Guidelines for Social Mobilization: Planning Communication-for-Behavioural-Impact (COMBI) in TB Control

Offered for download from the Stop TB Advocacy, Communication and Social Mobilization (ASCM) web portal on the Stop TB Partnership website, this is a draft version of a guide outlining the key steps for developing a communication-for-behavioural-impact (COMBI) plan to increase tuberculosis (TB) case detection rates. It was created by the Social Mobilization and Training Team - Control, Prevention and Eradication Department - Programme on Communicable Diseases, at the World Health Organization (WHO).

As explained here, COMBI is a process which strategically blends a variety of communication interventions intended to engage individuals and groups in considering recommended healthy behaviours and to encourage the adoption and maintenance of those behaviours. "The key to COMBI planning is to strive for an integrated approach with a judicious blend and selection of communication actions appropriate to the behavioural outcome desired, and not to believe one single kind of communication intervention is all-powerful."

In the context of TB, COMBI integrated actions include:

• Public relations/advocacy/administrative mobilisation: for putting the particular healthy behaviour on the business sector and administrative/programme management agenda via: the mass media (news coverage, talk shows, soap operas, celebrity spokespersons, discussion programmes); meetings/discussions with various categories of government and community leadership, service providers, administrators, and business managers; official memoranda; and partnership meetings.
• Community mobilisation: including use of: participatory research; group meetings; partnership sessions; school activities; traditional media; music, song, and dance; road shows; community drama; leaflets; posters; pamphlets; videos; and home visits.
• Sustained appropriate advertising and promotion via radio, television, newspapers and other available media, engaging people in reviewing the merits of the recommended behaviour vis-à-vis the "cost" of carrying it out.
• Personal selling/interpersonal communication/counselling: involving volunteers, schoolchildren, social development workers, other field staff, at the community level, in homes and particularly at service points, with appropriate informational literature and additional incentives, and allowing for careful listening to people's concerns and addressing them.
• Point-of-service promotion: emphasising easily accessible and readily available TB diagnosis and treatment.

This guide is divided into 2 parts. Part One briefly examines the main factors related to TB control. Seven social mobilisation and communication challenges facing the promotion of Directly Observed Treatment Short-Course (DOTS) services are described. COMBI is then situated in relation to other approaches associated with COMBI and TB control promoting healthy behaviour, the principal ones being: social mobilisation; social marketing; and information, education, and communication (IEC).

Part Two describes the 10 steps in developing a COMBI plan. Specific points are illustrated using extracts from a COMBI plan for TB control developed in Kerala State, India. Several tips on COMBI planning are provided.

Annex 1 offers a basic outline for a COMBI plan of action.