1

16-18 January 2013Addis Adeba Rocio BERZALEthiopie C4D Specialist Niger

African leadership for child survival

Promoting social and behaviour change for Child survival

Setting the basis - (from 2006 to mid-2008)• Research LANCET, pilot design, secure resources (HR and financial)• Identify & develop coordination mechanisms (national and local)

1. 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)2. Social Mobilization

• Creation of partnership and networks (trad. chiefs, women, youth) • Media campaigns

3. Advocacy • Local (imams, traditional chiefs) and national levels (partners)

Community empowermentFrom 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

SITAN

DIFFUSION SITAN

PLAN

ANALYSIS

PLAN

ACTION

ANALYSIS

CONTACT

CONTACT

ACTIONDIFFUSION

Scaling up: communities, agents of change

Identify acteurs Establish trust relationships Using stimulus guiding dialogue

Community self- diagnosis

Community plan of action

Promotion KFP• Celebration of progress• Certification «communauté Modèle»

• Amplication horizontale et verticale

Community assesment

Catalyseurs• Facilitators/ volunteers• Supervisors (NGO)

• Traditional Mass media/ actors of change

• Modern Mass media

• Step 1• Identification

of problem

• Step 2• Involving leaders

and participants

• Step 3 • Clarification

perceptions Training

• Etape 4• Expression of

individuals and collectifs needs (census/ cartographie)

Step 5•Evaluation current situation•Vision •Establish’ objectifs• Reaching consensus about activities

Step 6Analyse and action plan

Step 7Sharing responsabilities (relais, village chief and religious

Step 8Social Mobilisation

Step 9Implementation activities

Step 10Community based monitoring system

Step 11 Participatory assessment

Step 12 Recognition of model families and villages

Changements individuels• Individual Changes• Competencies• Ideation : Knowledge,

Self- Confidence, Risk Perception, subjective Norms, self Image,

Emotions, Self-efficiency, Social Influence, personal advocacy

• Intentions• Behavior•

• Social Changes • Leadership• Level and equity of

participation • Information equity • Collective Self-

efficiency • Ownership• Social Cohesion • Social norms •

• Community Dialogue

• Collective action

Societal impact

Cons

trai

ntes

and

ext

erna

l sup

port

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 FAMILIESCommunes Total pop. Children 0-5

5 140,331 28,766

Communes Total pop. Children 0-530 1,076,159 183,859

Scaling up in 5 regions with 6 NGOs (from mid-2009)

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

• Individual behaviour changes are supported and accelerated

Results accelerated in individual & social change (INS Survey and LASDEL study in 2012)

• 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..)

Practices Intervention zones Control zonesEarly breastfeeding initiation (within 1 hour after delivery)

88.7% 76.5%

Exclusive breastfeeding 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%

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

Organization of transportation of pregnant women to the health centersHusbands more supportive of health facility attendance The “community cart” gives community members access to health services

Young leaders

• Model leader

s

“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 Ambassado

rs

Local media trained in KFP becomes spokespersons and organizes public broadcasts with population

Volunteers create demand for products and health services among the populationVolunteers 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)

ITN ownership25%

Others (<2% each)

11%

Reduction in nutrition

19%

Careseeking for malaria

9%

Vit A supp.9%

Careseeking for pneumonia

8%

ORS + Zinc5%

Measles vaccine

5%

Hib vaccine4%

Changes in BF practices 3% TT in preg 2%

22

• 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

Bibliography

Many thanks