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SELECTED COUNTRY HIGHLIGHTS
In 2003, USAID/Ethiopia requested that HCP help strengthen the communication component of USAID-funded programs. Specifically, HCP provided BCC assistance for health, HIV/AIDS, and education programs. HCP worked with USAID partners in these program areas to coordinate approaches and activities, build BCC capacity, and implement high-impact BCC activities as an integral part of their programs. HCP Ethiopia is currently implementing broad initiatives around HIV/AIDS, child survival, and reproductive health. In all three areas, community-level activities were or will be enriched and supported by mass media. HCP's initiatives in Ethiopia are unified by the common theme of the Championship Activity Cycle, in which groups of participants strive to achieve “champion” status by fulfilling defined requirements. This cycle is based on the premise that the combination of defined goals and healthy competition can motivate collective action, which can, in turn, reinforce individual-level behavior change. The cycle begins with setting clear goals for participants. Participants then work towards these goals, completing program activities. These activities are innovative and engaging, spurring participants to both collective action and individual behavior change. Once participants have reached the pre-set goals, they are awarded Champion status. This achievement is celebrated in the media and at community festivals, encouraging continued participation and generating interest in the program from new groups. In the HIV/AIDS initiative, for example, youth clubs must complete certain activities in order to become champions. In the child survival initiative, kebeles (an administrative unit composed of several communities) can achieve champion status by meeting the goals they set for themselves in the areas of health and education. Through mass media and community-level activities, HCP “brands” the concept of champion status, creating buzz and inspiring individuals, groups, and communities to participate in project activities and adopt healthy behaviors. HCP expects that the use of this concept will lead to vibrant, sustainable programs that can be taken to scale.
“Ankoay” is the Malagasy name of the indigenous, endangered fish eagle whose habitat is primarily on the northwest quarter of the island. The overall goal of the “Ankoay” program is to transform youth groups into community leaders in the fight against AIDS. Youth groups earn the distinction of being an "Ankoay" by successfully meeting a package of AIDS-prevention requirements. The “Ankoay” program draws upon the best life skills approaches identified after consulting close to 20 curricula and program guides. Groups of young people work through a series of highly participatory activities, developing life skills such as decision-making, goal-setting, self-esteem, communication. The “Ankoay” activity book promotes the development of positive social norms and skills, while role plays and skits focus on behavior change through modeling. The Youth Passport, in turn, works through individual personalization and reflection. Together these materials allow youth to experience difficult and high-risk situations in a safe environment and to then proclaim their values to the larger community. The “Ankoay” program was launched in April of 2005 via 100 scout troops directly linked to the largest churches in the country. Shortly afterwards, the National Anti-AIDS Committee (CNLS) — an organization that reports directly to the President of Madagascar — “bought in” to the model. CNLS actively promoted the “Ankoay” model to the Malagasy branch of FIFA (World Soccer Federation), UNFPA, the Ministry of Youth Sports and Culture, and smaller NGOs. Efforts are underway to also bring the Ministry of Education on board. So, although the program is relatively young, its potential is remarkably broad. During the coming year, HCP will focus on rolling out the program through established social networks and using mass media to brand “Ankoay” as a symbol of excellence and service.
HCP's most important contribution in Mozambique thus far was helping develop a National HIV/AIDS Communication Strategy that articulates a shared vision for public sector and civil society organizations and coordinates implementation of their actions to fight HIV/AIDS in the country. After various attempts and eventually reaching an impasse, HCP was called to assist the National AIDS Council (NAC) in constructing a strategic communication vision that would gain consensus among key local partners, international donors, and community-based organizations. The communication strategy has become the fundamental tool for NAC to take action, coordinate the nationwide response to HIV/AIDS among partners, implement a geographically diverse intervention, and show results of the direction taken. HCP also partnered with the most important academic institution in the country, the Eduardo Mondlane University (UEM), to form the first generation of “Health Communicators” in Mozambique. With assistance from HCP, a hands-on course on HIV/AIDS Strategic Communication was institutionalized. The training course includes frequent on-campus HIV/AIDS awareness and behavior change campaigns. UEM is now sharing its success story and bringing this model of HIV/AIDS strategic communication to other leading universities in the country.
In Namibia, HCP is putting into practice the concept of community self-determination and ownership of health communication activities. Through an exploratory phase of community self-assessment, community members become highly motivated to address the challenges of HIV and AIDS in their communities. This process transforms communities' perspective from “what can we do to help this HIV project reach its objectives” to “what can the HIV project do to help us reach our objectives.” This creates a demand for the services of the program, as well as ownership of the process and results. HCP is also looking at how health communication both accelerates and improves the quality of community actions in Namibia. Through the modeling of approaches, collaborative materials development, and mass distribution, the health communication activities accelerate the diffusion of the community approach from community to community. By making accurate information accessible and by providing innovative and participatory approaches to behavioral change (such as life skills approaches, among others) in the communities, the quality of community interventions is improved. Lastly, HCP's work on interpersonal communication trainings for PMTCT and ART services with the Ministry of Health and Social Services is a ground-breaking area in Namibia. The MOHSS is investigating ways to incorporate this into their pre-service and in-service training cycles to ensure sustainability after HCP ends. The vast majority of efforts are focused on the medical/technical issues, whereas this training focuses on the needs of the client and provider. This has been a perspective that has been largely neglected in the PMTCT and ART scale up, but one that can make a huge difference in adherence, client satisfaction, and in reducing provider burn-out.
HCP anticipates an enduring legacy in South Africa in three areas. The first is in the use of innovative satellite technology for interactive distance learning for nurses and other health providers in health facilities throughout the nation. This is an innovation that increases access and quality of training available to health providers, particularly in remote locations, without them having to leave their post. The second is in the area of establishing direct links between mass media entertainment-education programs and civil society activities at the community level to capitalize on the strengths of both approaches. SABC produces and broadcasts an EE serial drama called Tsha Tsha. CADRE and HCP then work with a number of civil society groups to adapt Tsha Tsha themes and storyline into community approaches including community drama and radio programs, and also through the use of a facilitation guide at university-based and other listeners' groups. This sort of collaboration had not happened before and is valued by all partners involved. This could be a model for future collaboration after HCP ends. The third is in the area of innovative and collaborative research design and analysis. Through a collective learning and action approach, the first national-level health survey will be conducted this year made possible by collaboration between the government, CADRE, and HCP. Each group will contribute human and financial resources, and none of the groups could have mounted as large a study alone. This type of collaboration has not been done before and is possible due to the creation of trusting and collaborative relations between organizations built up over the years. Again, this is a precedent-setting collaboration that could be a model for future research activities in the country.
In Uganda, HCP's legacy will be the continued operation of the Young Empowered and Healthy (YEAH) Campaign Implementation Unit (IU) as a sustainable mechanism to support coordinated social and behavior change communication initiatives for young people. Also, a more youth-friendly society will facilitate the adoption of positive sexual and reproductive health behaviors and gender-equitable attitudes among young people. A partnership of two local health communication non-governmental organizations, the IU will independently manage multi-channel and multi-media SRH communication among young people for the Ugandan government and its partners. It will allow for multiple donor buy-in to future communication campaigns and programs implemented on behalf of the government. Paralleling this institutional strengthening in technical, administrative, and financial systems, will be an increase in the adoption of positive behaviors and attitudes by young people and increased community dialogue, collective action, and strong networks that encourage positive SRH behaviors and attitudes and protect young people from sexual exploitation. HCP also hopes to increase the capacity of the National Malaria Control Program to communicate accurate, updated, and relevant information on malaria control to its partners and the general public; increase patient knowledge about and adherence to ART; and offer training courses for health communicators in HIV/AIDS social and behavior change communication institutionalized within Makerere University and the Mildmay Centre.
HCP's legacy in Zambia will be individuals, households, and communities taking positive health actions to improve the quality of their lives. Communities will recognize, analyze, and prioritize resources and needs and take collective action to maintain and improve their health. In communities where malaria previously destroyed the prospects of children thriving and realizing their full potential, families and health providers will work together to find viable local solutions to save lives. Where youth once felt they had no voice, supported by their families and communities they will lead their peers in developing the skills and means to win the war against HIV/AIDS. Men and women will be more respectful of one another and model the benefits of gender equitable relationships and shared responsibility for insuring the health of their families. Engaged leaders will actively promote stigma reduction, protection of children, and elimination of harmful traditional practices. Strengthened local organizations and networks that have partnered with HCP will continue to lead the way to achieving lasting, positive social change that promises to transform Zambia into a healthier, more prosperous nation.
Because of BCCP's capacity and central position as the IEC leader in Bangladesh, it is able to orchestrate all the key government, donor, and NGO partners to rally and support the expansion of the innovative ARH program. The program's success can be attributed to a number of factors. Partners from a wide range of sectors — INGO, donors, NGOs, government and private — should be involved in a participatory way from the beginning and throughout. The program's logo, quality materials, and effective methodologies should be jointly owned. It was also made clear early on that HCP would only be able to bear the costs of TA and any organization that wanted to be involved would have to secure their own funds for implementation. The program included high quality Training of Trainers (TOTs) for selected trainers from organizations and government groups, and active working groups and networks like the ARH Working Group and the Life Skills Trainers Network It had support from the private sector and easy access to high quality materials at cost from a publishing house. Capacity building at all levels was part of the media and materials development and implementation process. Anyone involved needed to feel like they gained something by being involved, regardless of whether they were a government person, a donor, a writer, a parent or an adolescent. Multi-level advocacy at the national, regional and community levels in both the public and private sectors was also important.
In India, HCP's main contribution in terms of leaving a legacy will be the capacity built among its local partners. The current focus is on the three main pillars that can have an impact on the HIV/AIDS pandemic in Maharashtra — the NGO sector, the corporate sector (public and private), and the media. HCP will have built the capacity of the local partner, Avert Society, and the NGOs supported by Avert, to plan and implement strategic communication interventions targeted at at-risk groups, youth, and the general public. Staff at the NGOs are being trained in interpersonal communication and counseling through a series of communication skills building workshops. HCP is helping Avert and the NGOs develop quality materials for the care and support initiatives in their communities. HCP is motivating the corporate and business sector to develop workplace intervention policies regarding HIV/AIDS; to actively contribute to HIV prevention among their workforce; and to support those employees who are HIV positive. A workplace intervention (WPI) advocacy kit was developed to increase capacity of corporations to effectively address HIV/AIDS prevention and create a workplace intervention policy for people living with HIV/AIDS (PLHA) in their organizations. HCP is engaging business and industry leaders and encouraging them to integrate HIV prevention messages into their already existing universal health and wellness programs. They are also encouraged to connect with NGOs and services available in their communities. A documentary film highlighting various workplace intervention practices will also help to motivate others in the corporate sector to launch similar WPI programs in their companies. The media is being sensitized and their capacity being built to report accurately and sensitively about HIV/AIDS issues. A series of media advocacy workshops will be conducted with print and electronic media firms, advertising agencies, and content creators including television, entertainment TV channels, production houses, film industry, script writers, and directors. These workshops will focus on motivating the media to report in-depth about HIV/AIDS, to provide accurate information without sensationalizing the issues. The workshops will orient the media professionals on how to follow ethical guidelines while covering stories about PLHA and their families. HCP believes that though building their capacity, the above three pillars of society will function as the foundation for sustainable HIV/AIDS prevention interventions and care and support campaigns in Maharashtra, India.
Although USAID funding to KuIS ended in June 2005, the organization carries on with other sources of support, including Exxon Mobil and the Global Fund, with funding for TB advocacy (total of $1.1 million). HCP has provided technical assistance to KuIS in organizational development, advocacy, and communication. KuIS has built an umbrella health advocacy organization of public, corporate, NGO, and faith-based organization members. KuIS has valuable experience in advocating for sound public health policies and for increased funding and other resources for necessary public health programs. HCP's legacy is leaving behind an organization that will continue to exist as long as Indonesians see the continuing need to advocate for increased public health investments not only at the national but especially at decentralized levels. KuIS was established by Indonesians to respond to the need to protect and promote investments in public health at a time when Indonesia was rapidly decentralizing. Began in 2000 it was a coalition of about 100 organizations leveraging public, NGO, FBO, and private sector resources to support preventive public health. Today, KuIS endures without funding from USAID. KuIS has sought to make preventive health a priority at the national, provincial, district and household levels with coordinated involvement of non-governmental stakeholders, especially those in the private sector, with priorities based on the government's Healthy Indonesia 2010 framework. Achievements include:
Advocacy. KuIS and its members successfully advocated for preventive health at the national, provincial, and local measures. KuIS was tapped by Commission 7, the health and social development commission at the National Parliament, to review and help refine local national level health policy in Law No.23/1992 and the Population Law No. 10/1992. KuIS helped set up town meetings for members of parliament and various constituencies and provided local technical expertise. It organized research of the costs to local governments of poor health and used this and other materials to advocate to provincial governors, heads of district planning bodies, NGOs, academics, health practitioners, and the media. KuIS facilitated the formation of the youth advocacy group, the Indonesian Youth Partnership (IYP). Behavior Change Communication. KuIS has organized numerous local behavior change communication efforts. KuIS campaigns have supported government priorities for preventive care related to maternal health, tobacco, nutrition, malaria, and children's health as well as campaigns on TB, diarrhea, improved hygiene and sanitation, and clean water. In selected districts, local coalitions organized the “Posyandu as a Social Center ” program to complement KuIS's community-based “Healthy Family Program” aimed to recognize households and families as producers of their own health. In 2004, KuIS launched the hand washing with soap campaign in the provinces of Banten and North Sumatra, based on extensive formative research. Implementing the country's first Hand Washing with Soap movement drew considerable interest from partners, donors and other stakeholders. The movement continues to package and promote its products to ensure buy-in from other donors and provide services to a broader audience to leverage additional funds while reducing incidence of acute diarrhea diseases. Stakeholders have added to the HWS effort. For example, the Provincial Health Promotion Board (PHPB) in North Sumatra province requested for all health proposals funded by PHPB to integrate HWS into all programs until 2007; mass media, the local government also gave their full support to this campaign and has urged all stakeholders to join the movement
HCP's program in Nepal will leave behind a model for social inclusion through strategic communication. The HCP project has demonstrated how to extend access to services of the existing USAID bilateral, the Nepal Family Health Program, to marginalized groups in Nepal, including dalit (low caste) and Muslim. The model is a strategic combination of a local language radio program and materials; integrated literacy classes with a radio listeners group component; improved links between the community and peripheral health services through participatory approaches; Female Community Health Volunteer mobilization; and support to the government to extend FP services to remote communities. With this comprehensive, localized approach, the program is able to help address inequities in the system and reach the groups with the most need for quality services and create demand for them. The experience makes the case for the crucial role of culturally appropriate adaptation of materials, the need to work with local NGOs and the public health system at the district and community level, the added value of integrating literacy classes with mass media interventions, the importance of adapting quality media and materials to the local context (i.e., adaptation at the local level is a better way to develop materials than generation at the local level). Despite the conflict raging in the country, this model has been successful primarily due to the high level of partnerships between NGOs and the district health system personnel, and the close involvement of the community and health facility staff.
The following scenario illustrates HCP's vision for what will happen in Egypt when the project ends: “The key to my future is the good health of my family – and look, I have it right here in the palm of my hand,” said Sameh, a 30-year-old mother of three as she holds up a picture of herself, her husband and her children, ages 9, 6, and 3. Sameh proudly shows us the photo as well as the attached booklet full of health messages and immunization information for each of her three children. “I know”, she continued “that when something is wrong with my children, I can go to our village health center or the “Ask Consult” Pharmacy down the street to get information about how to make my child well”. Although the Communication for Healthy Living Project (CHL) ended over five years ago, Sameh and her neighbors still benefit from the health messages that continue to be disseminated thanks to a local grant received by the Community Development Association in her village. On this same trip, we visit Ahmed, the neighborhood pharmacist who belongs to the “Ask, Consult” group of pharmacists that received training on issues related to family health through a USAID grant provided to the CHL Project. Ahmed says participation in this group increased both his knowledge base and his business. “Clients come to me because they know I can give them reliable information about their health. They trust me.” The “Ask- Consult” logo winks down at us from the walls of Ahmed's pharmacy. “Participation in this group makes me eligible for discounts on pharmaceuticals and even a computer. Membership in this group of over 15,000 pharmacists is affordable and offers significant benefits. “The job I do is important to my community, I need to be sure I have the information my clients need to make them healthy”. Ahmed's final words are drowned out by the sound of laughter outside as the Governor of Minya arrives for the annual newlywed event in Minya. Governorates throughout Egypt have been working with private sector companies to promote healthy lifestyles through annual events. Private companies now clamor to underwrite government sponsored health events that address the needs of families. They want their products to be associated with good health and, above all, a positive future! They are proud to have a long standing relationship with the government to underwrite health events in the governorates.
HCP will leave a legacy of a more health-competent Jordan, where individuals, the government, health care professionals, and private companies take responsibility for a wide range of health issues. As a middle-income country with improving infectious and maternal and child health status, Jordan is now focusing on chronic diseases. HCP is helping with a cross-cutting approach (branded with the slogan “Our Health, Our Responsibility”) that addresses health issues across traditional health-sector divides, and fosters behavior change communication on many inter-related health issues under one umbrella. HCP's approach has drawn a diverse group of partner organizations into mutually beneficial relationships that ultimately improve health. For example, one partner, Al Ghad newspaper, began publishing a weekly health section with technical assistance from the project. Another company, Baltelco, aims to establish itself as the premiere internet services company not only in Jordan but regionally. Baltelco's partnership with HCP allows the company to expand in the area of health communication, while HCP benefits from a pioneering company's innovations in internet technology. These partnerships are an important legacy for HCP, because they represent the innovation, skill, and motivation of the next generation of health communicators in Jordan. To be successful, a cross-cutting approach must be founded on a comprehensive theory (e.g., health competence); project a unified vision; be based on a unified operational design (e.g., life stage); and deliver a simply understood, unifying message for people (Your Health, Your wealth or Jordan's slogan). Key messages should reposition “health” by linking it with happiness, or well-being, instead of “medical” conditions or services. It must be implemented with multiple partners, necessitating cooperation, joint ownership, and greatly increased capacity (through peer to peer learning). And finally, it must be evaluated with tools that show tangible results (across health areas), making the case for both the lateral "multiplier" and longitudinal "investment" effects of health competence (for individuals or communities).
HCP is working in partnership with public and private institutions, governmental, and non-governmental organizations in Haiti and hopes this leads to a sustained partnership among a variety of organizations for the attainment of common goals related to HIV/AIDS prevention, treatment, and care among youth. HCP now has a solid partnership with the Haiti MOH National AIDS program Youth coordination division and BCC working group. HCP is also working with various partners to implement AB interventions, including the MOH, religious organizations, Youth NGOs, media organizations, and schools. It supported the development of an ABY strategy and action with the MOH and its partners. HCP developed reference documents for partners, including curricula within the context of ABY, parent curricula, Catholic peer educator training manual, a community manual, and an ABY message guide. It is building the capacity of the MOH and its partners in assessing through participatory quality intervention the quality of youth services. Some partners need limited TA at the present time, while others need significant TA. HCP hopes to leave behind local teams at different levels (including the communities) to carry out their own HC activities or programs, as well as support each other in the development, implementation, and evaluation of HC programs. HCP hopes to increase the capacity of communities' and youth to analyze the issues underlying the HIV pandemic, search for possible solutions at different levels (including quality improvement of youth services), take action, and advocate for change. Community tools and materials will be produced to ensure sustainability of the activities. The main axis and focus of HCP's program are youth. They are “branding” the program in their country and leaving behind, as a legacy, a message of “ESPWA” (hope) among youth.
The most important contribution HCP made in Honduras is related to the HIV/AIDS program under the leadership of the Ministry of Health. This program focused on multiple domains as indicated in the Health Competence framework and included the political, community, and individual level. Focusing on high level policy makers guaranteed the support of the mass media campaign for youth and led to ownership of the campaign by the MOH. It also resulted in a high level of cost-sharing. The MOH paid for expanding the presence of the campaign on television. In addition, HCP was the first to develop, implement, and evaluate an HIV/AIDS communication intervention that included a Garifuna-targeted radio drama. HCP raised the visibility of strategic communication in Honduras to a different level by demonstrating it to be a science as well as an art that can be measured and be effective. |