Check Am O! Campaign

The Check Am O! campaign was developed using a human-centred design (HCD) process that revealed that many Nigerians either did not understand the threat of TB or know how to appropriately seek testing and treatment for it. TB-related stigma and discrimination were also high. Nigerians typically undergo long treatment journeys, often going to multiple places for help, such as local chemists or to religious and traditional leaders, before finally going to a health facility. (See Related Summaries, below, to find out more about the HCD process that led up to this campaign.)



The campaign, therefore, set out to simplify and de-stigmatise the process of seeking treatment. One way it sought to do this was to shift the tone of TB social and behaviour change (SBC) interventions from fear based to confidence building. New materials were produced with animation instead of scary pictures of people who have TB, and with bright, friendly colours to catch attention.  



Mass media

The campaign's mass media and social media approach included animated videos on television and social media and radio spots that portrayed community members in relatable community settings encouraging people who had been coughing for two weeks or more to go for a TB test. These videos and spots were produced in five languages. The media campaign was launched in December 2020, and, with the onset of the COVID-19 pandemic, the messages were adapted to address TB within the context of COVID-19.



Social mobilisation

The community mobilisation activities included motorised campaigns in TB hotspots in partnership with service delivery partners and engagement of patent medicine vendors, market associations, and religious leaders to refer suspected TB cases among their clients and congregants. In particular, Breakthrough ACTION-Nigeria worked with religious leaders, as research had shown that one of the places people go when they think they might have TB is religious centres, or they meet with religious leaders. The project trained more than 1,500 religious leaders to give them greater knowledge about the symptoms and the burden of the disease and to enable them to refer their congregants to health centres if they had symptoms suggestive of TB. Nearly 300,000 people were reached with TB messages shared by leaders of the Christian and Muslim faiths over two years, with more than 12,900 referred for testing.



Through the motorised campaign (which was started in November 2020), the project sought to bring the campaign to where the people were, share information about TB, and provide simultaneous TB services. It involved the use of a "hype" vehicle equipped with a sound system and branded campaign logos. The project conducted prior community engagement to prepare the community gatekeepers for the activity. The hype vehicle entered a community playing music interspersed with pre-recorded TB jingles to attract attention. Mobilisers then went on foot to engage in-depth and one-on-one with community members about TB, sharing pamphlets, answering questions, and making referrals. Service delivery partners also established a fixed point for TB testing in the community so that people with symptoms suggestive of TB could get appropriate referrals, testing, and treatment.



TB call centre

Breakthrough ACTION-Nigeria also worked with the National Tuberculosis and Leprosy Control Programme (NTBLCP) to increase the capacity of the National TB Call Center, including expanding the number of trained operators, adding interactive voice response (IVR), and obtaining a short code (3340) instead of the 11-digit phone number, to ease recall and enable more effective cross-promotion on the mass media. In addition, the locations of the nearest testing and treatment centres in each local government area were made available on social media and provided via the National TB call centre. The campaign spots were also available on-demand via mobile phone on Airtel's 3-2-1 service.



According to Breakthrough ACTION, after the start of the Check Am O! campaign and upgrades to the call centre, there was a 530% increase in the number of calls (more than 790,000 total) received between January 2021 and December 2022. And 70% of the callers said they had learned about the hotline through the campaign's radio and television spots.



A number of materials were produced by the campaign:

• Campaign print materials, which included posters, flyers, banners, and factsheets;
• Job aids for health care workers to provide user-friendly guidance on TB care and treatment clinical management; and
• "Advocacy, Communication, and Social Mobilisation Guidelines for the Tuberculosis Programme in Nigeria 2020-2025", which serves as a resource for implementing and standardising effective SBC interventions for TB testing and treatment programmes.

To access the above campaign materials online, click here.

Tuberculosis

Background information

Nigeria has the highest tuberculosis burden in Africa. According to the Lancet Infectious Diseases, TB incidence rose in Nigeria from 418,000 cases in 2017 to 429,000 cases in 2018, and deaths also rose from 155,000 to 157,000 within the same period. Only one in four people with TB are estimated to get proper diagnosis and treatment, allowing the disease to spread.



Prior to 2019, Nigeria maintained a case notification rate for TB less than 24%, one of the lowest in the world (Nigeria Tuberculosis Profile, World Health Organization, 2017).



Overall impact

• Within a year of the campaign's start, TB case notification in Nigeria increased by 50%, despite hindrances created by the COVID-19 pandemic.
• At a community level, over 170,000 presumptive TB cases were referred for testing, and over 82,000 directly referred TB cases were tested.  

Lessons learned

According to Breakthrough ACTION, the success in increasing case notifications in Nigeria can be attributed to a number of factors, which include:

• Co-developing interventions with beneficiaries using the HCD approach;
• Providing actionable information that can connect people to services within their own areas;
• Ensuring the actionable information is available to the people through mass and interactive media; and
• Deploying community SBC approaches in collaboration with service delivery partners for seamless testing of presumptive cases.