An Adaptable Communication Strategy for Demand Generation: ORS and Zinc

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 reproductive, maternal, newborn, and child health (RMNCH), the I-Kit. Materials associated with the I-Kit, like this commodity-specific strategy document for oral rehydration salts (ORS) and zinc, 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; and 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). 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 ORS and zinc (beginning on page 28) details each step for this specific commodity used to treat, among other illnesses, diarrhoeal diseases, based upon the World Health Organization (WHO) guidelines. The health and commodity context are detailed with information on:

• diarrhoeal disease prevalence;
• commodity formulation recommendations and availability - the document stating that zinc availability can be a problem, and further testing of co-packaging is needed, as well as analysis of cost and demand for the product - "Bangladesh had success scaling up zinc with a sustained mass media campaign combined with provider training, advocacy and product availability..."; and 
• an audience and communication analysis - "[A] literature identified the following key facilitators for ORS and zinc demand and utilization”: supportive policy environment; low perceived threat of diarrhoea; knowledge gaps of most effective treatment; perceived degree of effectiveness of ORS and zinc; and access to commodities, including cost and distance to facilities.

The vision given as an example is that: "Among caregivers of children under five, ORS and zinc is the preferred treatment for uncomplicated diarrhea."

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. For example, for caregivers of under-5 children, messages from respected and familiar sources confirming the benefits of ORS/zinc, e.g., "mothers in my community use ORS and zinc to treat diarrhea". For clinical providers, for example, messages may appeal to prestige, professionalism, and client satisfaction. For male partners, for example, messages may suggest that good fathers provide the money for purchase of the commodity in order to ensure the health of their children.

Activities and interventions of message dissemination are detailed as a starting point for situational customisation, providing a base for message integration across a range of intervention areas and communication channels. "The Diarrhea & Pneumonia Working group recommends that misconceptions about a need for additional medicines may be addressed through mass media, but should be reinforced through counselling with providers and community health workers, or through IPC [interpersonal communication] activities. In contexts where traditional beliefs, religious beliefs or influential, extended family are barriers to using ORS and zinc, careful research and multi-stage communication strategies will likely be required."

The following are examples of potential areas for linkages when designing a demand generation programme for diarrhoea management programmes:

• "Community-based integrated management of childhood illnesses (c-IMCI) programs
• Quality of care improvement initiatives for service providers/clinics, both public and private
• Pharmaceutical medical detailing programs, especially those promoting medicines for treatment of children under five
• Private sector social franchises - especially those targeting women of reproductive age or offering services for children under five
• Pre-service education and existing continuing education or in-service refresher training initiatives for clinical and non-clinical providers
• School and community-based WASH [Water, Sanitation and Hygiene] programs
• Supply chain management and market shaping
• Programs providing health education and health care in communities or clinics, such as immunization and antenatal/postnatal care, as opportunities to provide counselling and disseminate materials.
• Cross-sectoral programs (e.g. education for women’s entrepreneurship, peace-building, agriculture or water resources, economic empowerment, transport)"

Charts (starting on page 56) of examples for mass media, clinic-based services, pharmacies, and community-based services and outreach give intervention areas, activities, purpose, and intended audience detailed for each. For example, under mass media, interventions might include: develop multi-episode TV/radio drama serials and produce radio call-in shows. Clinical service interventions might include: set up a "diarrhea treatment corner" in clinics and hold provider trainings for "face-to-face counselling". Work with pharmacies might include, among others, branding and logo development. Structural interventions might include, for example: "Utilize resources from Scaling Up Lifesaving Commodities for Women, Children, and Newborns: An Advocacy Toolkit [See related summaries below.] to create an advocacy strategy for ORS and zinc demand, raise awareness and engage stakeholders in addressing ORS and zinc policy gaps."

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.