Transcript Slide 1

CRS/GHANA’S
PRESENTATION
DANISH WATER FORUM & NETWORK
FOR INTERNATIONAL HEALTH
WORKSHOP
SOGAKOPE
18 – 20 SEPTEMBER 2007
TOPIC:
CRS’ BEHAVIOR CHANGE
STRATEGIES, SUCCESSES,
CHALLENGES AND LESSONS
LEARNED
OVERVIEW OF CATHOLIC RELIEF
SERVICES PROGRAMMING
History/Background of CRS’ Work in Ghana
• CRS has operated in Ghana since 1958 with the goal of
improving the quality of life among the poor and the most
vulnerable and helping victims of natural and man-made
disasters. The choice of beneficiaries is based on the
agency’s mandate to alleviate suffering and its
commitment to work for the poorest of the poor. These are
most often women and children in food insecure
households in rural communities where the major income
generating activities are rain-fed farming and small scale
local based agro-processing.
History/Background of CRS’ Work in
Ghana Cont.
To achieve its goal, CRS/Ghana acts as a
service and support agency for programs
and projects, which are implemented by the
Catholic Church, the Government of Ghana
and its various ministries, departments and
agencies, and other religious and non
religious and non-governmental
organizations that pursue common
development goals.
History/Background of CRS’ Work in
Ghana Cont.
• CRS/Ghana has interventions and programs in
several development sectors, including Education,
Health, Water and Sanitation, HIV/AIDS, Safety
Net Initiatives, Peace-Building and Conflict
Transformation, and Agribusiness.
• The three regions in the northern most part of
Ghana are cited in the Ghana Poverty Reduction
Strategy II as the regions experiencing extreme
poverty.
History/Background of CRS’ Work in
Ghana Cont.
These are also the regions with the highest levels
of malnutrition and stunting among children,
highest child morbidity and mortality rates, lowest school
enrollment and completion rates, especially among girls,
highest adult illiteracy levels, and the regions with the most
recurrent cases of guinea worm and other water-borne
diseases. As such, in pursuit of CRS’ global determination
to reach out to the “poorest of the poor”, CRS/Ghana made
a just decision since 1987 to focus its limited resources in
the three northern regions, in all its 34 districts.
Programs/Interventions
• Working with local church ,government partners, and other
NGOs, CRS/Ghana supports development through specific
activities or programs as outlined below.
• School Feeding: provides hot meals for pre and primary
school children and take home rations for girls to promote
enrollment, attendance and retention of school aged pupils.
• School Health Education Program (SHEP):
Recognizing the link between health and school
attendance, SHEP promotes appropriate hygiene practices,
teaches health education and provides children with
deworming tablets twice yearly
Programs/Interventions (Con’t)
• Quality Education Improvement Program
(QEIP): Improving educational attainment in
target schools through improved quality of
primary education using methods and activities
that are proven to yield results.
• Water and Sanitation: Improving access to water
and sanitation facilities for participating
communities by providing technical and
infrastructural support in addition to improving
hygiene practices by training community based
water and sanitation committees.
Programs/Interventions (Con’t)
• Agribusiness: Increasing incomes and yield for rural
farmers producing selected crops by adding value and
facilitating marketing linkages
• Peace Building: Supporting five satellite peace centers
throughout Tamale Ecclesiastical Province with training
and inputs to mediate and transform conflicts in selected
communities.
• Leprosy Support: Providing targeted hospitals materials
and support to improve the care of leprosy patients.
• Safety Net Initiatives (SNI): Providing food assistance to
marginalized and vulnerable groups ( PLWHA,
Orphanages, the Aged, physically challenged, visually
impaired and learning disability institutions, etc)
• HIV/AIDS: providing care and support to PLWHAs
Programs/Interventions (Con’t)
• Health Sector: Child Survival: The Child
Survival program relies on four key
objectives namely:
– Improving key household health and nutrition
behaviors among mothers of young children
– Improving accessibility of health services to
rural communities
– Improving quality of health services
– Increasing utilization of health services
Programs/Interventions (Con’t)
• INAAM (INTERGRATED NUTRITION ACTION
AGAINST MALNUTRITION
This focuses on rehabilitating undernourished children by
using quick impact and assets-based approaches at both the
community and facility level. These approaches include:
Focused Nutrition Intervention (FNI): Facility based
treatment of severe child under-nutrition
Child Survival Assistance/Targeted Food and EducationEducational support and appropriate food inputsPositive
Deviance (PD)/Hearth Approach-Assets based approach
that utilizes community based resources to rehabilitate
undernourished children. Central to the above stated
programs is the fact that they all hinge on the behaviour
attitude and situations of people.
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Why CRS Employs Behaviour
Change Strategies in its programs
CRS merely facilitates a process to aid the
communities/beneficiaries to change their attitudes or
behaviours towards a particular action or inaction, which
when not checked might generate into situations that
negatively affects one or more sectors of their lives.
These will then further exasperate an already declining
status of wellbeing. Thus cardinal to the successful
implementation of all these programs is the effective
participation of partners and beneficiaries in accepted
behaviour change strategies aimed at improving an
identified negative, harmful and sometimes life
threatening situation.
CRS’ BEHAVIOUR CHANGE
COMMUNICATION (BCC) STRATEGIES
• In the context of CRS’ work, we describe BCC as the
development of interventions that best empower target
groups to identify problems, evolve solutions and mobilize
resources and skills to address the problems.
• In the design of BCC strategies, CRS is guided by the
Academy for Educational Development’s (AED’s)
BEHAVE Framework. BEHAVE employs easy-to-use
tools based on principles of behavioral science to make
four strategic decisions:
BCC Strategies (Con’t)- BEHAVE
Model
• Who the primary target groups are that should be
reached with BCC
• What actions should be taken to change behaviour
• what the psychosocial, structural, or other
determinants and factors are that make the most
difference in the target group’s choice to act
• What strategies will be effective in addressing
those determinants and factors?
Selection of BCC Strategy
Once a BCC strategy is determined, it is further scrutinized
and categorized into the following 3 main categories:
• Instruction: This is communication designed to improve skills e.g. how
to wash hands, or brush teeth, how to prevent guinea worm infection,
how to breast feed exclusively
• Advocacy: Communication for removing environmental constraints
e.g. socio-cultural factors or norms that affect hygiene promotion and
education, exclusive breast feeding, high taxes that make mosquito
nets too expensive for people to buy.
• Promotion/Counseling: -Communication designed to change ideational
factors e.g. knowledge, attitudes (belief & values), perceived risks,
social influence, emotions etc.
CRS’ BCC Strategies
The key BCC strategies/activities most frequently employed are:
• INSTRUCTION - Communication designed to improve skills e.g. how
to wash hands properly with soap,
- Hygiene and sanitation education
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Nutrition education
Environmental education
Sensitization
Demonstration
Development and use of Health guides and other teaching/learning
materials
– Wall/pocket calendars
– Posters
– Child to child
CRS’ BCC Strategies (Con’t)
• ADVOCACY - Communication for removing environmental constrait
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- Community sensitization and meetings
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- Trainings
- Health Talks
- Radio Broadcast
- Drama
- Focus group discussions using appreciative inquirybest practices.
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- Handouts
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- Incentives-wheel barrows, hand washing containers
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- Child to child methodologies
CRS’ BCC Strategies (Con’t)
Promotion/counseling -Communication designed to change
ideational factors e.g. knowledge, attitudes etc.
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Drama, role play
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Quiz Competitions
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Health campaigns
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Health walks/circle of assessment
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Games
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Posters
Principles Guiding BCC
Participatory Hygiene and Transformation Tools (PHAST): knowledge and
tools from PHAST methodologies are adapted for various BCC strategies
across all sectors in the development of relevant and appropriate target
strategies.
Appreciative Inquiry: Recognizing that beneficiaries have a lot of
potential and a assets CRS usually employs AI to build on these localbased assets in the development of appropriate BCC strategies.
Regular review/Assessment meeetings: BCC strategies are constantly
reviewed to ascertain its relevance, impacts and acceptance by
beneficiaries. These reviews and assessments are usually conducted
with expert consultants in BCC and behavioural science.
Principles Guiding BCC (Con’t)
• Partnership/Collaborations: For continuity and sustainability CRS and
partners (GES/GHS/Community) has put in place structures to make
its BCC strategies more effective. Some structures established within
beneficiary communities include:
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School Health Clubs
Community School Health Management Committee
Community food Management Committees
Mothers Clubs
Watsan Committees
Community Volunteers attached to outreach clinics
Regional and district GES/CRS Partner supervisors
Partnership/Collaboration (Con’t)
In addition to these CRS-established structures, CRS
also works with already government established
structures such as SMC/PTAs, Regional and
District SHEP coordinators, Environmental
officers, District water and Sanitation Teams
(DWSTs), Community Health Nurses, District
Health Management Teams (DHMT)
Assemblypersons, area Council /unit Committee
members, chiefs, religious leaders magazias and
other community leaders.
Impact/Achievement of BCC
PERCENTAGE OF PUPILS WHO DEMONSTRATE AND
PRACTICE APPROPRIATE HYGIENE BEHAVIOUR
Baseline
2003
2006
(Target)
2006
(Achieved)
42.8%
47.8%
79%
Percentage of pupils in program schools
who consume de-worming medication twice per
year
Baseline 2003
Target 2006
Achieved 2006
0
85
86
Increase in Enrolment and Attendance
Indicator
Baseline
2006
Target
2006
Achieved
2006
48,827
53,700
# of Pupils
enrolled in
150,145
Program schools
(boys &girls)
157,650
171,240
% increase in
attendance of
pupils (boys &
girls)
50
59.3
# of Girls
44,388
enrolled in
program Schools
24.6
Increase in Enrolment and
Attendance
Indicator
% increase in
girls’ attendance
% of teachers in
program schools
effectively
planning their
lessons
% of teachers in
program schools
using pupil-
Baseline
2006
Target
2006
Achieved
2006
24.5
55
83
78.0
-
97.0
19.7
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62.4
Nutritional Status of Children under 5
years
STUNTING
DISTRICT
BASELINE2004
MID-TERM 2006
Moderate
Lawra
19.6%
11.2%
Severe
Lawra
7.6%
3.7%
Moderate
East Mamprusi
21.8%
19.7%
Severe
East Mamprusi
16.7%
7.4%
Moderate
Saboba
25.3%
15.4%
Severe
Saboba
18.9%
7.7%
Moderate
Bongo
24.8%
15.9%
Severe
Bongo
11.8%
9.3%
Moderate
Wa
20.9%
8.5%
Severe
Wa
20.3%
16.9%
Water & Latrine Provision
Facility
2005
2006
2007
Boreholes
4
6
8
HH
Latrines
140
510
600
Usage of Household Latrines
Year
# of
Communities
Household
Latrines
Family
Size
2005
7
70
420
2006
13
494
2,964
2007
19
500
3,000
SUCCESS STORIES
• 1. Adaboya School/community: The School Health Club
action plan had contribution of shea nuts as an activity. All
children willingly contributed and money used to purchase
10 cartoons of soap and the rest used to buy shares in the
Bongo Community Bank
• 2. Feo SHEP Club constructed a urinal whilst community
provided coaltar for painting. School Health Clubs
engaging in income generating ventures like basket/hat
weaving to support SHEP activities
SUCCESS STORIES (Con’t)
• 3. SHEP Club members asking for land from opinion leaders for
farming purposes to sustain the program
• 4. SHEP teachers integrating the program into capitation grants by
adding provision of soap to their School Performance Improvement
Plan
• 5. As a result of effective animation, the communities of Langbinsi and
Namangu in the East Mamprusi district have evolved a good
maintenance strategy ( by employing young girls who keep registers of
money collected on water fetched) by collecting token amount of
money on each bucket of water collected and saving it at the bank to
yield profit. Use of the money to purchase spare parts for maintenance
SUCCESS STORIES (Con’t)
• 6. A Community Health Volunteer through her active
involvement in CRS health program by working with
nurses and keeping of good records, finally gained
admission into the Nursing school
• 7. Mothers (lactating and pregnant) attend clinics regularly
even though food incentives given has ceased
• 8. Mothers of malnourished children are learning from
mothers of well-nourished children how to combine locally
available food commodities to ensure that their children
grow strong and healthy
CHALLENGES
• Post –intervention assessment
• Dissemination of information to the larger
community
• Target and coverage (scope)
• Ineffective coordination among stakeholders
(NGOs and District assemblies)
• Volunteerism fatigue (motivation, migration, etc)
• Lack of clear-cut policy directives e.g. SHEP
• Enforcement of bye-laws
• Inadequate funding
LESSONS LEARNED
• Collaboration /consultation with key partners helps in
synchronizing activities
• For greater impact and success involves direct
beneficiaries in programme planning information and
assessment.
• Capacity-building is a key tool
• Behaviour change is a process – it takes time to see the
impact
• Hardware and Software leads to total behaviour change
(improved health)
• Total coverage enhances behaviour change
• “A good cloth sells itself”. Here good work promotes itself
• THANK YOU FOR YOUR
ATTENTION!!