Case Study: Essential Malaria Actions in Ethiopia

This 7-page report shares the experience and lessons learned from C-Change Initiatives in Ethiopia designed to address and reduce malaria morbidity and mortality by scaling up coverage of proven malaria prevention and control interventions such as long-lasting insecticide-treated bed nets (LLIN), indoor residual spraying (IRS) in households, and improved case management.
 
Given the task of providing technical and programme support to the key malaria stakeholders to “maximise access to, use of, and adherence to all main malaria prevention and control interventions-“ C-Change’s goal in Ethiopia was communication-oriented: mass media, interpersonal communication, and community engagement are part of the strategy to “empower Ethiopian families to take preventative and treatment-seeking actions related to malaria and antenatal care/maternal, newborn, and child health, so that families’ health status is improved.”
 
C-Change created teaching tools and skills-based trainings that “can be owned and managed by woreda (district) and kebele (municipality) level teams” which would help to overcome barriers such as a lack of understanding about the severity of the risks of malaria, an absence of socio-cultural norms to use of LLINs, low acceptance of IRS, slow response to seek medical care when a fever begins, and a lack of adherence to treatment.  
 
C-Change Ethiopia designed their project to overcome these barriers by:

• “Addressing social norms and attitudes linked to malaria and increasing self-efficacy for positive malaria actions”;
• “Designing interventions that embrace an integrated approach using three strategic approaches (i.e., advocacy, social/community mobilisation, and behavioural change) for maximum impact”;
• “Effecting household behaviour change by influencing communal social norms through the use of a Model Community approach.”

Once the barriers and norms were identified, “six cross-cutting communication strategies” were developed:

• "Strategy 1: Use research to inform and guide problem analysis, strategy development, and programmatic design.
• Strategy 2: Actively engage the community by leveraging existing structures and community such as Health Extension Workers (HEWs), volunteer Community Health Workers (vCHWs), and other volunteers to mobilise communities for action to control malaria.
• Strategy 3: Reinforce interpersonal communication interventions via the application of mass media interventions to promote essential actions to families.
• Strategy 4: Strengthen capacity in SBCC by providing training and mentorship at all levels of the ORHB and other Regional Health Bureaus structure, emphasising practical communication applications and establishment of a mentoring relationship at all levels.
• Strategy 5: Strengthen partnership and the linkages among stakeholders, e.g. health centers, HEWs, vCHWs, local organisations, schools, and individual families, to build a cohesive, comprehensive effort to boost malaria control efforts.
• Strategy 6: Ensure the sustainability of prevention and control activities after project completion through the application of capacity building interventions at the local, regional, and federal levels."

Through coordination and communication, malaria stakeholders throughout the country came together in workshops to “develop a common approach to SBCC interventions and cross-partner coordination” eventually leading to the formation of the Malaria Communication Taskforce. The taskforce continued coordination efforts including the task of harmonising messages to be shared about malaria prevention health actions for families and communities, ultimately coming up with “8 essential malaria actions (EMA) that were considered crucial behaviours and adoptable at the individual level."

Informed with these EMA and various communication tools, C-Change and CARE began the Model Communities campaign which “seeks to engage the targeted population at both the family and community levels by utilising local experts and/or champion those community members who have already adopted the desired behaviour” to share “their successful practices with other community members.”  First, they trained community champions to promote the EMAs. Families who adopt all the desired practices are certified and receive recognition as Model Families, and when a certain level of the community is engaged, a community is recognised as a Model Community. There are concurrent radio campaigns accompanying the local organising.
 
By the time of this report, the campaign had successfully run for three years and awarded Model Family status and Community Champion recognition to 209,563 families in four woredas representing 517 kebeles. The campaign model has also been replicated in Kenya (2012), and the Democratic Republic of Congo (2011).
 
Campaigners note that, among the factors for success they have learned in the process, it is important to use “multiple, reinforcing channels” to get the messages across at many levels. Tools should be simple and easy to follow as well as replicable so that trainers can be trained from the regions to the kebeles. Coordination will help to “ensure scale, saturation, and sustainability.”