Drafting a Malaria in Pregnancy Strategy
In this section you will be guided through each element of a MiP SBCC strategy. Download this template and complete it by reviewing each of the steps below. While the content and examples in this guidance are MiP specific, the process is not. This template and the steps to completing it may be used to guide the development of any health topic.
MiP SBCC Strategy Template
Which MiP issues are the most pressing?
Keep in mind the age old saying "focus demands sacrifice." SBCC is most effective when targeted. What issues does your country have the resources to address and measure?
- Are service providers adequately trained in interpersonal communication?
- Do service providers provide patient counseling?
- Are pregnant women seeking care for fever the same or next day of symptoms' onset?
- Does your country distribute LLINs at during ANC or at after institutional delivery, distribute LLINs through continuous distribution channels, subsidize or encourage obtaining LLINs in the private sector?
- Do pregnant women sleep under LLINs during dry seasons as well as rainy seasons?
- Are pregnant women prioritized in inter-household allocation of LLINs?
- Policy makers: has procurement of small-dose folic acid been prioritized?
- Policy makers: is the national IPTp policy enforced?
- Service providers: are service providers providing correct SP dosage to healthy pregnant women at correct times?
- Service providers: are service providers explaining the purpose, benefits, and potential side-effects of SP?
- Service Providers: are service encouraging early and frequent ANC attendance?
- Pregnant women: are pregnant women attending ANC early in their first trimester and monthly thereafter?
In two to three paragraphs, summarize only the most important findings of your situation analysis (behaviors that need to be changed or encouraged) and then introduce what theory-based strategy will be used to influence this change. At this level, it is important to lay out general areas of focus, leaving room for local variation and adaptation as regions in each country will have different needs.
For example, perhaps levels of MiP knowledge and awareness are high in your country. Your situation analysis suggests that previous projects reported male involvement in household decision making is very important. National surveys report that women of reproductive age have high levels of radio exposure, and trust their peers most when asked who influences their attitudes. You decide not to base your national MiP focus on raising awareness or increasing perceived severity (an approach that might have relied on the extended parallel process model), instead, stakeholders decide that priority should be placed on increasing positive attitudes about ANC between husbands and wives, and strengthening confidence and trust between pregnant women and service providers. Choosing social learning theory as a theoretical base, you direct regional authorities and implementing partners to pilot, refine, and scale up interpersonal communication approaches that model positive interactions between couples and pregnant women and service providers, emphasizing the benefits of LLINs, IPTp, and prompt care seeking behavior. The reach of national television and radio stations is limited in your country, so you recommend SBCC capacity strengthening activities with local radio stations and journalists and direct funding to prioritize local media outlets, interpersonal communication, and social mobilization channels.
Which behaviors will lead to the greatest reductions in morbidity and mortality?
These behaviors should match those prioritized in your country's Malaria Strategic Plan. Your list should not be an all-inclusive wishlist, but a pragmatic selection of behaviors that can be measured over time.
- Proportion of pregnant women who seek treatment for fever the same or next day
- Service providers: explain how to take medication, why it is necessary, and discuss side effects
- Policy makers: ensure adequate supplies of LLINs are available at front line facilities and in the community
- Policy makers: endorse removal of taxes and major financial barriers to obtaining LLINs
- Policy makers: support coordinate and harmonized LLIN distribution strategy
- Proportion of service providers who provide available LLINs during ANC or institutional delivery
- Proportion of service providers who encourage pregnant women to sleep under an LLIN every night
- Proportion of pregnant women that slept under an LLIN the previous night
- Proportion of pregnant women who encouraged their friends of family to sleep under an LLIN
- Proportion of pregnant women who ask for an LLIN during ANC or institutional delivery
- Proportion of pregnant women who discuss LLIN use with their spouse
- Proportion of spouses who encourage their wife to sleep under an LLIN
- Policy makers: enforce national IPTp policy
- Proportion of pregnant women who attend ANC in first trimester
- Proportion of pregnant women who receive IPTp 1, 2, 3, and 4
- Service providers: provide SP and explain its purpose and potential side-effects
How to influence behaviors?
Communication objectives are the most important aspect of an SBCC strategy. Be careful to base your decisions about how to influence your target audiences on available data.
- Increase perceived risk of malaria infection
- Increase perceived severity of malaria infection to mother and unborn child
- Increase self-efficacy to attend ANC early and regularly
- Increase proportion of spouses who agree to discuss the important of prompt care seeking for fever with their wives
- Increase proportion of pregnant women who encourage others to attend ANC early and regularly
- Increase perceived response-efficacy of LLINs among pregnant women and their families
- Increase self-efficacy to obtain LLINs (at ANC or in private sector)
- Increase self-efficacy to sleep under LLIN every night
- Increase perceived response-efficacy of SP among pregnant women and service providers
- Increase perceived safety of SP among pregnant women and service providers
- Increase self-efficacy of pregnant women to request SP during ANC
Who to influence?
Specific groups of people whose behavior needs to change or who can enable or support a specific change in the behavior of others.
Key promises for the communication objective "Increase the proportion of health facility-based doctors, nurses and midwives who believe SP is a life-saving and safe means of preventing malaria in pregnancy from 2016 baseline levels to more than 75% by 2020.
- Pregnant women in their first and second pregnancies
- Pregnant women with HIV
- Pregnant women who understand the benefits of ANC but choose not to attend
- Pregnant women who are unaware of the benefits of ANC
- Service providers (doctors, nurses, midwives, community health workers)
- Husbands of pregnant women
- Mothers and mothers-in-law of pregnant women
- Community leaders (religious, traditional, governmental)
- Community-based organizations (women's savings and loan groups)
Motivate your audience
Means of motivating or convincing a target audience that a behavior is beneficial to them.
Key promises for the communication objective "Increase the proportion of health facility-based doctors, nurses and midwives who believe SP is a life-saving and safe means of preventing malaria in pregnancy from 2016 baseline levels to more than 75% by 2020.
- Your workload will be reduced because there will be fewer cases of severe anaemia, stillbirths and miscarriages resulting from malaria during pregnancy.
- You will have better pregnancy outcomes.
- You will be recognized as a professional who provides quality care.
Prove a behavior is do-able
Describe ways that a specific behavior is achievable, within someone's ability to adopt.
Supporting points for the communication objective "Increase the proportion of health facility-based doctors, nurses and midwives who believe SP is a life-saving and safe means of preventing malaria in pregnancy from 2016 baseline levels to more than 75% by 2020.
- IPTp-SP is cost-effective and prevents the adverse consequences of malaria (i.e., placental infection, clinical malaria, maternal anaemia, foetal anaemia, low birth weight and mortality).
- Severe maternal anaemia is reduced by 38%.
- Low birth weight is reduced by 29%.
- Neonatal mortality is reduced by 31%.
- Malaria in pregnancy can avert newborn deaths. (About 300,000 deaths could have been averted if IPTp-SP and ITN coverage had increased to 80% from 2009-2012.)
- IPTp-SP continues to protect against low birth weight even in areas of low malaria transmission. (Malaria in pregnancy can avert newborn deaths.)
- IPTp will continue to be important until malaria has been eradicated.
Framing message content
The exact words that need to be communicated (and framed for maximum impact) to target audiences.
Mediums of communication
A mix of interpersonal communication, social mobilization, mass media or materials that will be used to influence identified audiences.
Intervention delivery
Articulate who will be communicating key messages and how this will be done.
You have completed the MiP section of your malaria SBCC strategy. You will notice that this I-Kit began with guidance on how to conduct a situation analysis, but that this template does not include a situation analysis. A program may or may not elect to conduct a separate situation analysis for each programatic area (vector control, MiP, case management). It is more likely one general situation analysis will be done, and each programmatic area will include elements in this template. For this reason choosing a theoretical model (a collection of several theories or theoretical concepts) may be more appropriate for an overall strategy, while specific theories may be more appropriate for specific programmatic areas like MiP. For example, the social-ecological and ideation models incorporate several theories and explain behavior change across different communication domains and in different levels of individual and social decision-making. For more about choosing theories for intervention-specific areas use the Center for Disease Control and Prevention's Theory Picker.
Would you like feedback on your new or revised MiP SBCC strategy? Email your strategy to miketoso@jhu.edu and the Roll Back Malaria SBCC Working Group MiP Task Force will review your strategy and submit feedback.
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