Community IEC/BCC Strategies in the Community Led Sustainable Health Project Phase II

1. Introduction

Village Education Resource Center (VERC), a Bangladeshi non-governmental organization (NGO), with the support from Simavi, a Dutch non-governmental health organization has been implementing a community led sustainable health project (CLSHP) in the three unions of Lalmohon upazila under Bhola district for three years from July 2006. In July 2009 the project was reviewed. The review report recommended for the continuation of the project with revised design, providing more emphasis on community empowerment for achieving the purpose of the project. Accordingly the second phase of the project was designed expanding to cover the entire Lalmohon upazila with the goal of institutionalizing an effective community managed sustainable health service accessible to all sections of people focusing on poor women and children in Lalmohan upazila attaining improved hygienic practices and health situation. Objectives of second phase are:

  • To bring long term change in behavioral practices by raising community awareness on health and hygiene issues and hence improve the general level of health.
  • To provide access to quality, affordable, sustainable health services in response to the beneficiaries’ needs.
  • To ensure that all members of the community, regardless of gender, age, disability or socio-economic situation have full access to the services available and participate fully in community led initiatives.

The project aims to undertake three prong strategies. First one is massive community awareness for preventive and promotive aspects of health, so that they can control their behaviours and environment resulting minimum sickness. For this, community will be segmented into children, adolescents boys and girls and adults male and females. Each of them will be made aware on different preventive and promotive health issues using multi-channels. Second strategy is to make the community aware about the different services available to them from government and NGO sectors for needed utilization, empower community representatives to negotiate with the service providers and their controller for re-scheduling the services to best suit with communities need and play watch-dog role for the services, so that communities are guaranteed with sustainable services.  The third among the strategies is to provide need based services to meet the requirements of the special groups of the community – located in difficult geographical locations, ethnic groups, marginalized communities etc.

The first strategy is being elaborated under this community IEC/BCC strategy, which also aims to empower the community with adequate information, so that they can modify their own behaviours accordingly and have better control over their environment so as to remain free from sickness.

 

 

2. IEC/BCC

The terms IEC and BCC are commonly used.  Information, Education and Communication (IEC) is a process of working with individuals, communities and societies to develop communication strategies to promote positive behaviors which are appropriate to their settings. Behavior Change Communication (BCC) is a process of working with individuals, communities and societies to develop communication strategies to promote positive behaviors which are appropriate to their settings; and provide a supportive environment which will enable people to initiate and sustain positive behaviors. Experience has shown that providing people with information and telling them how they should behave (“teaching” them) is not enough to bring about behavior change. While providing information to help people to make a personal decision is a necessary part of behavior change, BCC recognizes that behavior is not only a matter of having information and making a personal choice. Behavior change also requires a supportive environment. Behavior change communication is influenced by “development” and “health services provision” and that the individual is influenced by community and society. Community and society provide the supportive environment necessary for behavior change. IEC is thus part of BCC while BCC builds on IEC.

 

3. Community IEC/BCC Strategies

Ten topics have been identified for the IEC/BCC in the project, which are

  • Reproductive and Sexual Health
  • Family Planning/Birth Control
  • Maternal Health – ANC, Birth Planning, PNC
  • Newborn care
  • Child Health – Immunization, Diarrhoea, Acute Respiratory Tract Infection
  • Nutrition – Breastfeeding, Supplementary feeding
  • Tuberculosis and Leprosy
  • Water, sanitation and environment
  • HIV/AIDS
  • Information about service facilities

 

Community people have been segmented into five groups for IEC/BCC activities, which are

  • Children groups
  • Adolescent Girls groups
  • Adolescent Boys groups
  • Adult Female groups
  • Adult Male groups

 

Each of the new nine wards of the unions/municipality will be divided into two and assigned to one community volunteer (CV). Each CV will form one group comprising 25-30 members drawn from his/her assigned catchment areas (half of new nine ward of the union/municipality) for each of the above mentioned segments. Thus each CV will form five groups (each for children, adolescent girls, adolescent boys, adult female and adult male) in his/her area. Each union/municipality will have eighteen groups for each of five segments of the community. Each union/municipality will have ninety groups, each comprising 25-30 members. The project areas will have one hundred and eighty groups for each five segments of the community and in total nine hundred groups.

Specific messages for each of the identified topics applicable for particular group will be identified and CVs will be extensively trained to deliver those messages following multiple and innovative channels. Examples of messages for particular topics for specific groups are given in the annexure. Following a structured guideline, CVs will conduct focussed group discussions (FGD) with each group to asses their existing knowledge, attitude and practice (KAP) about identified health issues. Compilation of the FGDs will form base-line KAP of the community. CVs will also be supplied with appropriate communication tools like poster, leaflet, flip chart, flash card, video, game tools (for children groups) for effective communication. CVs to keep records of their respective group-members, so that same people turn up in every sessions and not new comers in each different sessions keeping the numbers in group same. CVs to keep record also about the topic discussed with attendants present. CVs will encourage members of the groups to disseminate information learned by them to their respective peers like children to other children, adolescent girls to other adolescent girls, adult male to other adult male etc. of the same area, so that wider population comes under coverage of message dissemination. Project may periodically arrange knowledge retention test among the members of segmented groups (children, adolescent boys, adult female etc.) – separately for the members who received messages by the CVs and others received messages from the peers and award prizes to the top achievers ceremoniously to raise interest and attention to the awareness raising programme. Mostly CVs will undertake group discussions using posters, flash cards, flip charts, video etc. for message dissemination. They will however consult respective group members to decide about the day, time and venue of their meeting to ensure maximum participation. Each CV to prepare a very details schedule of disseminating all the messages of the topics (some topics may require several days) to all five groups within two and half years of the project time. CV will have to adopt according to the group. Adult males may not be available before night as busy with other works. They may be better available in the market place, may be around tea-stall. Adolescent boys, girls and children may be available only in the afternoon as remain busy in schools in the morning. Adult females may suit better a bit after mid day after finishing the lunch. Children may learn faster and quickly through games. Messages may be punched within the game, like snake-ladder etc.

Male CV may find difficulty in handling adolescent girls and adult females, particularly for some sensitive issues like reproductive/sexual health, menstrual hygiene management etc. Similarly female CV may have the same difficulty with adult males or adolescent boys for sensitive issues like reproductive/sexual health, night pollution etc. Involvement of Health Motivators and Programme Organizers while scheduling sessions may resolve the problem by bringing same sex CV to handle respective groups.    

Members of the Community Support Groups and Health Watch Committees will also be thoroughly oriented about the messages and topics by the assigned Health Motivators and Programme Organizers respectively.

    • Monitoring

 

Base-line KAP of the selected topics will be available for each group independently or collectively of a ward, union/municipality or entire project areas. Similarly all groups collective KAP will also be available for any defined geographical area or the entire project. Periodic competition for assessing knowledge retention as mentioned above may provide information for monitoring. Also practice of people as evidenced in uptake of care like immunization (both child and female), ANC, PNC, contraceptive acceptance, available from routine date collection will be used to monitor effectiveness of the IEC/BCC undertaken. 

    • Conclusion

 

Health promotion has no end. However for the limited duration project and also considering budget and human resources available, the project has identified limited priority topics for promotion. Also the project can’t reach to each of the community members for promotion due to obvious limitations. Project has segmented audience into five categories based on sex and age and aimed to disseminate messages to the core members of each segment with the expectation of snow-ball effect from them to the wider community. Since each family is expected to reach through multiple members – child, adolescent girl/boy, adult male/female etc., expectation is the synergistic action within the family and community for better and effective compliance.

Reproductive and Sexual Health

Adult Male and Female Groups; Adolescent Girls and Boys Groups

  • General idea of reproductive system with organs involved and their functions of both sexes

Male: Penis, Testis; growth with age; sperm production and pathway of travel; body and psychological changes in puberty; night pollution
Female: Breast, Vagina, Uterus, Cervix, Fallopian Tubes, Ovary; growth with age, menstruation, menstrual hygiene management, body and psychological changes in puberty, Breast and Cervical Cancer

  • Conception
  • Infertility
  • Sex of child determination
  • Sexually transmitted diseases and protected sex
  • Violence against women
  • Eve teasing
  • Acid throwing

This topics is not applicable for Children group

 

 

Family Planning/Birth Control

Adult Male and Female Groups; Adolescent Girls and Boys Groups

  • Necessity and urgency of Population Control in Bangladesh
  • Methods of Birth Control

Male:  Condom, Vasectomy
Female: Oral Pill, Injectable, IUD, Norplant, Tubectomy
Temporary, Long-acting and Permanent Methods
Couple suitability of method
Side-effect and complication of each method

  • Availability of methods: FWA, UHWC, UZHC, MCWC
  • MR, Abortion, Emergency Contraception Pill

This topics is not applicable for Children group

 

 

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Quarterly Programme Meeting 19-21 July 2011