Transcript African leadership for child survival 16-18 January 2013 Addis Adeba Ethiopie Rocio BERZAL C4D Specialist Niger.

African leadership for child survival
16-18 January 2013
Addis Adeba
Ethiopie
Rocio BERZAL
C4D Specialist Niger
1
Promoting social and behaviour change
for Child survival
Setting the basis - (from 2006 to mid-2008)
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1.
2.
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Research LANCET, pilot design, secure resources (HR and financial)
Identify & develop coordination mechanisms (national and local)
Social & Behaviour change communication
•IPC / community workers + participatory communication for individual change
(proximity and traditional media, cinema, theatre, community radios…)
•Community empowerment / participation for collective change (community
learning, community-led design, implementation and M&E of action plans)
Social Mobilization
•Creation of partnership and networks (trad. chiefs, women, youth)
•Media campaigns
Advocacy
•Local (imams, traditional chiefs) and national levels (partners)
Community empowerment
From Collective learning…
Introduce approach, build trust
…To Collective action:
Participatory community
assessment
Village plan of action
Meetings to discuss the
progress
Annual celebration of
champions
Community advocates
Community assesment
Promotion KFP
Scaling up: communities, agents of change
ANALYSIS
•Celebration of progress
•Certification «communauté Modèle»
DIFFUSION
SITAN
ACTION
CONTACT
•Amplication
horizontale et
verticale
PLAN
PLAN
DIFFUSION
ACTION
Community plan
of action
ANALYSIS
SITAN
Community self- diagnosis
CONTACT
Identify acteurs
Establish trust relationships
Using stimulus guiding dialogue
Catalyseurs
•Facilitators/ volunteers
•Supervisors (NGO)
•Traditional Mass media/ actors of
change
•Modern Mass media
•Step 1
•Identification of
problem
•Step 3
•Clarification
perceptions
•Step 2
•Involving leaders
and participants
Training
•Etape 4
•Expression of
individuals and
collectifs needs
(census/
cartographie)
Step 6
Analyse and action plan
Step 5
•Evaluation current
situation
•Vision
•Establish’ objectifs
• Reaching
consensus about
activities
•Collective action
Step 7
Sharing
responsabilitie
s (relais,
village chief
and religious
Step 8
Social
Mobilisation
Step 9
Implementatio
n activities
Social Influence, personal
advocacy
•Individual Changes
•Intentions
•Competencies
•Ideation : Knowledge, Self- •Behavior
Confidence, Risk Perception, •
subjective Norms, self Image,
Emotions, Self-efficiency,
Changements individuels
Step 10
Community
based
monitoring
system
Step 11
Participatory
assessment
•Social Changes
•Leadership
•Level and equity of
participation
•Information equity
•Collective Selfefficiency
Societal impact
Step 12
Recognition of
model families and
villages
•Ownership
•Social Cohesion
•Social norms
•
Constraintes and external support
•Community Dialogue
Analyse data on KFP and community
interaction with health system
Community-based monitoring form allows gathering data on KFP
adoption and sharing /discussing indicators with health workers
at village level.
The purpose of the village
action plan is outline different
actions to help the practices
adoption.
A problem of supply/resource
issues could be outlined in the
action plan to stress this issue
and find solutions, included
advocacy actions. Monitoring
tool.pptx
SCALING UP FROM 140,000 TO 2 MILLION FAMILIES
Communes
Total pop.
Children 0-5
5
140,331
28,766
Scaling up in 5 regions with 6 NGOs (from mid-2009)
Communes
Total pop.
Children 0-5
30
1,076,159
183,859
Scaling up through other programme entry doors (from mid 2011)
WASH, EDUCATION, CASH TRANSFER
Communes
Total pop.
Children 0-5
15 (WASH/HEALTH)
600,000
120,000
8 (CASH TRANSFER)
280,000
56,000
4 (EDUCATION)
120,000
24,000
Results accelerated in individual
& social change (INS Survey and LASDEL study in 2012)
• Individual behaviour changes are supported and accelerated
Practices
Intervention zones
Control zones
Early breastfeeding initiation (within 1 hour after
delivery)
Exclusive breastfeeding
88.7%
76.5%
77.4%
53.7%
Vitamine A (one dose received in the past months)
86.8%
79.1%
Women hand washing with soap
78.9%
76.2%
Mothers using ORS treatment
58.3%
29.1%
• Social change: increased participation, sense of ownership, change
of social norms (EBF, assisted delivery..), the community enters in a
dynamic of change (various initiatives related to hygiene,
education..)
Empirical evidences
Public sanitation days
Building of public garbage bins
“Social cohesion”: The village had created a
“food bank,” solidarity system organized to
invest in nutrition activities
Young
leaders
Organization of transportation of pregnant women
to the health centers
Husbands more supportive of health facility
attendance
The “community cart” gives community members
access to health services
Model
leaders
“You can see the change by looking at the health of
our children. I think I can convince the others. When
women saw my baby recently they all commented
on how healthy my baby looked”.
KFP
Ambassadors
Local media trained in KFP
becomes spokespersons and
organizes public broadcasts
with population
Volunteers create demand for products and health
services among the population
Volunteers generate knowledge and information
about care-seeking and monitor behaviours
Volunteers assist the health staff of the health
center by holding communication sessions for
patients
Approaches for scaling up in 2013:
consolidating gains and increasing impact
Increasing alliances to scale –up coverage focused on ICCM,
nutrition and social safety nets:
• MDG Initiative at level of 8 health districts supported by EU
• Modelling a community-based nutrition program to reduce
and prevent chronic malnutrition
• Safety nets: Cash transfer + KFP in 1,000 villages
• Alliance with WFP in 1200 CRENAMs and 29 Health Districts
• Alliance with UNFPA, Mens involvement initiative « Schools for
husbands » in 1 region
Evidence: Almost 60,000 children’s lives saved in 2009!
Proportion of child lives saved in 2009, by intervention or risk factor
reduction (List JHU team)
Careseeking
for malaria
9%
Vit A
supp.
9%
Careseeking for
pneumonia
8%
ORS + Zinc
5%
Reduction
in nutrition
19%
Measles vaccine
5%
19% lives saved
Others
(<2% each)
11%
Hib vaccine
4%
ITN ownership
25%
Changes in BF
practices 3%
TT in preg 2%
Bibliography
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LANCET series 2003, 2004
Proposal for Spanish Government : Fomentar la incorporacion de practicas familiares a
fin de promover la supervivencia del niño en Niger, Unicef Niger, 2008
KAP study on KFP, KONE Mariatou, Niger, juillet 2008
EDSN MICS III 2006, EDSN MICS IV 2012. INS NIGER
Narrative of an Action Research project in Communication for Social and Behavior
Change, in five municipalities of Maradi and Zinder, Niger. Manuela Varrasso
Enquête quantitative sur les Pratiques Familiales Essentiels. INS, Niger. Avril 2012.
La promotion des Pratiques Familiales Essentiels au Niger, LASDEL-Avril 2012.
Figueroa M.E., Lawrence Kincaid D., Rani M., Lewis G., Communication for Social
Change: An Integrated Model for Measuring the Process and Its Outcomes,
Communication for Social Change Working Paper Series I, The Rockefeller Foundation
and Johns Hopkins University Center for Communication Programs, New York, 2002
LANCET. Reduction in child mortality in Niger: a Countdown to 2015 country case study
Agbessi Amouzou, Oumarou Habi, Khaled Bensaïd, and the Niger Countdown Case
Study Working Group
Qualitative research to identify solutions to local barriers to care-seeking and
treatment for diarrhoea , malaria and pneumonia in Niger. Juliet Bedford, 2012
Review/analysis of UNICEF Community-Led Total Sanitation and Essential Family
Practices Communication for Development Interventions in Niger. Karen Greiner 2012
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Many thanks