Draft Communication Strategy for Forest Triangle Malaria Prevention

Transcription

1 Draft Communication Strategy for Forest Triangle Malaria Prevention NetWorks December 16, Background Despite the impressive reduction of malaria morbidity and mortality in recent years in the Greater Mekong Sub-region, there continues to be risks for malaria outbreaks. Such was the case in Lao PDR in late 2012/early 2013 where malaria cases have been steadily increasing particularly in the southern provinces of the country bordering Viet Nam and Cambodia. Malaria Consortium (MC) was commissioned by NetWorks, a five-year project funded by PMI, to conduct a qualitative assessment of personal protection measures and behaviours among at-risk populations along the Lao PDR, Vietnam, and Cambodia borders ( Forest Triangle ). The assessment aimed to help understand the knowledge and behaviours regarding malaria prevention/protections measures, health seeking behaviours and communication preferences of the community members and migrant workers to develop a well-informed behaviour change communication strategy to better reach out to the high risk groups and avoid such malaria outbreaks in the future. In 2014, a qualitative assessment using purposive sampling was carried out in the two high risk districts, Phatoumphone and Taoy of Southern Lao PDR. A total of 16 Focus group discussions (FGD), 9 Key Informant Interviews (KII), and 33 In-depth (IDI) interviews were conducted with a total of 169 participants including community members, migrant workers, village volunteers and village chiefs, to understand the malaria prevention and treatment behaviours and effective communication channels of the target communities. Potential participants were recruited based on their availability, special knowledge, interest, and willingness to participate in the study. A variety of respondents, different tools and data collections teams helped validate and triangulate the information. This communication strategy is based on the key findings from the qualitative assessment. 1.1 Key study findings Community members and migrant workers from both districts reported malaria as most common health problem that affected the target communities. According to majority of the participants, migrant workers, farm workers and forest goers were considered most vulnerable groups to malaria. While most respondents knew that mosquitoes transmit malaria, many also associated it with drinking dirty or unclean water. 1

2 Delayed health care seeking was norm and majority of community members and migrant workers reported starting with self-medication when they got fever. Many community members preferred going to village health volunteers for being more accessible for malaria diagnosis and treatment. However, seasonal stock-outs at village volunteers and health centre level caused hassle for community members and migrant workers to hire a transport to go the next level health facility. Participants frequently mentioned provincial hospital for severe malaria treatment. No preventive and treatment services were available at the private companies and migrant workplaces which limited their timely access to malaria information and treatment. Money, distance, stock-out at village and health centre, language and attitude of health care providers mentioned as key barriers to health care seeking for malaria. The majority of the community members reported higher access to Long Lasting Insecticide Treated Nets (LLINs) than the mobile and migrant workers. However, many community members complained that LLINs distribution was not sufficient to cover their family members and they had to purchase conventional nets to fill in the gap. Many preferred the conventional nets as they were softer and bigger in height and size than the distributed LLINs. The access of migrant workers to LLINs was very low. The majority of migrants working in the private companies or farms mentioned that they did not receive any LLIN nets due to their non-eligibility for LLINs. Repellents, coils, long sleeved clothes, fire, smoke and environmental sanitation were among the other key methods cited to prevent malaria in target communities. The community members appreciated the free distribution of LLINs, however they expressed their discontent with size, hardness, roughness and big holes of the LLIN bed nets. Many complained against the adverse effects of LLIN use including burning, itching and rashes. Most wished for soft and large size LLINs to accommodate 4-5 members of the family. Most of the migrants demanded LLINs and some specifically aspired for the long lasting insecticide hammock nets (LLIHNs). The majority of the participants received malaria messages through health education sessions conducted by health centre staff, district and provincial health staff, doctors and village malaria volunteers. Many also mentioned receiving messages through Information Education and Communication (IEC) materials i.e. pamphlets, posters, radio and television. Interpersonal communication through village health volunteers and health staff was the most preferred and effective communication method for both the community members and migrant workers. Other suggested methods included loud speakers, colourful posters with a calendar, pictorial brochures, billboards for migrant workplaces and regular health education sessions for community members and migrant workers at their workplaces. 2

3 2 Communication Strategy 2.1 LLIN Access Problem 1: Migrants and mobile workers are not eligible for LLIN distribution within Lao PDR Targets: Policymakers and employers of mobile and migrant workers Policymakers expand eligibility of migrants and mobile workers to allow them to access LLINs Employers provide LLINs at subsidized or full cost rates, using buy-back programs or other credit mechanism, to their employees who are at-risk of malaria Workplace programs that provide LLINs up front to the worker, taking the cost out of the employee s salary/paycheck on a weekly or monthly basis Policymakers quantify additional nets needed to protect mobile and migrant workers and their families and include them in mass distribution o Mass distribution BCC activities are conducted in multiple languages to ensure expatriate populations are informed about the distribution. Protecting every person in Lao PDR, regardless of their origin, benefits the rest of the population and reduces malaria burden. Emphasize benefits to employers of increased worker productivity due to reduced malaria episodes Problem 2: Migrant workers are using protection measures that are unlikely to be effective Targets: Mobile and migrant workers and their families For night-workers: Purchase and use personal protection measures that are effective at preventing malaria For migrant and mobile workers not working at night: Sleep under LLIN every night For night workers: Explore treated clothing as an option to prevent infective bites during working hours. Subsidized sales of clothing-treatment kits are a possibility. 3

4 For migrant and mobile workers not working at night: expand access to LLINs and encourage use Position new prevention method/llins as more effective and safer than coils and repellents. Emphasize increased earnings and productivity due to reduced malaria episodes 2.2 Treatment seeking behavior Problem 1: Majority of people first self-treat when they have fever Targets: Community members, mobile and migrant workers and their families Population seeks out diagnosis and treatment from qualified sources when they have fever (VHV or health facilities) Improve stockouts at health facilities Improve stockouts at VHV level Expand accessibility of diagnosis and treatment services to reach the most at-risk populations o Establish diagnosis and treatment options at workplaces or within migrant/mobile communities, by training a malaria focal point from within those communities/workplaces in use of RDTs o Identify small shops or other points that serve migrant and mobile workers, esp those that speak their language, training shopkeeper to provide malaria information, RDTs, and appropriate treatment. Promote speed and ease of accessing qualified testing and treatment from the alternative providers, including overcoming language barrier Promote importance of prompt treatment seeking in getting back to work quickly, being more productive Promote quality of testing and treatment over mystery pills obtained through unqualified vendors Training materials for alternative providers, job aids 4

5 2.3 Reaching at-risk populations with BCC messages Problem 1: village volunteers lack regular training/refresher training and sufficient job aids to conduct effective BCC/IEC health education Targets: Village health volunteers VHV conduct health education sessions, counseling, referrals, and diagnosis and treatment correctly and consistently Establish ongoing training opportunities for VHV Produce and distribute standardized job aids that cover key messages, and procedures for referral, diagnosis and treatment. Establish quarterly health education sessions instead of once per year to reinforce message retention (Standard communication messages) Frequently Asked Questions guide to assist with follow-up questions from interpersonal communication sessions Problem 2: Migrant workers not reached through standard outreach (radio, IPC) Targets: Migrant and mobile workers Migrant and mobile workers have access to malaria information through a reliable source Recruit VHVs that speak Chinese/Vietnamese etc to specifically target expatriate populations. Facilitate their travel to hard-to-reach populations, particularly by recruiting VHV from within these communities. Broadcast malaria radio spots in additional languages through loud speakers and radio (if radio reaches target population) Produce print materials in additional languages to leave behind with literate expatriate populations. These might include billboards at workplaces, brochures. 5

6 (Standard communication messages) 2.4 Enabling environment To create enabling environment for the successful behavior change communication activities, following activities are required at the community and health facility level:community participation Community engagement is very important to create ownership and enable the communities to play a positive role in malaria prevention and control in their communities. Following community mobilization activities are required to foster the sustainability of the behaviour change communication activities: Sensitization/advocacy meeting at community, district and provincial level To engage the community, it would be very important to first sensitize them on the malaria situation so that they could understand the severity of the issue and could play a more active role in the malaria control programme. The community sensitization meetings should be held at community, district and provincial levels with key stakeholders i.e. community members, teachers, religious leaders, village leaders, private providers, private businessmen, company owners and village, district and provincial authorities to ensure their support in the malaria control interventions Formation/revitalization of community based structure/village health committees There is a dire need to form/revitalize (if already exist) the community based structures i.e. village health committees to engage the key stakeholders in planning, implementation and decision making of the malaria prevention and control activities at the village level. This will develop a sense of responsibility, ownership and mutual accountability among the community members to plan, monitor and implement the malaria related activities at the village level. At the moment, mostly village chief is being engaged at the community level which does not reflect the genuine community participation. To ensure the real community participation, the village health committees should be formed or revitalized if already exist. The committees should include key stakeholders including volunteers, teachers, community based organizations, religious leaders, village leaders, and village chiefs. The roles and responsibilities of the each members of the committee should be defined so that they could play an important role in the malaria prevention and control activities in their villages. The committee should also be engaged in all the community level distributions i.e. bed net, repellent distribution to ensure that the commodities are reaching to all targeted community members Capacity building For the successful implementation of behaviour change communication strategy, capacity building of the key implementers in the following areas is required: Training of trainer for district level staff in community mobilization and behaviour change communication The district and provincial malaria staff are the key implementers and therefore should be well aware of the community mobilization and behaviour change communication approaches to better design and implement their programmes. The training on community mobilization and behaviour change 6

7 communication will not only improve their understanding of community engagement and bottom up approaches but also help them involve the communities in their programmes in a more effective manner. The district and provincial level staff can further organize trickle down training for their concerned health centre staff and village volunteers Training of volunteers in communication and facilitation skills Village malaria volunteers are the key change agent at the grass-root level. The qualitative study suggests that they are one of the most preferred channels of communication for the target communities. However, during the interview with volunteer, we found that there is no regular training or refresher training of the village volunteers. As the volunteers are responsible for health education, they should be equipped with the required communication and facilitating skills and adult learning techniques to conduct effective health education activities in their communities. The community volunteers should be properly trained in communication skills, key malaria messages, adult learning methodologies and use of IEC materials to better perform their work Training of health care providers in communication and counselling skills Many participants mentioned that the unfriendly attitude of health care providers as one of the barrier to access health care at the public hospitals. Therefore, to sensitize the health care providers on patient friendly services, a special component on communication and counselling skills should be added in the training curriculum of health care providers to improve their provider-patient relationships Strengthening of linkages among volunteers and health staff The qualitative study revealed that village malaria volunteers visit the health centre to submit their reports on monthly basis. During the visit, they meet with health centre staff on individual basis. They miss the opportunity to meet and interact with their fellow volunteers as they all come on different timings. The monthly visit is an important activity which should be utilized in a more useful fashion. At the moment, the individual meetings have only one item agenda i.e. reporting. The meeting opportunity can strengthened the linkages among volunteers and health staff. This could be more useful by providing on job training to the volunteers. Health centre staff can prepare topics regarding malaria every month to share with village volunteers to build their capacity on regular basis. This on job training will build their capacity and confidence to perform their job well and enable them to better answer the malaria related questions of the community. 7