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Dr. Owembabazi, Director Uganda Health Cooperative

Malaria Communities ProgramSeptember 13, 2010

Applying Behavior Change Applying Behavior Change Communication Communication

to Prevent and Treat Malaria in Ugandato Prevent and Treat Malaria in Uganda

HealthPartnersHealthPartners

• Is an independent, member-owned and democratically-governed health insurance organization created with equity financed by members who invest in order to benefit through their patronage.

• Helped Ugandans develop the Uganda Health Cooperative based on the same model

• UHC/MCP builds on this model to increase the sustainable impact of malaria prevention and treatment interventions

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ObjectivesObjectives

% of pregnant women and children under 5 that sleep under a long lasting insecticide treated bednet (LLIN) every night from 42% to 90%;

% of pregnant women receiving 2 or more doses of Sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp) during their pregnancy from 27% to 85%;

• Build sustainable, local organizational capacity to reduce malaria and to manage health schemes protecting at least 14,000 members.

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StrategiesStrategies

• Follow MOH Directives• Implement cascade of

sensitization and training

• Address national, district, sub-district and community levels

• Build capacity using existing systems and resources

• Sustainability Framework

• Train trainers• Develop partnerships• Local stakeholders

drive change • Active engagement of

religious and political leaders, employer groups, schools....

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Behavior Change Behavior Change Communication (BCC)Communication (BCC)

• Research and identify – local barriers to change– key target groups

• Develop a plan that directly addresses barriers for each target group with a range of interventions and support

• Build local capacity to lead and support change

• Monitor results and adapt accordingly5

Children and adults with malaria Children and adults with malaria are not getting proper and early are not getting proper and early

treatment*treatment*Communication challenges at household level

• Poor knowledge about signs and symptoms of malaria and importance of early treatment

• Common use of traditional medicines and self-treatment with inappropriate drugs

• Inadequate knowledge about appropriate treatment drugs and dosages for children and adults

• Poor compliance with proper treatment regimens• Lack of access to health services and information

* National Communication Strategy for Malaria Control in Uganda 2005-2010;

Ministry of Health National Malaria Control Programme

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Children and adults with malaria Children and adults with malaria are not getting proper and early are not getting proper and early

treatment*treatment*Communication challenges at service delivery level

• Many staff not knowledgeable about appropriate treatment drugs and dosages

• Lack of access to up-to-date policies and treatment guidelines

• Stock-outs and inadequate supplies of appropriate drugs

• Lack of community drug distributors in many locations* National Communication Strategy for Malaria Control in Uganda 2005-2010: Ministry of Health National Malaria Control Programme

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Pregnant women are not Pregnant women are not preventing and treating malaria preventing and treating malaria

correctly*correctly*Communication challenges at household level• Poor knowledge about the dangers of malaria in pregnancy• Lack of knowledge about IPT for malaria in pregnancy• Fears about the effects of taking drugs during pregnancy• Poor ANC attendance practices (too few, too late)

Communication challenges at service delivery level• Many service providers not knowledgeable about IPT and

appropriate treatment of malaria in pregnancy• Lack of access to up-to-date policies and treatment guidelines• Stock-outs and inadequate supplies of appropriate drugs• New drug policy change to A/L• Providers at understaffed facilities have little time for IEC and

counseling about IPT

* National Communication Strategy for Malaria Control in Uganda 2005-2010 by the Ministry of Health National Malaria Control Programme

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Low use of ITNS/LLINS*Low use of ITNS/LLINS*

Communication challenges at household level• Lack of information and knowledge ● Inappropriate use

about benefits of ITNs/LLINs and ● Inconvenientimportance of preventing malaria ● High cost

• Lack of access and re-treatment services • Concerns about safety and effects of chemicals

Communication challenges at service delivery level• Providers lack information and knowledge about ITNs/LLINs• Providers at understaffed facilities have little time for promotion and

IEC on benefits and appropriate use• Low demand discourages private sector and community vendors from

stocking ITNs/LLINs and re-treatment supplies

* National Communication Strategy for Malaria Control in Uganda 2005-2010 by the Ministry of Health National Malaria Control Programme

Community-Owned Community-Owned Cooperative Health Cooperative Health

FinancingFinancing• Built local stakeholder capacity to

sustainably manage a member-owned, prepaid health cooperative to reduce barrier of cost when seeking care

• Developed training resources to apply behavior change communication principles to helping people join health cooperatives

• Membership provided to volunteers at a discount

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Responding to Responding to Feedback and Feedback and OpportunitiesOpportunities

• Piloting Village Savings and Loan projects to enable VHT to learn to work collaboratively together and to help increase their income

• Implemented data centers in health facilities for improved communication and coordination of resources

• Participating in LLIN distribution campaign

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Behavior Change Behavior Change InterventionsInterventions

• Provided resources to support VHT BCC efforts including– flip charts,

brochures and posters

– data registers– small incentives

like certificates, pens and bags

• Trained village health teams (VHT)

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Health Facility ResourcesHealth Facility Resources

Provided:– LLIN demonstration

kits for VHT to borrow

– posters on best care practices and healthy treatment seeking

– Cups and safe water for observed IPT

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Channels of Channels of CommunicationCommunication

Embraced local channels of communication– Aired radio

announcements – Commissioned

drama shows– Incorporated

dancing

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Support Systems for Support Systems for Change Change

• Linked VHT to HW for quarterly support supervision meetings

• Invited local leaders to HW-led quarterly meetings

• Engaged religious leaders to lead by example and promote VHT services

• Initiated quarterly District Health Team-led stakeholder meetings and supplied a toolkit to support adoption of this practice

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Thank You!Thank You!

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