Step 1: Analyze the Situation
Global situation analyses for each of the commodities are provided below as illustrative examples. These are representative of the global situation, and should be adapted based on data and research from the local context.
Every demand generation strategy should begin with a thorough analysis of relevant information to assess the social and behavioral determinants driving demand for the commodities in the local context. A strong situation analysis provides a comprehensive understanding of the operating environment, foundational information on the commodity and guides the identification of strategic priorities for the demand generation strategy.
What is already known about the social and behavioral drivers of demand generation for misoprostol, magnesium sulfate, and chlorhexidine?
A global review of the evidence on the social and behavioral drivers of demand for the maternal
and newborn health commodities was conducted and synthesized into summary tables for maternal and newborn health. This research was analyzed and described in a full report and spotlight brief. Background information and technical documents, such as technical briefs and links to key resources, are available for misoprostol, magnesium sulfate, and chlorhexidine.
Why conduct a situation analysis?
The situation analysis focuses on gaining a deeper understanding of the challenges and barriers to address within a specific context that influence the current demand and utilization of a priority RMNCH commodity, including individual knowledge, attitudes and behaviors of providers, end-users and other influencing audiences; social and cultural norms; potential constraints on and facilitators for individual and collective change; and media access and use by the intended audiences. It also examines the status of each commodity, including relevant policies, regulations, manufacturing, prices, supply-chains, and availability. In short, the situation analysis answers the question, “Where are we now?”
How should I conduct a situation analysis in my country?
Conducting a situation analysis typically involves collating available data and resources and then convening a group of stakeholders to review and identify key information.
“Conducting a National Assessment on Demand Generation for Underutilized, Life-Saving Commodities: Guidance and Tools” provides guidance to country-based partners to carry out collection of relevant data. Sources of country-specific secondary data may include Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS), quantitative and qualitative research conducted by NGOs, or private sector market research, where available, such as Nielsen. RMNCH policies and guidelines may also assist in analyzing the situation.
The tool also provides semi-structured interview guides to collect information from key stakeholders, including RMNCH program staff within the Ministry of Health, procurement agencies, donors and other experts such as private sector wholesalers, manufacturers and academic institutions.
Lastly, the tool provides guidance in holding a stakeholder workshop to review the findings and reach consensus on implications and next steps for country activities.
If existing data, particularly on social and behavioral drivers, is not sufficient, is outdated, or does not provide enough insight into priority audiences, it may be necessary to conduct additional primary formative research through quantitative surveys or qualitative research methods such as focus group discussions, key informant interviews, and observation checklists. It may be especially important to conduct formative research around provider attitudes and other drivers to provider behavior, as this information is typically less available. If primary formative research is required, the findings should be analyzed prior to the start of strategy development. Guidance and tools to conduct formative research are provided in the additional resources listed.
What are the key questions to ask?
The situation analysis has two main sections:
Health and Commodity Context:
An important part of the situation analysis is information on the health situation and the commodity context. This section examines the prevalence of postpartum hemorrhage, preeclampsia, and neonatal sepsis, recommended treatment protocols for all three conditions, and issues around commodity registration, prices, manufacturing, supply-chains, and point-of-access for end-users.
Audience and Communication Analysis:
The audience and communication analysis examines the social and behavioral drivers that facilitate or act as barriers to uptake of the commodity. Completing this section enables program managers to
- Determine potential audiences and their characteristics, those who influence them, and the drivers and barriers to behavior change.
- Identify potential communication resources, including communication channels, ongoing activities, and organizational and professional resources.
- Assess the environment to determine availability of products and services being promoted, accessibility, affordability and acceptability.
- Assess the social, economic and political conditions influencing behavior.
Illustrative questions are provided to guide a situation analysis for misoprostol, magnesium sulfate, and chlorhexidine.
Integrating Gender into the Situation Analysis
Gender norms, cultural expectations, and roles of males and females within a community may be key barriers to increasing demand for misoprostol, magnesium sulfate, and chlorhexidine. Therefore, it is important to identify gender-related determinants of health behavior during the situation analysis in order to achieve successful program design and implementation.
Addressing the Role of Gender in the Demand for RMNCH Commodities: A Programming Guide provides information and practical tools to help program managers determine how gender norms and roles for both men and women affect the demand for the commodities, and how to address these norms and roles to ultimately increase the demand for and utilization of these commodities. The Guide includes guidance and a checklist on integrating gender into the situation analysis.
Using the Situation Analysis to Identify Strategic Priorities
After developing a strong situation analysis, program managers should be able to identify the key implications or challenges from the data. What are the reasons that misoprostol, magnesium sulfate, and chlorhexidine are not being utilized? Are the commodities available? Are they affordable? Are they part of the national essential medicines list or standard delivery protocols? What do potential users – end-user, health care providers, and health educators – believe about the commodity? What is the potential market for commodities? Finally, select only a few key factors that the demand generation strategy will address. While it is tempting to address all factors, successful communication programs focus on the factors that will have the biggest impact given available resources.
Population Services International Global Social Marketing Department offers the following series of questions to guide the selection of strategic priorities:
What?
Data Collection: Using all the relevant sources you can identify, collect and report the type of facts that will help you make demand generation strategy decisions.
So What?
Data Analysis: Identify possible implications that the facts may have on the demand generation strategies.
Now What?
Identify Strategic Priorities: Choose which implications to address in the demand generation strategy. Limit to 3-5 strategic priorities in order to focus the plan.
Examples:
Mothers and service providers around the world have a strong desire to apply something to the umbilical cord stump. In the absence of a specifically recommended product, they will use a variety of traditional and non-traditional substances. Putting nothing on the stump in some cultures and communities is seen as unacceptable.
Examples:
Traditional and non-traditional substances are applied to the cord stump for a number of reasons, including, but not limited to: preventing or treating infection; drying, lubricating, softening, protecting, or healing the cord stump; accelerating cord detachment; and following traditional practices. However, not all of these substances are clean or hygienic, potentially increasing infection risk.
Examples:
Positioning chlorhexidine as the best substance for cord care, building on existing desires to apply something to the cord stump.
The risk of dying of PE/E is approximately 300 times higher for women in developing countries due to a lack of access to quality, affordable care and life-saving supplies.
When detected early (typically during ANC visits) and in a mild stage, pre-eclampsia can be treated and the morbidity and mortality linked to eclampsia can be lowered. This requires effective detection of PE/E, availability of screening and treatment supplies, and health care providers who know how to provide related services.
Teaching pregnant women and their families how to detect PE/E warning signs is important, as is encouraging pregnant women to attend ANC clinic visits.
Training providers how to quickly and effectively screen for, diagnose, and treat PE/EC with magnesium sulfate as a first-line treatment is crucial.
TBAs, midwives, and health facilities are the main sources of information about bleeding after childbirth
Telling pregnant women about excessive post-partum bleeding has not changed the fact the PPH is the number one or two leading cause of maternal mortality in many countries and settings. To significantly reduce deaths from PPH, those who deliver babies need be advised and enabled to have on hand an effective uterotonic to prevent or treat PPH.
Where a high proportion of births take place at home, having providers recommend misoprostol to women preparing for birth and making misoprostol available at community level becomes a Strategic Priority.
Illustrative Examples of Situation Analyses in Maternal and Newborn Health
Global situation analyses for each of the commodities are provided below as illustrative examples. These are representative of the global situation, and should be adapted based on data and research from the local context.
- Global Situation Analysis for Misoprostol
- Global Situation Analysis for Magnesium Sulfate
- Global Situation Analysis for Chlorhexidine
By clicking on the links above, you can view these examples by step either as a preview (which does not require download) or download in MS Word or PDF. A full version of each commodity strategy is also available under “Adaptable Strategies” in the right sidebar in MS Word or PDF formats. The full strategy includes both guidance and illustrative content for the entire strategy.
About the Life-Saving Commodities in Maternal and Newborn Health
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