAs. Secondary
  13. 13. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 13  Health facility level: Health Unit Management Committees, Health workers (Doctors, Nurses and Midwives)  District level: Politicians such as Resident District Commissioners, LC - V Chairpersons  Community level: Chiefs, local councils, VHTs, NGOs/CBOs such as Red Cross, religious organizations such as (ADRA), Schools, Parents &Teachers Associations, Community volunteers, community leaders, Traditional Birth Attendants and extension workers. Tertiary National Level:  Ministry of Health taking the lead and other relevant line ministries complementing its efforts such as: Ministry of Education, Ministry of Finance and Planning and Ministry of Local Government;  Members of Parliament, Religious and Traditional leaders, Media houses and service organizations such as Rotary and Lions Clubs and NGOs such as Uganda Red Cross Society.  Professional bodies such as Uganda Medical and Dental Association, Uganda Pediatric Association, Uganda Nursing Council, Uganda Health and Allied Professionals Association; religious organizations, through their medical Bureau such as Catholic, Protestant, Muslim and Orthodox Medical Bureau.  Development partners such as USAID, DFID, KOICA, CIDA, JICA and others. Table 2: Target Audience & Behavior/participant analysis Target Audience Current behavior Barriers to desired behavior (causes) Behavioral objectives (2017) Primary 1. Women of Child Bearing Age, Pregnant and lactating women, husbands and caretakers  Women of Child bearing Ages, Pregnant and Lactating Women not practicing Key RMNCH Behaviors  Knowledge Barriers Inadequate knowledge on benefits of RMNCH (ANC, birth preparedness, emergency readiness, skilled birth attendance at delivery, PNC, Early initiation of Breastfeeding, maternal nutrition, immunization, HIV, hand washing).  Only 21 % male partners  80% target women, husbands and caretakers understand the importance, birth preparedness, ANC, danger signs and three delays , institutional deliveries, PNC and (annex for detailed package)
  14. 14. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 14 Target Audience Current behavior Barriers to desired behavior (causes) Behavioral objectives (2017) have knowledge on ANC  Attitude barriers - Pregnancy considered a normal practice in many communities And women who deliver at home without medical assistance held in high regard5 - Limited decision making power of women during pregnancy, Child Birth and post- partum period - Religious and traditional beliefs; Ingestion of herbs to quicken labor, refusing caesarian section on the pretext that women are supposed to deliver normally to prove woman hood and culture of silence/non expression of pain 6  Practice barriers  Only 58% of births attended by skilled birth attendants (UDHS 2011) Only 48% women are having four or more ANCs visits 80% of mothers, husbands and caregivers recognize pregnancy as a special period requiring special care and consider women who deliver in facilities as positive role models  80% women involved in decisions regarding pregnancy, child birth and postpartum  80% of target populations shun practice of herbs for quicken labor and appreciate the importance of caesarian in case of obstructed labor 70% births attended by skilled birth attendants 70% mothers seek all four ANC visits 70% women receive postnatal care in the first two days after delivery. 5 Kyomuhendo GB 2000, Ndyomugyenyi 1998) 6 Kyomuhendo GB 2000, Ndyomugyenyi 1998)
  15. 15. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 15 Target Audience Current behavior Barriers to desired behavior (causes) Behavioral objectives (2017) Only 33% women receive postnatal care in the first two days after delivery. Secondary: 2. VHTs VHTs do not mobilize communities for RMNCH services  Knowledge Barrier - Inadequate knowledge on benefits of Key RMNCH practices  Attitude Barrier - Lack of motivation to promote RMNCH services  Practice Barrier - Do not mobilize communities to avail RMNCH services  80% VHTs have knowledge on key RMNCH practices  80 % of functional VHTs mobilize communities for availing the RMNCH services 3. Health unit management committee (HUMC) HUMC members do not attend regular quarterly meetings to discuss health issues and support community activities  Knowledge Barrier Lack of knowledge on the importance of RMNCH service for maternal and child survival  Attitude Barrier Lack of motivation to attend meetings concerning health issues  Practice Barrier In adequate supervision monitoring support at the community level  80% HUMC are functional and members regularly attend quarterly meetings and  80% functional HUMC engaged in monitoring and supervision at community level 4. Health workers Health workers do not counsel mothers or give complete information to mothers regarding RMNCH package  Knowledge Barrier Inadequate interpersonal communication skills e.g. counselling skills  Attitude barrier In appropriate treatment of parents  80% Health workers trained in counselling and interpersonal skills  80% health workers treat parents with respect  80% of health workers counsel women on key
  16. 16. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 16 Target Audience Current behavior Barriers to desired behavior (causes) Behavioral objectives (2017) (often rebuke parents)  Practice barrier Health workers do not counsel women on Key RMNCH services. RMNCH services 5. Traditional and religious leaders Tradition and religious leaders not engaged in RMNCH promotion  Knowledge Barrier Lack of knowledge on the importance of and  Attitude Barrier Existence of traditional beliefs (Ingestion of herbs to quicken labor, refusing caesarian section on the pretext that women are supposed to deliver normally to prove woman hood and culture of silence/non expression of pain 7 Practice barrier Traditional and religious leaders do not promote RMNCH services  80% of all major religious association oriented on RMNCH package and engaged in social mobilization for RMNCH  80% of all major religious association shun traditional practices harmful to maternal, new born and child health  80% of all major religious association oriented on RMNCH package and promote RMNCH services 6. Media National and district media do not adequately cover RMNCH activities  Knowledge Barrier - Lack of knowledge and capacity to present RMNCH issues and resulting maternal and child mortality as a news worthy  Attitude barrier Little interest in  80% 0f all key national and district media oriented on RMNCH  80% 0f all key national and district media oriented on RMNCH report and cover key RMNCH activities 7 Kyomuhendo GB 2000, Ndyomugyenyi 1998)
  17. 17. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 17 Target Audience Current behavior Barriers to desired behavior (causes) Behavioral objectives (2017) comprehensive coverage of RMNCH Practice barrier National and district media do not adequately cover RMNCH activities 7. National and district policy makers/ leaders • National and district leaders not aware their role in mobilization and promotion of RMNCH • Knowledge Barrier Inadequate knowledge and orientation of policy makers /influential leaders on their role in mobilization and promotion of RMNCH  Attitude Barrier National and district leaders have the tendency to be donor dependent and do not take the lead  Practice Barrier Leaders not performing an oversight function in their constituencies and districts  80% National and district leaders oriented on RMNCH package and their role in mobilization and promotion of RMNCH  80% of the oriented national and district policy makers and leaders engage in oversight functions in their constituencies and districts 8. Development partners • Uncoordinated sector support by donors • Practice barrier Uncoordinated sector investment  80% donor funds coordinate through the sector coordination committee
  18. 18. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 18 Chapter III STRATEGIC COMMUNICATION INTERVENTIONS 3.1. Communication Strategies The development and implementation of this strategy is based on the recognition that behavior change communication can be effective when planned and implemented using a combination of communication approaches with appropriate behavior change models. Relevant behavior change approaches, models and theories were identified and applied to analyze the behaviors of primary, secondary and tertiary/advocacy target audiences. This analysis provided insight into the behaviors of individuals and factors responsible for the less than optimal uptake of RMNCH services. This has enabled the identification and design of relevant interventions and messages to address the problem behaviors. In order to achieve the communication and behavioral objectives, a three pronged Communication for Development approach with three main strategies will be used, namely;  Behavior Change Communication  Social mobilization  Advocacy 3.2. Behavior Change Communication (BCC) BCC interventions will be implemented at the household level through IPC involving VHTs, Scouts / Girl guides, LC1s, and through mass media (radio spots/talkshows. Although mothers are the primary target at household level, recent research and experiences have shown that there are structural barriers to women’s decision making. Hence, the household will be further segmented to include other decision makers; such as mothers, husbands/fathers, grandparents, aunties, mothers-in-law and fathers-in-law. Health promotion interventions will target the specific behavioral barriers at the family/household level and create awareness through the following interventions: IPC through IEC materials
  19. 19. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 19 The VHTs will have the main responsibility for IPC using IEC packages supported by health assistants. The IEC packages will include pictorial cards and informative leaflets covering important aspects of RMNCH; these will provide information on birth preparedness, Antenatal care, delivery, postnatal care, early initiation of breastfeeding, infant and young child feeing, family planning, pneumonia, malaria and diarrhea prevention, hygiene, sanitation, nutrition etc. IEC materials in addition to being used in individual and group counseling can also be used for training purposes. Information materials will also be developed for promotional activities conducted by health workers, LCs, Scouts/Girl Guides, religious leaders and teachers. Mother to mother education and women’s group This strategy has been used in many countries with significant results and the most effective application of peer- to –peer education. Mothers will be trained to advise other mothers and pregnant women on key RMNCH practices. Mass Media: Mass Media will be used to make Public Service Announcements (PSA) by government agencies. These are very important in keeping messages in public eyes. Short spots, talk shows, PSA and jingles to promote RMNCH will be developed for airing on radio and TV. PSA messages will create awareness and understanding regarding importance of RMNCH and motivate people to adopt positive behaviors. Innovative use of mobile health and related information communication technologies: The focus will be in enhancing health literacy and care seeking among mothers through provision of relevant health information to pregnant women and new mothers using personalized text or voice messages encouraging them to visit the local health facility for antenatal care, immunization or remind them to complete birth plan and go for skilled delivery and post natal care. Existing mobile health initiatives like mTrac and community engagement initiatives like U Report will be utilized for real time reporting on existing gaps and barriers to RMNCH at all levels. Disease prevention and patient self-management will also be supported through short messages no more than sixty characters or less to enrolled mobile phone users. Options will also be explored to use SMS system to connect remote populations to their health providers. Involvement of goodwill ambassadors:
  20. 20. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 20 The involvement of goodwill ambassadors for promotion of social causes has been found to be very effective and bears positive results the world over. Well-known and popular personalities and media stars possess charisma and charm that is needed to add visibility and credibility to the cause. In a bid to make the RMNCH communication more persuasive and relevant to the target audiences, a panel of goodwill ambassadors belonging to different walks of life (sports stars, media celebrities, religious leaders and doctors) will be selected in consultation with partners to promote RMNCH services. Programme Communication Activities:  Mapping of active VHTs nationwide  Training / Orientation of VHTs on key messages for RMNCH  Awareness raising through individual/Group counseling sessions  Awareness raising through Public Service Announcements, TV, talk shows, Radio spots/jingles, DJ mentions, children’s voices and testimonies from satisfied users of immunization services.  Dissemination of messages in newspapers through articles and strip adverts.  Development and dissemination of SMS messages  Sensitization sessions with Goodwill Ambassadors  Promotional visits by Goodwill Ambassadors to communities 3.3. Social mobilization with specific focus on the hard to reach areas Social mobilization will operate at the district, sub district and village level. In addition to parents, it will target local politicians, religious leaders, traditional leaders, opinion leaders, community groups, and teachers. Social mobilization is not only crucial for sustainable behavioral change, it is also an effective strategy for community empowerment and participation. It will create awareness and seek to change people’s behavior at village level and will entail the following activities. Formation of Alliances/Support Groups The District Health Management Team (DHMT) with the help of local volunteers (teachers/health-workers) will be responsible for forming support groups at the community level, to advocate and participate in program activities. The support groups will include local religious leaders, health workers, teachers, NGO/CBO representatives. These support groups will provide an excellent venue for imparting knowledge on RMNCH. These
  21. 21. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 21 groups will meet on a regular basis and plan how to provide solutions with mutual understanding and sharing of experience. Community Based Participatory Activities: Activities will be organized and supervised by DHMTs. IPC through the VHTs and partner NGOs supported by IEC materials will be the main channels of communication for these activities. Informative/educational materials will be designed and developed for various members of the support groups. The materials developed for traditional and religious leaders will be designed to directly address any cultural constraints and false religious beliefs, and will be in the form of fact sheets and videos. Community and school based sports and other info- entertainment activities: This component will focus on educating and mobilizing communities around RMNCH through community and school based sports activities. These activities will entail massive community interest and involvement. The teachers will be involved in school based interactive/informative activities for promotion of RMNCH. Focal persons and sports champions will be identified in each community to support future activities. Drama groups will be trained in each community and school on key RMNCH messages. Community screening of relevant documentaries etc. will also be part of this component. Social Mobilization Activities:  Community sessions and dialogue/group discussions with various target groups organized by DHMTs/DHE  Alliances formed with community leaders, NGOs, religious/cultural leaders  Revitalization of Health Unit Management Committees (HUMCs) to support linking services with communities  Community based media activities; music, dance and drama performances as well as puppet shows on RMNCH by DHMTs  Establishment of community radio listeners’ groups by VHTs to mobilize the communities, listen and participate in radio discussion programmes on RMNCH  Conducting sensitization sessions with religious, traditional and community leaders  Conducting sensitization sessions with teachers to create awareness  School based activities conducted by teachers
  22. 22. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 22  Additional activities may include street theatre, community meetings, sports days, school-based activities, and seminars, celebration of important health events e.g. World Health Day, Child Days Plus 3.4. Advocacy: Advocacy will target individuals involved at all levels of policy and decision making. At the National level it will target ministers, MPs, and other relevant people in the ministries. At the District level it will target the district councils and heads of departments. The district level advocacy will entail dialogue with District Health Officers (DCOs), heads of departments and councilors. Media agencies and their representatives at national and district levels will also be targeted. Newspaper articles, seminars and workshops/meetings will be employed to make policy makers more aware of the magnitude of risks associated with low RMNCH service utilization; of the immediate and secondary (including economic) benefits; and of the potential action to be taken by them such as supportive legislation and its enforcement. National commitments to international conventions like the Rights of the Child will be used to legitimize demand for government support. The advocacy component will focus on the following: Policy/Legislation: Ensure that the government and parliament set up a strong enforcement, regulatory and monitoring system for RMNCH. Capacity Building: Build the capacity of policy makers, parliamentarians at national and district level for implementing the advocacy strategy. Also, advocacy capacity of the NGOs and the media will be strengthened to effectively publicize and promote RMNCH services. Awareness Raising: Raise awareness of government officials and affiliated partners about the consequences of un skilled birth attendance, low antenatal and post natal visits, lack of early initiation of breastfeeding, low immunization coverage. Partners will also be given an orientation on means of achieving RMNCH targets.
  23. 23. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 23 Advocacy Activities:  Develop/adapt advocacy kit for political leaders, traditional and religious leaders at national and district levels.  Conduct high level advocacy meetings to revive the support and commitment of political, religious and traditional leaders for RMNCH/APR.  Seek endorsement statements from credible authorities in government, traditional and religious organizations and medical professionals in support of APR.  Meetings on key RMNCH concerns with district leaders, heads of departments, religious and traditional leaders and key partners.  Launch the Communication strategy by a key figure in government, either the First Lady or Minister of Health.  Capacity building of policy makers to develop supportive policy and implementation  Sensitization/Capacity Building sessions with media representatives
  24. 24. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 24 Chapter IV SPECIAL STRATEGIES - MALE INVOLVEMENT, HEALHT WORKERS MOTIVATION, HARD TO REACH 4.1. Male Involvement Men are critical players in decision making regarding major RMNCH practices; contraceptive use, maternal nutrition, institutional deliveries etc. However, despite recognition of the urgent need for male involvement, both globally and at the National level, limited attention has been given to engagement of this critical target group.8 Hence, at the community level lack of comprehensive knowledge of key RMNCH practices and low male involvement leads to poor utilization of the RMNCH services9. The communication strategy aims to use gender transformative (that confronts and transforms gender norms) and gender sensitive (that is aware of the gender norms in a specific context and how these impact gender relations and decision making) approaches to involvement of men in RMNCH. The messages and training tools developed will enable the communities to explore and understand how gender roles can impact health outcomes and how male involvement is critical for positive RMNCH outcomes. Research conducted by WHO - Promundo and UNFPA literature review of Men’s role in gender equality highlight two main areas that gender transformative programs could use to increase male involvement in RMNCH; 1. Engaging men as partners in reproductive health. 2. Engaging men as agents of change in RMNCH10. 4.2. Key Strategies Following key strategies will be used; 8 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO 9 ‘A Promise Renewed; Reproductive Maternal, Newborn and Child Health Sharpened Plan for Uganda (2013)’. 10 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO
  25. 25. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 25 4.2.1. Group Education Using traditional approaches like story-telling, dance groups, mimes etc. the group education sessions will have a high entertainment component. The three core activities under the group activities will include; Gender Roles and expectation The group will jointly examine gender roles, expected gender behavior ‘Act like a man’, Act like a woman’ and gender relations in their community and how these impact both male and female reproductive health and RMNCH outcomes. Child care: Using role plays and simple games like ‘passing the crying doll’ representing a ‘new born baby’ teach men essential ‘child care’. The focus should be on educating them on joint child care and showing that although it seems simple, child care is extremely tiring a woman (mother) needs support of her partner. Key Barriers: Key barriers identified for each region will be further explored; No communication between couples on pregnancy, pregnancy considered a normal practice and women delivering at home without medical assistance held in high regard, Limited decision making power of women during pregnancy, child birth and post- partum period, religious and traditional beliefs; Ingestion of herbs to quicken labor, early marriage, girl education etc. 4.2.2. Selection of Male change agents The use of men as change agents for promotion of RMNCH has proven useful in different context in increasing male involvement in RMNCH. The male change agents will be chosen from ordinary fathers, religious cultural leaders, parliamentarians etc. Tools and materials will be developed for building their capacity on promoting and mobilizing for RMNCH. 4.2.3. Campaigns and community mobilization As mentioned earlier the strategy will use gender transformative communication messaging and approaches. In addition to community level tools and materials, a mass campaign will be designed around male role in child caring and raring and in the broader RMNCH programme. The campaign will move beyond the individual and target how parents, religious cultural leaders and communities perceive gender norms and roles around RMNCH.
  26. 26. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 26 4.2.4. Health Workers attitude Health workers attitude has been highlighted as a key factor in impacting male participation in RMNCH and PMTCT.11 A checklist will be developed to assess health facility friendliness to male and female clients. Specific focus will be training health workers in dealing with the needs of male clients and engaging them in RMNCH. Some of the areas of focus will include; health workers behavior towards male clients;12 harsh behavior from skilled health workers a big barrier for male clients returning (especially PMTCT). Quality of care; Health workers are often burdened and taking care of participating male members is considered an additional burden. Hence, need to build their knowledge on the importance of male involvement. Lack of space and resources; Clinics often have limited space to accommodate male partners who may be discouraged from accompanying women to clinics. 4.3. Health Workers Motivation Health workers motivation is a critical factor impacting the quality of services. The health care workforce, the foundation of the health system, is under increasing pressure to perform higher quality of work with limited resources. Under the current circumstances, a focus on knowledge and skill base alone cannot remove many of the bottlenecks faced in the delivery of quality care. Simple, low cost catalytic interventions focusing on putting in place incentive mechanisms for staff motivation need to be explored as the MOH and partners prepare for the national scale critical RMNCH services. This is especially crucial with promotion of institutional deliveries. Recent research shows that although distance is a key factor inhibiting institutional deliveries, mothers and caregivers are willing to travel longer distance if the facility is perceived to provide good quality service13. Activities  Creating a non-monetary incentive mechanism for health workers to Incentivize Implementation of the RMNCH package based on the RMNCH score card. An in-depth study conducted recently in Uganda ‘Our side of the story’ clearly identifies motivators and bottlenecks to health facility staff performance. Majority of the motivators are 11 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO 12 Engaging men and boys in RMNCH, 2013, Promunoo, UNFPA, WHO 13 Assessing access to barriers to maternal health care; measuring bypassing to identify health center needs in rural Uganda, Justin O Parkhurst and Freddie Ssnegooba, 20 April 2009
  27. 27. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 27 unrelated to financial incentives (pride, prestige, trust, acknowledgement etc.). A second study, ‘non-financial incentives for health workers retention in Uganda’ will also inform this component.  Improve the quality of service by putting in place a ‘Certification Mechanism’ for health facilities. A major factor impacting RMNCH services is the variation in services between facilities and no differentiation between well performing and poor performing health facilities. A district based certification component will ensure recognition of compliant facilities and will also regulate the huge variation in quality of service across various districts and health facilities. This will greatly enhance staff motivation  Leader boards will be set up in each district highlighting the top performing health facilities based on the score card. The leader boards will be updated quarterly. The leader board data will be shared widely and will be published quarterly in newspapers. The feed- back to the health facilities will ensure a health competition within health facilities. This data will also be shared on the LCD screens in the health ministry and on a public website.  Using mTrac a SMS based disease surveillance, medicines tracking system for removing ‘Supply Side Bottlenecks' to health workers’ motivation. Stock out of medicines and other essential commodities has been identified as a huge de- motivator for the health facility staff. mTrac data is now fully incorporated into the MoH’s Surveillance Unit’s weekly news bulletin and reports of drug stock-outs, and is being integrated into the national DHIS2 database. The system will build accountabilities on all sides. 4.2. Specific activities for Hard to reach: In line with the Sharpened Plan the communication strategy focuses on high burden districts and within these districts on the underserved and hard to reach communities. The districts are being supported by MOH and partners to map hard to reach populations in their social maps and micro plans. These populations usually require additional resources extra planning to be reached. Some additional activities are listed below.  Identify the hard to reach and underserved populations and their locations  Rapid assessment on the reasons why particular special groups do not believe in and utilize RMNCH services
  28. 28. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 28  Identification of grassroots NGOs and FBOs and engage them to mobilize the hard to reach communities in coordination with DHMTs  Intensive use of mass media and community radio with emphasis on interactive radio discussion programmes especially on local FM and community radio stations  Intensive community mobilization using film vans, street bashes/road shows/market days to mobilize and sensitize communities on RMNCH/APR  Establish outreaches and or mobile service teams to cover hard to access populations  Formation of District Communication Committee  Identification of focal person within the District Health Management Team (Health Education Officer/other)  Identification of local volunteers (teacher/health-worker) and formation of support groups at community level to advocate and participate in program activities 4.3. Collaboration and Networking: Collaboration and networking is an important component of the communication strategy as it will strengthen alliances and partnerships among duty bearers and partners so they can implement advocacy, social mobilization and communication interventions that promote RMNCH services. Activities:  Revise Terms of reference for the social mobilization subcommittee to address issues on mobilization for RMNCH.  Conduct monthly social mobilization sub-committee meetings to review progress on action items and plan for continuity in mobilizing for RMNCH. Hold joint planning meetings to develop the annual communication implementation plan.  Conduct joint workshop to develop M&E communication indicators  Conduct joint monitoring and support supervision of communication and advocacy activities.  Conduct behavioral research to guide monitoring and evaluation of communication interventions
  29. 29. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 29 CHAPTER V TRAINING AND CAPACITY BUILDING 5.1. Training and capacity building; The implementation of the communication strategy requires strengthening communication capacity in immunization at all levels. 5.2. Training of Trainers (TOT): A pool of Master trainers will be trained at the national level in social mobilization/advocacy, design and implementation of the strategy. Further cascade training conducted at the district level. The Master Trainers will be nominated by the Ministry of health at the national level. 5.3. Training of District Health Management Teams (District Health Educator, District Health Inspector and District Health Visitor): Capacity building of the district health management teams in communication is crucial for the implementation of the RMNCH social mobilization strategy at the district/implementation level. This will not be a one- time activity but a series of participatory workshops will be conducted to equip them with the necessary communication and mobilization skills for RMNCH. 5.4. VHTs, LC1s, Chiefs, religious leaders, teachers, TBAs and health assistants: For sustained behavior change at community and household level, interpersonal communication and counseling skills of the service providers at community level such as VHTs and LC1s are extremely important. They will be trained to enhance their interpersonal communication and counseling skills, and in the use of IEC materials related to RMNCH. They will also receive basic training in community mobilization to form local alliances/support groups. Activities:  Develop/update training manual/guidelines on communication for RMNCH services  Conduct training/orientation of service providers on communication, counselling and mobilization skills for promotion of RMNCH  Facilitate the development of action plans on mobilization of communities for RMNCH
  30. 30. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 30  Conduct follow-up and provide support supervision to the trained service providers to monitor implementation of community mobilization activities.  Conduct meetings with Health Unit Management Committees and the community to provide feedback on challenges and success stories on mobilization for RMNCH services.  Conduct quarterly review meetings with DHMTs to share experiences and update plans for timely implementation
  31. 31. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 31 Chapter VI Strategy Implementation 6.1. Implementation Modalities The implementation of this strategy will be executed at different levels to promote advocacy, social mobilisation and behaviour change communication interventions. At national level, the strategy will be used as a resource mobilisation tool and implementation guide at various levels. As a resource mobilisation tool, it will be presented to government and development partners to mobilise financial resources to support implementation of RMNCH activities. A phased approach to implementation will be applied based on the understanding that it is not possible to do everything in this strategy at once. Activities will be implemented in a phased manner in consideration of what priority activities should precede others and build momentum for subsequent activities over the period of five years. Special emphasis will be laid on high burden districts in line with the priorities of the Sharpened Plan. The phasing of implementation will provide a balanced approach towards addressing issues in a gradual process while building on the achievements of the previous phases and strengthening the effectiveness of each phase. Some preparatory activities will be implemented during the first year of the strategy such as development of IEC materials/messages and training guidelines, putting in place the M&E framework as well as training service providers. These will build a foundation that will support implementation of subsequent activities. It is important to point out that the phasing of implementation will mean giving some activities more focus/intensity and others low focus /intensity depending on the period of implementation during the five year period. For example, during the first year, in addition to preparatory activities, other activities such as advocacy with key partners national and district, mass media campaigns, mapping of community resources will be undertaken with high intensity to build momentum, while community based activities will take time to build momentum. In the second year to third and fourth years of implementation, activities of the first year will have built momentum and community level implementation will be of high intensity. During the fifth year, there will be greater focus to gear up for evaluation of communication and
  32. 32. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 32 advocacy interventions. The table below illustrates how key activities in the communication strategy will be implemented in phases with varying degrees of intensity in a period of five years. Table 3: A Phased Approach to implementation of the RMNCH Strategy TIMELINE AND LEVEL OF FOCUS FOR IMPLEMENTATION Communication Approach Major Activities Year 1 Year 2 Year 3 Year 4 Year 5 Programme Communication Conduct formative research Develop IEC materials and messages Conduct mass media activities Conduct community outreach activities Social Mobilisation Develop/update communication training guidelines Train service providers (VHTs, Health Educators) Develop M & E communication indicators Conduct support supervision Conduct monitoring and evaluation Conduct quarterly review meetings Advocacy Develop advocacy kit Conduct advocacy meetings for national and district level, political leaders and other leaders Launch Communication Strategy Low Intensity Monitoring and Evaluation High Intensity Monitoring
  33. 33. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 33 The communication strategy will be implemented as follows: 3.1Dissemination of strategy to partners and stakeholders Once the communication strategy is approved by MOH, UNICEF, UNFPA, WHO and other partners, it will be launched by a high level profile leader in government to relevant key partners and stakeholders who include policy makers at the highest level in the relevant ministries and development partners. This will be done to solicit their support and buy-in for support to RMNCH programme by advocating for allocation of adequate financial resources. This will be done at national and district levels. 3.2 Development of annual communication plan The HP&E Division will develop an annual implementation plan that provides a framework for operationalising implementation of the communication strategy for RMNCH at different levels. The plan will highlight communication, social mobilisation and advocacy activities to be implemented at national and district levels. 3.3 Development and production of training and IEC materials/messages Effective communication and advocacy outcomes will be achieved with support of well-targeted and focused IEC materials, messages and training guidelines/manuals which will enhance knowledge and understanding of RMNCH among parents, caretakers and service providers. The training materials will be used to equip service providers with knowledge and skills in mobilization, communication and counselling for RMNCH while IEC materials and messages will be used to create/increase awareness and knowledge on RMNCH among parents, caretakers and members of the community. Once the training guidelines have been developed/adapted, training of service providers will commence at regional level in preparation for countrywide mobilization for RMNCH services. 3.4 Coordination and management of the strategy Implementation of communication and advocacy activities needs to be managed and coordinated to ensure stakeholders execute their roles more effectively through partner complementation. The implementation of the communication strategy will be managed by HP&E Division and coordinated
  34. 34. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 34 through the Social mobilisation sub-committee. This committee will advise on technical issues related to communication and advocacy for RMNCH.
  35. 35. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 35 Appendices Annex 1: INTEGRATED ACTION PLAN 2014-2015 EXPECTED RESULTS OF C4D INTERVENTIONS FOR APR IN UGANDA High impact behaviors  Pregnant women go for at least 4 antenatal check-ups (ANC+) and 4 post natal visits (PNC)  Pregnant mothers and Families accept skilled birth attendance and referral for institutional deliveries  Lactating mother breastfeed within one hour (feed colostrums) and exclusively breastfeed for the first 6 months  Child care givers provide infants appropriate complementary feeding from 6 months  Family members practice hand washing with soap/ash at four critical times and stop open defecation  Child care givers manage diarrhea at home through correct use of ORT and recognize early signs of dehydration  Family members practice appropriate care seeking behavior for pneumonia and neonatal conditions  Families have their children immunized against preventable diseases  Families use iodized salt, iron folate, and vitamin a supplementation to protect mothers and children against micronutrient deficiencies
  36. 36. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 36 Strategic Objective C4D Approach Activities Participant Group Time frame Communication Materials Responsible Agency 201 4 201 5 NATIONAL LEVEL Launch a national sensitization and advocacy campaign for maternal and newborn health to ensure high level commitment by government, political and religious leaders. Advocacy 1.1. National launch ceremony to introduce and sensitize decision makers and policy makers at national level on APR Parliamentarians, GoU officials, key stakeholders, development partners, national other opinion leaders Done2013 Speeches/Talking points Advocacy package - 1 File folder, - Brochure - Media kit: FAQs, stories/ articles written by UNICEF UNICEF/MOH 1.2. Orientation session with parliamentarians on integrated maternal and child survival package Parliamentarians Talking points Media Kits: FAQs Feature stories Speeches 1.3. Orientation session with faith based leaders on integrated maternal and child survival package; Specific focus on skilled birth attendance Religious leaders from all faiths Presentations Briefing Kits. FAQs 1.4. Orientation sessions with National traditional herbalist and healers association; their role in support of RMNCH Traditional healers and herbalists Presentations Briefing Kits. FAQs 1.5. Media engagement and regular interaction - Partner with Daily monitor; other print media; Invitations in advocacy, social mobilization
  37. 37. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 37 Strategic Objective C4D Approach Activities Participant Group Time frame Communication Materials Responsible Agency national daily newspaper, national radio to cover nutrition and EPI Medical Review NTV-TV/radio events; Q&A’s; interviews; 1.7. Private sector engagement with Private not for profit (PNFP) organizations implementing RMNCH. Private not for profit (PNFP) Draft MoA, Briefing materials (flyer/brochure) 1.8. Advocacy meetings with corporate groups for sharing corporate social responsibility as part of public-private partnership Corporate groups: petroleum companies; Draft MoA, Briefing materials (flyer/brochure), backdrop, banners Q&A’s RMNCH 1.9. Negotiation meetings with mobile telephone corporation managers. Partnership with mobile telecom companies in RMNCH program for rapid info dissemination during the FHDs/CHDs and rapid monitoring. CSR Telecommunications Company Invitation letter Memo of agreement with mobile phone company 1.9. Develop and implement a health workers motivation strategy; Design incentive package, integrated quality assurance elements, client/mothers satisfaction surveys to rate facilities UNEPI, WHO,UNICEF & technical partners MOH Incentive package, leader boards, brochure District Level Advocacy Develop integrated communication micro plans for APR focused districts Update existing micro pans for Polio, FHDs/ CHDS to develop integrated micro for the RMNCH Template
  38. 38. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 38 Strategic Objective C4D Approach Activities Participant Group Time frame Communication Materials Responsible Agency Include RMNCH in the agenda of all regular monthly meetings to be held at district level (e.g. DHMTs, Health Unit Management Committees meeting, Health Sector Working groups) Letter from DG; DHOs on prioritization of RMNCH. Orientation with DHMTs on health workers motivation strategy package and indicators for tracking progress. Presentation District Level Mobilize and sensitize communities, particularly at sub county level, on maternal and newborn health. Social Mobilization Revitalization of HUMCs to link services with communities; community sessions, defaulter tracking etc. DHMTs, Health facility in charges Posters Cascading National Coalition on RMNCH to sub national level and development of a work plan for the alliance in focused districts Representation from religious leaders, CSOs/NGOs health professionals, media, school teachers Religious leaders, NGOs/CSOs, teachers, health professionals public/private, media/cable operators Infor Kit; rationale, FAQs, actions to be taken by each group DHMT/NGO partner Quarterly review of the alliances to update on the work plan In line with the work plan alliance members to hold meetings in their respective sectors Religious leaders, NGOs/CSOs, teachers, health professionals public/private, media/cable Presentations, Mobilize schools and use NGO/UJL, DHMT, Flyers, Banners
  39. 39. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 39 Strategic Objective C4D Approach Activities Participant Group Time frame Communication Materials Responsible Agency school children and sports based activities for social mobilization to communicate with mothers and caregivers on important RMNCH issues Teachers Use of mobile technology (e.g. mtrac) for reaching mothers and fathers with a full package of RMNCH messages. Including development of voice content and delivery mechanism Mothers, fathers, Short messages Establishment of community radio listeners’ groups by VHTs: to mobilize the communities, listen and participate in radio discussion programmes on immunization. Mothers, fathers, faith based leaders Script for Radio program Household/Community Review, develop and disseminate health promotion materials on birth preparedness, danger signs, emergency preparedness including emergency transportation Behavior Change Communica tion (BCC)/ Community engagement Review and revise materials on RMNCH to prepare new interactive materials; pictoral cards, videos, SMS messaging on birth preparedness, danger signs, emergency preparedness, MOH,UNICEF, UNFPA,WHO,USAID /MCHIP Presentations, Communication material for review Developing and airing radio messages on key RMNCH practices with specific focus on ANC/PNC and skilled birth attendance MOH,UNICEF, UNFPA,WHO,USAID /MCHIP Radio script Public announcements and messages on mass media and endorsement by good will Mothers, father, caretakers Script
  40. 40. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 40 Strategic Objective C4D Approach Activities Participant Group Time frame Communication Materials Responsible Agency and communication system at the community level. ambassadress One day refresher training on IPC. Community dialogue and social mobilization for RMNCH for frontline workers at district and community level VHTs,LC1s, Scouts, vaccinators NGO/CBOs, Training Manual One day training for peer to peer education mothers trained on advising mothers and pregnant women on key RMNCH practices Mothers Training Manual Mobilization for community mapping to identify, include and support underserved poor families and disadvantaged pregnant women, lactating mothers, un- immunized/ defaulting children Community, families, health facility staff Mapping Template Register families/caregivers with U5 children and pregnant mothers and use SMS/ other mobile telephony solutions to remind mothers of RI+ , antenatal schedule and to give educational tips messages on NBC, RI/PCV, EBF, WASH, IYCF. Families/ husbands/ mothers/ caregivers With mobile phones 20 13- 20 15 Prepared messaging for transmission as scheduled (long term) TBD
  41. 41. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 41 Strategic Objective C4D Approach Activities Participant Group Time frame Communication Materials Responsible Agency Group and individual counselling sessions with mothers, fathers and other care givers by VHTs/LC1s, Scouts to motivate mothers, caregivers on RMNCH, reinforcing mass media messages and addressing queries Mothers, caregivers VHT manual Integrated flip chart One page leaflet on key RMNCH Scripts and lyrics for folk song for community meetings, Completion of Birth preparedness plan for each pregnant mother; Delivery date, ANC visits, transportation, cash, name of health worker etc. (Health facility midwives with family support groups) Mothers, husbands, family, community Birth plan Mobilization through churches and mosques; Sunday and Friday sermons Community Families Brochure for Imam Masjid Enhancing health literacy and care seeking among mothers through SMS. Provision of relevant health information to pregnant women and new mothers using personalized text or voice messages Mothers, pregnant women Script
  42. 42. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 42 Annex 1: Stages of Behavir change The Stages of Behavior Change theory explains the various steps an individual or stakeholder group goes in order to change behavior. Individuals and organizations start at different steps and they may not go through each of step of the process or in the same order or at the same speed. They can leap up or move down several steps at a time. Once they have moved up there is no guarantee that they will not move back. Hence, sustained effort is needed to keep y target audiences on an upward path. Different strategies will help stakeholders move up the ladder; knowledge through media, friends, trusted cultural and religious leaders etc. Therefore it is extremely important to know what stage the majority of a particular target groups is at in order to employ the right strategy. For example if majority of mother lack knowledge on key RMNCH practices the first important strategy to reach this group may be mass media for fast dissemination of information. However, as people move up the ladder they may have more questions regarding the new behavior and in this case more interpersonal strategies will be effective.
  43. 43. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 43 The social ecological models explain the link between the individual behavior and the enabling environment. In the past development approaches focused on individual behavior change. But since then we have learnt that individuals often do not or cannot change behavior without support from the environment around them; Parents, spouses, peers, friends, community and religious leaders etc. Factors like such as family pressure, community norms, and the larger policy and legal environment can affect the health related behaviors an individual engages in. Thus and individuals behavioral choices should be seen in the larger context of his and her environment. Hence, interventions are needed at different levels of the environment to facilitate behavior change. Annex 2: Social ecological model
  44. 44. INTEGRATED ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION STRATEGY AND ACTION PLAN FOR ‘A PROMISE RENEWED’ 44 Annex 5: Matrix for assessing Demand side barriers (adapted14 ) 14

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