An Adaptable Communication Strategy for Amoxicillin

This strategy document is written to support communication on one of the "13 Lifesaving Commodities" as described in Demand Generation Implementation Kit for Underutilized Commodities in RMNCH, the I-Kit. Materials associated with the I-Kit, like this commodity-specific strategy document for amoxicillin, were created to support the efforts of; communication professionals working directly on social and behaviour change communication (SBCC) programmes, as well; as; other professionals working in RMNCH. It was created as a "quick-start foundation based on available evidence to provide guidance" for communication designed to: create new users; convince members of the intended audience to adopt new behaviours, products, or services; increase demand among existing users; convince current users to increase or sustain the practice of the promoted behaviour and/or to increase or sustain the use of promoted products and services; take market share from competing behaviours (e.g., convincing caregivers to seek health care immediately) and products or services (e.g., convincing caregivers to use oral rehydration solution (ORS) and zinc instead of other anti-diarrhoea medicines). Thus, the goal is to create informed and voluntary demand, help providers and clients interact effectively, shift social and cultural norms to support sustained commodity uptake, and encourage appropriate use of the commodity.

The strategy document offers key concept discussions on SBCC, social marketing, and channels and approaches, including advocacy, community mobilisation, entertainment education, information and communication technologies (ICTs), and mass and traditional media. The conceptual framework for the strategy is structured as a multi-directional continuum of social and environmental contexts: the individual level family and peer networks, community, and social and structural. The communication strategy includes 6 steps:

• "Analyze the Situation
• Define a Vision
• Choose Intended Audiences
• Select Key Messages
• Determine Activities and Interventions
• Plan for Monitoring and Evaluation"

The illustrative strategy for amoxicillin (beginning on page 29) details each step for this specific commodity used to treat, among other illnesses, childhood pneumonia, based upon the World Health Organization guidelines. The health and commodity context are detailed with information on:

• childhood pneumonia prevalence;
• commodity availability - with this communication strategy included: Packaging in kits that include illustrated directions designed to assist caregivers and community health workers (CHWs) to understand the dosages and comply with treatment regimens; and
• an audience and communication analysis of barriers to SBCC, including:
• addressing community members on the urgency of bringing children for treatment and addressing caregiver beliefs about childhood illness - "trying to 'replace' traditional beliefs with science is unlikely to resonate with target audiences..." and
• ensuring that pharmacy and shop owners, clinicians, and CHWs have the knowledge needed to recognise and treat the illness with this commodity.

The vision given as an example contains two elements:

• Caregivers of children under five will recognise symptoms and seek care immediately for pneumonia;
• Healthcare providers will correctly diagnose and treat pneumonia with amoxicillin (dispersible tablets).

The description of choosing primary and secondary (influencing) audience segments is illustrated by a detailed audience analysis with examples of possible audience members and their situations.  Message development is individuated for each audience in its particular locale and includes an objective, positioning, a key promise, support statements, and key messages. Activities and interventions of message dissemination are detailed in examples of mass media, clinic-based services, pharmacies, and community-based services and outreach with intervention areas, activities, purpose, and intended audience detailed for each. For example, under outreach, an activity might be enlisting champions among satisfied mothers who could be community advocates to reinforce beliefs about amoxicillin treatment and treatment urgency and dispel myths and misconceptions about pneumonia treatment for caregivers, extended family, and communities. Monitoring and evaluation is detailed in examples of indicators, metrics, methods, sources to leverage, and tracking alignment, among others.

The Demand Generation for Reproductive, Maternal, Newborn, and Child Health Commodities activities are implemented by the Health Communication Capacity Collaborative (HC3) at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU-CCP), with support from the RMNCH Trust Fund and the United States Agency for International Development (USAID), in partnership with Demand Generation sub-group of the UNCoLSC Demand, Access and Performance Technical Resource Team, including Population Services International (PSI), International Consortium on Emergency Contraception (ICEC), Jhpiego, and other partners.