2011
MNCH/PMTCT
Communication
Strategy
Johns Hopkins Bloomberg School of Public Health, Center for
Communication Programs
National AIDS Resource Center
1.
INTRODUCTION __________________________________________________ 1
2.
CONTEXT ________________________________________________________ 1
2.1.
Objectives of the MNCH/PMTCT Communication Strategy ______________________________2
2.1.1. Sociopolitical and Environmental Objectives ______________________________________________ 2
2.1.2. Service Delivery Objectives _________________________________________________________________ 2
2.1.3. Community Level Objectives ________________________________________________________________ 2
2.1.4. Individual Level Objectives _________________________________________________________________ 3
3.
GUIDING PRINCIPLES ______________________________________________ 3
4.
LEVELS OF STRATEGY ______________________________________________ 4
4.1.
5.
Barriers to PMTCT _____________________________________________________________________________5
CREATIVE BRIEF BY AUDIENCE _______________________________________ 6
5.1.
Individual Domain _____________________________________________________________________________6
5.1.1. Pregnant Women ____________________________________________________________________________ 6
5.1.2. HIV Positive Pregnant Women ______________________________________________________________ 9
5.1.3. Male Partners ______________________________________________________________________________ 11
5.2.
Community Domain _________________________________________________________________________ 14
5.2.1. Men and Women of Reproductive Age ___________________________________________________ 14
5.2.2. Influential Leaders _________________________________________________________________________ 16
5.3.
Service Delivery Domain ___________________________________________________________________ 17
5.3.1. Health Service Providers at Facilities ____________________________________________________ 17
5.3.2. Support Staff at Health Facilities__________________________________________________________ 20
5.3.3. Community Based Service Providers (Health Extension Workers) ____________________ 22
1. Introduction
The PMTCT communication strategy is developed through a collaborative effort of
the Ministry of Health, the HIV/AIDS Prevention and Control Office (HAPCO),
Johns Hopkins University Bloomberg School of Public Health Center for
Communication Programs (CCP), and different partners.
CCP conducted a literature review to assess the current situation in the country
regarding Maternal, Newborn, and Child Health (MNCH)/ Prevention of Mother-toChild Transmission of HIV (PMTCT) services and materials. Furthermore, in order to
better understand the barriers and facilitators impacting pregnant women in general
and HIV positive pregnant women in particular from accessing services, focused
group discussions with HIV positive mothers was conducted.
In addition, CCP, in collaboration with the Federal Ministry of Health, HAPCO and
other partners, conducted a workshop from 14 to 17 December, 2010. The workshop
allowed stakeholders to come to a shared consensus on major themes linked with
PMTCT, which prolongs to be an essential constituent of the larger MNCH
communication.
Health professionals and representatives from various organizations intervening on
PMTCT, HIV positive pregnant women, the Federal Ministry of Health, and HAPCO
participated in the workshop. The workshop included a review of the literature review
conducted by CCP, a review of existing materials on PMTCT services, and
presentations on national and community level responses to PMTCT, the process of
behavior change, and steps to design behavior change communication materials,
audience segmentation and branding. This MNCH/PMTCT communication strategy
directly reflects the outputs of the strategy development workshop.
2. Context
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PMTCT is a first-rate means to guard children from HIV, and to recognize those
children who entail treatment in the early hours. Prior to the age of 2, 50% of HIVpositive children die. In general these deaths could be barred with premature
diagnosis and commencement of treatment. Nevertheless, a small number of women
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According to the 2010 FMOH/HAPCO Single Point Estimate, the number of pregnant
mothers who were living with HIV reaches 90,311. At the same time 14,276 HIVpositive children were expected to be born. Little accessibility and uptake of
prevention of MTCT (PMTCT) services were believed to be the major causes to the
prevalence. Only 38% of health centers and hospitals in the country supplied PMTCT
services and 68% of women got ANC services from health sects, health centres or
hospitals that did not grant PMTCT services in 2009. Among the pregnant women
who attended ANC in the 1,103 health facilities offering PMTCT, 84% were tested
and received their results. Thus, the overall percentage of pregnant women who got
tested remains low. The proportion of those antenatal clients who tested positive was
2.1% and only 58% of the HIV positive mothers received ARV prophylaxis. (FMOH
Service Delivery Data 2009/2010).
obtain HIV testing in the period of pregnancy and, amongst those who are reactive;
hardly any of the infant gets tested.
Mothers, or parents as a whole, are required to get sufficient and integrated care,
information from family planning to avoiding unintended pregnancies, receiving
ANC services including HIV testing and counselling, and availing ARVs for HIV
reactive pregnant mothers and their newborn, and early diagnosis of infants (National
Health Sector Development Plan – IV).
2.1.
Objectives of the MNCH/PMTCT Communication Strategy
This MNCH/PMTCT communication strategy addresses issues surrounding little
accessibility and minimized uptake of Mother-to-Child Transmission (MTCT)
services. Specifically, the strategy addresses:
 Lack of consumption of health services, specially ANC/PNC/PMTCT services
 Deprived ease of use and fragile link of ANC/PNC/PMTCT services within
other health services
 Scarce resources for MNCH services
 Reduced accessibility of user-friendly healthcare services, and
 Shortage of PMTCT focused media messages
Therefore, the interventions outlined under this strategy will contribute to the
following goal and objectives:
GOAL: All expecting mothers will benefit from health services that ensure the health
of the mother and the baby, and prevent the transmission of HIV from an HIV
positive mother to the newborn.
2.1.1. Sociopolitical and Environmental Objectives
 For policymakers to be committed to allocate adequate resources to expand
and integrate MNCH/PMTCT services,
 For heads of regional and woreda health offices to prioritize and integrate
MNCH/PMTCT services within health facilities,
 To improve the quality of MNCH/PMTCT services provided in catchment
areas.
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2.1.3. Community Level Objectives
 To increase awareness and eliminate misconceptions about MNCH/PMTCT
and harmful traditional practices regarding MNCH/PMTCT, encourage
2
2.1.2. Service Delivery Objectives
 For MNCH/PMTCT services to be user-friendly and easily accessible,
accommodating for male partners,
 To increase the knowledge and skills of Health Extension Workers (HEWs) on
MNCH/PMTCT, and enable them to properly communicate with clients,
 To increase the percentage of HEWs that provide appropriate ANC/PMTCT
services at the kebele level
discussions at the household and community levels, and foster positive attitude
towards health services
2.1.4. Individual Level Objectives
 To encourage service seeking behavior among pregnant women and their
partners regarding MNCH/PMTCT and other HIV services such as HIV
Testing and Counseling;
 To raise awareness and understanding of the benefits of partner involvement,
and increase the number of male partners who support their significant other
during and after pregnancy, by encouraging them to get MNCH/PMTCT
services, planning and preparing for birth, and being actively involved in all
aspects of MNCH;
 To increase the number of partners who remain faithful to their significant
other;
 To increase the number of HIV positive pregnant women who disclose their
status to their partners; and
 To increase the number of HIV positive women who discuss family planning
needs with their partners and health service provider.
3. Guiding Principles
Behavior change oriented: For maximum impact, communication
interventions should have specific and measurable behavioural objectives,
address factors that influence behaviour, and reflect a multi-channelled
approach. Channels and interventions should be complementary and
mutually reinforcing.

Audience-centered: Design of messages, materials, and communication
interventions will rely on a thorough understanding of the audiences for which
they are intended. This includes pretesting messages and materials, as well as
involving audience members in the development of approaches and materials.

Evidence-based: Communication interventions and strategies will be based
on research and lessons learned through prior and ongoing programs.

Culturally appropriate: Communication will take into account cultural
norms, beliefs, and practices that influence the uptake of MNCH/PMTCT
services, and will be delivered in a culturally sensitive manner.

Community participation: The engagement of communities is essential in
formulating a strong response that is locally appropriate and draws on
available resources.
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
3
This MNCH/PMTCT communication strategy and its implementation will be guided
by the following principles:

Services-linked: All communication will refer MNCH/PMTCT clients and
caregivers to service providers and/or will be implemented at the service
delivery sites.

Human rights: The framework reinforces equity of access, confidentiality of
services and information, and gender-sensitivity.

Commitment and Coordination: Commitment to building local capacity
and coordinating partner efforts in MNCH/PMTCT communication is
essential.

Partner involvement: The effectiveness of MNCH/PMTCT services highly
demands the involvement of male partners in supporting their partners to get
the services.
4. Levels of Strategy
Communication does not occur in a vacuum. Numerous factors at different levels play
various roles in shaping human behavior and societal values and attitudes. Effective
communication is grounded in a particular socio-ecological context, including
enabling environments, service delivery systems, communities, households, and
individuals.
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4
Therefore, the MNCH/PMTCT communication strategy is modeled after the
ecological model, identifying and understanding pathways to change within the
complexity of the system to address these behavioral pathways. The following
diagram illustrates the pathways to healthy behaviors regarding MNCH/PMTCT.
4.1.
Barriers to PMTCT
Using the above pathways framework, potential barriers to PMTCT and different
audiences are identified at the three levels. The following matrix summarize the
barriers at the three levels.
Domain
Barrier
Low level of ANC/PMTCT/PNC awareness
Lack of economic empowerment for women
Traditional gender norms
Negative perception of ANC/PMTCT service delivery
Individual
Conservative religious beliefs that impact ANC/PMTCT uptake
Heavy reliance on traditional birth attendants
Lack of self-efficacy
Poor health seeking behavior
Male dominance
Lack of information on MNCH
Negative perception towards health services
Community
Use of traditional birth attendants and traditional healers
Conservative cultural and religious beliefs and attitudes
Lack of same sex health service providers
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5
Service Delivery
Poor referral linkages
Lack of user-friendly services
Limitations in supplies and equipment
Lack of guidelines and job aids for service providers
Poor interpersonal communication between clients and service
providers
Lack of continuing education, supervision, guidance on client
handling for health service providers
Problems relating to human resources such as lack of motivation,
and lack of training and support on client handling
Environmental/
Policy
High transportation costs and poor road systems in many areas
High cost of services
5. Creative Brief by Audience
5.1.
Individual Domain
Three key audience groups are identified under the individual domain, namely:
pregnant women, HIV positive pregnant women, and male partners. Outlined below is
the strategy for these three groups.
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Audience Profile
Shewaamene is 18 years old with elementary level education. Currently she lives in
Desse, and is married and pregnant with her first child. She is a house wife, and does
every chore in the house. As a hobby she enjoys weaving and threading cotton.
Shewaamene dreams of a prosperous life with three healthy children. One of her
greatest fears is that drought will leave her family without any means to survive. Her
loving husband Taye is older than her, and controls the family’s money that he brings
from his farming. He spends much of his time farming or at the market selling their
crops. She is not economically empowered and relies solely on her husband. Her
grandmother is a role model to her, because she was a strong woman that raised a
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5.1.1. Pregnant Women
large family and maintained a peaceful home without any complaints. With regards to
ANC, Shewaamene does not have much exposure to the media outside of a small
radio that she listens to when her husband is home. Her understanding of
ANC/HIV/PMTCT is very low, and she does not know both her and her husband’s
status. She is aware of the health facility in her area, but believes that women only
access health services when there are complications with their pregnancies. Thus far,
she feels healthy, and does not intend to visit a health facility. She and her husband
have never discussed visiting the clinic, and she plans to deliver at home with the
local traditional birth attendant.
Pregnant women that are aware of ANC/PMTCT services are often afraid to seek
services for fear of getting tested and learning their status. There is also a stigma
associated with being seen accessing services or getting tested. Male dominance often
makes it challenging to discuss testing with their partners. Increasing awareness and
open communication about the importance of knowing your status in order to prevent
MTCT is key. Pregnant women along with their families often don’t unaware of the
importance of ANC. Pregnant women often visit health center only when there is a
complication with the pregnancy. For those that do seek ANC, there is a drop in
follow-up after the first visit. Pregnant women are unaware of ANC/PMTCT services.
There is a need to increase the awareness level and self-efficacy of pregnant women.
Communication Objectives
 Increase the percentage of pregnant women who discuss HIV testing with their
partners and get tested;
 Increase the percentage of pregnant women who are aware of MNCH/PMTCT
services, contextualize risk of not utilizing ANC services, and complete the
recommended 4 ANC visits during pregnancy;
 Increase the number of women who give birth at health facilities or with a
skilled birth attendant;
 Increase the percentage of mothers who follow through PNC and exclusive
infant feeding for the first six months after delivery.
Key Issues
 Male dominance acts as a barrier to accessing ANC/PMTCT services.
 Lack of knowledge about discordant result in regards to testing.
 Overall there is a lack of follow up after the 1st visit for many pregnant
women.
 There is a lack of support of family members and partner to access
ANC/PMTCT.
Institutional delivery or by a skilled
birth attendant helps keep the mother

If you attend an ANC clinic a trained
health provider will assist you.
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
Supporting Statement
 If you are positive there is care for
you. (Not to worry!)
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Key Promise and Supporting Statements
Key Promise
 Attending ANC/PMTCT can provide
a safe delivery for mothers and
improve the chances of having a
healthy baby.
and the baby safe and healthy.


The birth of a a healthy child is
important for everyone.
Attending ANC/PMTCT can impact
the health of both parents.
Call to Action
 Be informed! Your baby’s health depends on it.

Come and visit the nearest health facility and see what services are available.

Communicate with your partner about your ANC needs for your family’s
health.

Attend at least 4 ANC visits so you have higher chances of getting a healthy
baby.
Activities for Pregnant Women
Popular entertainment:
music, drum and lyrics
Make sure the lyrics of the
songs are specific to the
topic.
Use participatory theater to
show the benefits of
attending ANC.
Use drums to call the
attention of the community
members.
Focus on market days or
churches.
Identify setting early, and
communicate with well
known women in the
community to guide the
events.
Work closely with health
posts and clinics so to make
sure they are prepared for
more clients.
Work with the MOH and city
admin.
(Once a month for 6 months)
Participatory theatre
Local horns with
testimonials
Audio drama (Iddir)
Develop an audio drama and
discussion guide that
addresses specific needs of
pregnant women.
Linkages
8
Detail
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Activity
Drama/Soap Opera
Develop a drama that can be
viewed in waiting rooms in
health facilities or TV that
focuses on the benefits of
accessing ANC
Put the topic a discussion
in community capacity
enhancement
Community discussions
hosted by extension workers
to address/answer any
questions/comments/concerns
from pregnant women and
further encourage them to
access services.
Magazine
Magazines that are available
at the hair dressers
5.1.2. HIV Positive Pregnant Women
Audience Profile
Beletu lives in the rural village outside of Merawi outside of Gojjam, and she is 2
months pregnant with her 5th child. She was educated up until 7th grade, and is a
house wife that takes care of her children. Her family is poor and their only source of
income is through her husband Alemu’s farming. She enjoys going to church and
coffee ceremonies with neighbors. Beletu was often getting ill and the HEW
recommended she get tested. When she went to the health center she learned about
her HIV status. Previously she lost a child within three months of giving birth, which
she now thinks may have been due to her HIV status. She has not told her husband
about her status because she does not know how to talk to him about this matter, and
he has never shown interest in getting tested and makes discriminatory remarks about
HIV+ people. Beletu has no decision making power, no knowledge/information about
ANC/PMTCT, and therefore does not plan to seek care and delivery at health
facilities. She is becoming increasingly concerned about her family’s financial
situation due to the fact that her husband if often ill and unable to farm.
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Communication Objectives
 To increase the percentage of HIV positive pregnant women who have
information about ANC/PMTCT services, who complete the recommended 4
ANC visits during their pregnancy and who deliver at health facilities.
 To increase the percentage of HIV positive pregnant women who follow
through PNC services, exclusively feed their newborns for the first six
months.
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There are HIV+ pregnant women that have no knowledge/information about
ANC/PMTCT and therefore do no seek care and delivery at health facilities.

Increase the percentage of HIV positive pregnant women who disclose their
HIV status to their partner and/or one other family/supportive friend.

Increase the percentage of HIV positive pregnant women who discuss family
planning needs with their provider and their partners.
Key Issues
 Most HIV+ pregnant women living in rural areas do not when, how, where,
and why they need ANC/PMTCT service so the coverage of ANC/PMTCT
services is very low and the recommended 4 ANC visits is not completed. In
addition, in Ethiopia, institutional delivery is very low and maternal mortality
is very high.
 There is lack of open communication between women and their partners, and
the sole decision-making power of male partners limits the ability of pregnant
women to seek services.
 Cultural practices related to the care of a new mother and her child conflicts
with recommended infant feeding practices.
Key Promises and Supporting Statements
Key Promise
Supporting Statement
 By being informed about
 By completing the 4 ANC visits
ANC/PMTCT services and by
o HIV+ pregnant women can
completing the recommended 4 ANC
get all the necessary tests and
visits, possible health complications
adhere to their treatments
that might affect the mother and the
o Decide on infant feeding
baby can be avoided.
options and adhere to it
o Can follow up with PNC care
o Can disclose her status to her
 By opting for institutional delivery,
partner
mothers to be can have safe deliveries
and there will be an increased chance
the baby will be born HIV-. Babies
 They can share their experiences with
will also receive the necessary
fellow pregnant mothers
treatments.

Open discussion with your partner
allows you to get the support you
need to have a healthy family.
Opt to deliver at health facilities

Adhere to treatments

Decide on feeding options and adhere

Disclose status to partner
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
10
Call to Action
 Attend ANC/PMTCT/PNC care

Understand signs of labor and go to health facilities if you experience these
signs
Activities for HIV Positive Pregnant Women
Activity
Description
To train volunteers, religious leaders, informal
community leaders, students, ant-AIDS clubs etc.
about the benefits of ANC/PMTCT. This activity
will be held in markets, informal local
celebrations, and schools.
Radio Show in drama format for
urban and semi-urban areas
Create radio serial dramas on various issues
concerning ANC/PMTCT services. This radio
show will be aired on National radios and
community radio stations.
A TV spot in which an Ad about
ANC/PMTC services will be
transmitted targeting HIV+
pregnant women and their partners
and families.
This Ad will feature beneficiaries/witnesses and
they will share their experiences and benefits they
received. It will be broadcasted on TV.
Brochures/leaflets will be produced
about the benefits of seeking
ANC/PMTCT services (urban
setting)
Brochures/leaflets will include short feasible
action messages together will benefits associated
with ANC/PMTCT services. This
brochures/leaflets will be distributed to PLHIV
associations, health facilities, and inform women
groups.
5.1.3. Male Partners
Yohannes is a 35 years old, newly married man, who is expecting his first child. He
and his wife live in Hawassa, where he is an accountant for a company, which
provides them with a comfortable living for his family. Yohannes is an avid sports
fan, and spends his free time attending games or watching them on TV. His wife is
financially dependent on him, which is common among both educated and
uneducated partners. He is aware of HIV, and is concerned because of his history
concerning MCPs. He has some information about ANC from coworkers and
community health workers, and fears his wife will have to get tested through ANC
services. He wants to have a healthy baby, but is unsure and unaware of correct
information regarding ANC and PMTCT. Yohannes thinks that men are not supposed
to be involved in ANC, but should show up for the delivery. He often receives
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Health Education for the rural
public
11
House to house campaign to
To train HEWSs on interpersonal communication
educate people on a one to one basis skills and to identify HIV+ pregnant mothers and
to link them with ANC/PMTCT services.
conflicting information from those around him regarding ANC/PMTCT. Yohannes’s
concern regarding his status also impacts his willingness to seek ANC/PMTCT
information, and encourage his wife to access services.
Male partners have limited knowledge of ANC/PMTCT services, and act as a relevant
barrier to women seeking services. With regards to testing, they are often fearful to
know their status due to stigma associate with HIV/AIDS. Attending health visits with
their female partners is often not seen as manly or culturally appropriate for some
communities, which presents additional challenges for pregnant women.
Communication Objectives
 Increase the percentage of partners who seek couples testing and counseling
services.
 Increase the percentage of partners who initiate and support taking their
significant others to ANC/PMTCT/PNC services.
 Increase the percentage of partners who know about and attend ANC/PMTCT
visit with significant other.
 Increase the percentage of partners who believe it is important to discuss
openly with their partners
 Increase the percentage of partners who support their significant other in
dealing with family members

Increase the percentage of partners who remain faithful to their significant
other
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Key Promises and Supporting Statements
Key Promise
Supporting Statement
 Your participation in all aspects of
 Partners who test positive are leading
pregnancy and child care impact the
healthy productive lives.
overall health of your baby and
partner.
 Involvement of male partners has
resulted in smooth pregnancy, safe
delivery, and HIV free babies
 Open discussion with your partner
allows you to get the support you
need to have a healthy family.
 Partner initiation of ANC/PMTCT
activities promotes a healthy family.
 Knowing your status is best for you
wife and baby.
 Partner initiation of ANC/PMTCT
activities promotes a healthy family.
 Responsible partners do take the lead
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Key Issues
 Male partners are afraid to get tested and know their results; therefore, they
don’t encourage their partners to test for the same reasons.
 ANC/PMTCT/PNC services highlight women and exclude men.
 Partners don’t feel they have a place at the fac.
 They feel it is not manly to participate (Due to various cultural norms, male
participation in maternal health along with child rearing is not encourage
and/or viewed as manly.)
in ANC/PMTCT/PNC services.

HIV free babies

Responsible partners care.

You and your partner do not
necessarily share the same HIV
status. Know your status.

Discordant couples can and do live
healthy and productive lives together.
Call to Actions
 Go together and get tested for your family!
 Take the lead!
 Go to ANC/PMTCT services together with your wife!
 Start preparing for your partner to deliver at a health facility.
Barbershop

Train all HEWs on male
involvement
Produce teaching aides
Visit and discuss approach
Message development
Selecting popular program
Pretest before wide scale
implementation
Male partners:
o Urban and semiurban


TV/Radio
Link with other entertainment
programs especially those
focused on sports

House to house visits of HEWs
Focus on sports:
 Magazine
 TV Program



Message development
Posters and flyers that are
available at the barber shop
Provide a training on basic
ANC/PMTCT information and
IP communication skills
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Interpersonal

communication


Popular

entertainment


Dissemination
 Development agents
 HEWs and kebele
administrators
 Channel: group gathering
 Concomitantly with other
group activities (sport
hangouts)
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Activities for Male Partners
Activity
Details
Community
Iddir (promote monogamy):
mobilization
 Discussion
 Role model approach
 IEC provision on male
involvement
Emphasize the need for
accountability from all males
and to resist harmful cultural
beliefs (infidelity)
Mass media
Radio/TV:
 Serial radio drama
 Radio spot
 Experience sharing on the
radio
 Talk show
TV:
 Reality program
5.2.
Community Domain
Under the community domain, two groups of audiences are identified. These are men
and women of reproductive age, and influential leaders.
5.2.1. Men and Women of Reproductive Age
Chaltu is 17 years old and lives outside Jimma on a farm with her family. She is in 8th
grade and aspires to be a nurse and live a comfortable life when she grows up. When
she is not at school, Chaltu helps out around the house with chores and takes care of
her siblings. Chaltu admires her aunt who lives in the city, and hopes to one day have
a health wealthy family of her own. One of her greatest fears is that she will have to
raise her children with minimal income. She is in a relationship and gets money from
her boyfriend from time to time. She experiences peer pressure in her schools and
neighborhoods. Her weakness is that she likes gifts from her boyfriend, and her
friends encourage her behavior. HIV is not her main concern, but she fears that she
will get pregnant out of wedlock. She has no access to the radio or TV and spends
most of her time with her boyfriend when she is not in school or doing chores. She is
a good student, but does not know about MNCH/ANC/PMTCT. She dreams to one
day have a family of her own, and see her children receive a proper education.
Men and women of reproductive age are lacking knowledge about ANC/PMTCT
services and have limited access to information.
Communication Objectives
 Prevent MTCT of HIV by engaging in discussions with peers about ANC and
PMTCT services and where to access these services at the household and
community level.
 Heavily influence communities by acknowledging, approving and promoting
MNCH/PMTCT services.
Key Issues
 By informing men and women of reproductive age about the benefits of ANC
and PMTCT services as well as where and when to access services, mother to
child transmission of HIV can be prevented.
By using these services, pregnant
mothers will benefit by having a
healthy pregnancy and a healthy
baby.

Attending ANC helps pregnant
mothers have healthy pregnancies and
babies as well as reduce birth related
complications

If PMTCT is neglected, there will be
an increase of children dyeing due to
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
Supporting Statement
 PMTCT services will greatly reduce
the transmission of HIV from mother
to child
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Key Promises and Supporting Statement
Key Promise
 By acknowledging and approving
of MNCH/PMTCT services, there
will be an increase in confidence
to attend health facilities and
utilize MNCH/PMTCT services.

In addition, the increasing
knowledge and awareness, the
lives of family members and peers 
can be saved, you will benefit
from learning new things about
MNCH/PMTCT services and
partner support can be increased.
MTCT
High infant and maternal mortality
rates occur due to the lack of
attending ANC/PMTCT services
Call to Actions
 Discuss about PMTCT services with partners, family members, and peers
 Encourage all pregnant women to attend ANC/PMTCT services
 Discuss about the benefits and where to access ANC/PMTCT services with
partners and peers
 Save money for transportation expenses
 Convince and encourage partners to accompany their pregnant wife/partner to
attend services with her.
The radio serial dramas will be produced in major
languages such as Amharic, Tigrinya and Oromifa.
The program will be about conversations between
model families using ANC/PMTCT services in
coffee ceremony settings. The program will
consist of 40 episodes to be aired on a weekly
basis on stations such as Radio Fanna and/or the
National Radio. The conversations will be
facilitated by community volunteers.
TV and radio testimonials
Invite good representatives who are using or used
ANC/PMTCT services to share their experiences.
The discussion will be conducted in specific
languages such as Amharic, Tigrinya, Oromifa etc.
to increase receptiveness and message retention.
This program will be aired twice a week on Radio
Fanna and/or the National Radio as well as ETV.
ANC/PMTCT community
conversation guide
Prepare ANC/PMTCT community conversation
facilitators guide to train community conversation
facilitators on ANC/PMTCT. ANC/PMTCT
conversations will be integrated into existing
community conversations.
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Produce radio serial dramas
for men and women of
reproductive age (15-49)
15
Activities for Men and Women of Reproductive Age
Activity
Description
5.2.2. Influential Leaders
Audience Profile
Ato Zeleke is a married man with three kids that lives in Dukem. He is 45+ and leads
an average lifestyle with his income as a farmer. He is respected among his
community members, and puts his good status to use by helping solve disputes among
community members. Ato Zeleke is highly involved in the church, which impacts his
influencing power. He spends quite a bit of time helping the marginalized populations
within his community. His only weakness is the fact that he does not practice what he
preaches therefore fears that people may not follow his advice. He listens to the radio
consistently, and in turn shares his findings with his community members. Through
listening to the radio he has minimal knowledge about AIDS, PMTCT, and ANC and
wants to contribute his part in PMTCT in his community. One of his goals in life is to
contribute to the betterment of his community.
There seems to be low knowledge among religious/influential leaders the importance
of male/partner involvement on ANC/PMTCT services. By empowering these
leaders with basic ANC knowledge, and educating them on both misconceptions and
harmful practices, leaders would be equipped with the capacity to promote
ANC/PMTCT in their communities.
Communication Objectives
 To create awareness and increase the knowledge of religious/influential
leaders on ANC/PMTCT services in order to enable them to advocate for
ANC/PMTCT uptake.
 To increase the proportion of religious/influential leaders who promote male/
partner involvement in ANC/PMTCT services.
Key Issues
 Influential leaders are well positioned to address the misconceptions about
MNCH/ANC/PMTCT and to address misconceptions about male partner
involvement in MNCH/PMTCT service.
An increase in responsible
partners that care for their
families will be observed and will
influence others to do the same.

As partners get satisfied with
ANC/PMTCT services and their
wives have undergone save
deliveries, religious/influential
leaders will gain respect and
recognition from partners in their
communities.
16

Supporting Statement
 By promoting partner involvement,
this can help partners know their HIV
status as well as make them aware of
the fact that they can have babies that
are HIV free.
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Key Promises and Support Statements
Key Promise
 Promoting partner involvement
and getting partners to participate
in ANC/PMTC services can be
seen as a sign of modern thinking
and as a sign of greater
knowledge. It will get you more
recognition and acceptance from
the community and your range of
influence will be broader.
Call to Actions
 Promote for partners to accompany their wives to ANC/PMTCT services
 Transmit messages to both partners and pregnant women to utilize
MNCH/PMTCT services.
Activities for Influential Leaders
Activity
Description

Capacity building to provide
sensitization training on the
basics/fundamentals of
ANC/PMTC

IEC/BCC materials to
provide the necessary
information on ANC/PMTCT 
and male involvement


Promotional Materials
5.3.
To deliver training modules that are
contextually appropriate to the audience to be
used in TOTs for focal persons. These focal
persons will be assisted in cascading their
trainings to religious/influential leaders at
kebele and woreda levels.
Quick guides to be used as reference materials
will be developed as well as motivational
audio spots (e.g. “Be responsible for the
betterment of your community and you will be
spiritually rewarded.”)

Umbrellas, bags, safe motherhood watches that
contain ANC/PMTCT promotional messages

Billboards /Banners (religious leaders
promoting ANC/PMTCT services

Radio programs and spots (formatted based on
drama and reality)

TV testimonials and formal messages (a priest
or sheik giving testimonials)
Service Delivery Domain
Audience groups under this domain can be further clustered into facility based
audiences and community based audiences. Facility based audiences include health
care providers and support staffs at health facilities while community based audiences
are Health Extension Workers (HEWs).
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Audience Profile
17
5.3.1. Health Service Providers at Facilities
Entisar is a midwife older than 30 years old and she is married with two kids. Her
husband lives abroad and she uses the money he sends her, along with her income, to
raise her children. She often fears that her husband may not come back from abroad,
and the she might end up alone. She is a hard worker, easy to get along with, and
generally tries to have a positive attitude. Despite having a positive attitude, Entisar
often feels overwhelmed by her work, and her number of clients at work. She is also
growing increasingly apathetic in her work seeing all the unnecessary HIV+ infants
coming to the health center, or the pregnant women that come to the hospital after
their condition has become severe. She is very emotionally connected to her work, but
the circumstances are impacting her. Entisar tries not to get discouraged, but the
challenges at work are affecting her relationship with clients. She finds strength in her
own children, and taking time to visit relatives in Bora. Her goal is to see her kids
succeed through education.
Health Service Providers seem to lack motivation about ANC/PMTC services and
uptake. They feel like no matter how much they try to convince their patients to
follow up with their care and treatments, HIV+ pregnant mothers are very difficult to
penetrate and to get them to return and keep up with their ANC/PMTCT services.
Service providers as a result do not give their full attention to client handling and
communication.
Communication Objectives
 To make service providers feel that they are responsible and can make a
difference in pregnant women who seek comprehensive follow up care.
 To increase the awareness of health care providers about the importance of
good client handling and well informed communication skills with clients.
Key Issues
 Most health care providers are not motivated about the services they provide
in relation to ANC/PMTCT.
 There is lack of awareness about the importance of good communication skills
and client handling.
The feeling and needs of clients
should be prioritized and respected

An increase of pregnant women
coming to facilities will be observed.
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
18
Key Promises and Support Statements
Key Promise
Supporting Statement
 Good client handling and proper
 Clients should be
communication plays a key role in
o given due attention during
increasing PMTCT rates which
reception
increases the chances of
o well communicated with
preventing the transmission of
o well informed about their
HIV from mother to child.
treatment every step of the
way

Clients lost to follow up will decrease
Call to Actions
 Clients should be received with smiling faces from contact to departure of the
health facility
 Clients should be given full attention at all times
 Communication with clients should be conducted in a respectful manner
 Health care providers should properly introduce themselves to their clients and
should make an effort to memorize and call their clients by their first names
 Health care providers should listen to their clients and respond with neutrality
and encouragement
 Health care providers should communicate to their clients about they are
going, what they are going to do, and what’s expected of them and their next
action
Activities for Health Service Providers
Activity
Description
To develop reality based
videos or films
To conduct trainings for
health care workers on
communicating and handling
clients effectively
To develop a radio or TV
program on interpersonal
communication skills for
health care workers
Medical newsletters, SMH newsletters, and
newsletters developed by profession associations will
be distributed at association meetings, training
campaigns and at health care facilities.
This reality video/film will be about the work life of
well trained and committed health care workers. This
video/film will be distributed at facilities with the
proper viewing equipments.
Training sessions will be conducted on select groups
of health care workers and materials will be developed
and finalized for distribution so that these materials
can be incorporated into the trainings.
To record skilled health care workers on their
effective use of interpersonal communications and to
produce TV spots in relation to safe motherhood and
PMTCT. Cassettes of these materials will be produced
and distributed to health facilities.
19
To develop communication
materials such as magazines
To print and distribute materials such as wall charts,
pocket books and cue cards to health care facilities
Page
To develop communication
materials such as job aids to
healthcare providers
5.3.2. Support Staff at Health Facilities
Audience Profile
Workitu is a 43 years old woman who works as a janitor at the health station. She has
a very basic education, and can only read very little. She is a poor widow who
provides for her children and grandchildren. Workitu believes strongly in the role of
men and women in society, and encourages her children and grandchildren to uphold
the social norms. She is hard working but unhappy due to her life’s condition, which
sometimes she reflects on how she interacts with clients. She worries about what
would happen to her children and grandchildren if she loses her job. One of her
greatest fears is that her family will be left with no one to take care of them. She is a
very religious woman. She enjoys having coffee with her neighbors, and is respected
member of her community. While at work, Workitu is often the first person clients
see when they enter the facility, but she focuses her attention on work. Despite
working at the clinic, she has very little knowledge about ANC/PMTCT, and services
provided at the health center. Women in her community respect her perspective on
maternal health; however, she has limited exposure to proper ANC/PMTCT care. She
had her children at home, and is unaware of the risks associated with traditional
birthing practices.
Support staff act as the entry point to every stage in ANC/PMTCT service delivery.
They have varying knowledge on ANC/PMTCT. Limited knowledge of
ANC/PMTCT services. Often they uphold traditional gender norms, which present
relevant barrier in women seeking services.
Communication Objectives
 Understand the benefits of male involvement and encourage its practice.
 Increase the percentage of support staff that feel more committed and
responsible to provide client-friendly services.
Key Issues
 Men do not visit health facilities and NOT provide desired partners support
because:
o Unfriendly approach if SS towards male clients
o Fear that people at health facility will question his manhood
 Clients are mistreated when they visit the health facilities, and can develop a
fear of accessing ANC/PMTCT services
By properly caring for clients:
o You will be contributing

Male need encouragement to have a
positive perspective on services

Couples/women seeking services are
in dire need of your help.
20

Supporting Statement
 Women coming for ANC/PMTCT
services need their partner’s support
and companionship
Page
Key Promises and Support Statements
Key Promise
 If you approach male clients
positively and treat them with
respect they will have a positive
outlook on ANC/PMTCT/PNC
services and encourage their
female partners to attend.
to the betterment of health
in your community
o You will be spiritually
rewarded
o You will be acknowledged
and rewarded in your
community and
workplace.

Mistreatment in ANC/PMTCT clinics
is a common complaint against
clients.

People are encouraged to access any
services can be easily discouraged at
the slightest hint of hostility.

It takes a man and woman to have a
healthy baby
Award
T-shirt
Hats
Umbrellas
Radio drama
Calendars
Details
 Weekly coffee group meetings within the
clinics/posts
 Group meets with Ato Gwadengna to discuss
incidents and receive advice on how to
improve/avoid such situations.
 Use the context of discussion to create a short
training/orientation for new staff
 Emphasis on interpersonal communication.
 Awarding best staff member of the month
within the health facilities.
 SS receive training on basic ANC/PMTCT
services within the health facilities.
 Wear/use IEC materials with text that say
“Ask me about ANC”
 Create I.D. of daily client knowledge about
services
 Use them as advocates of ANC/PMTCT in the
community.
 Serial drama that addresses issues of client
friendly services and male involvement
 Program situated in context of clinic/post
 Speakers put up in clinic to let staff listen
while working
 Staff can discuss and raise issues (during a
coffee group)
 Use religious references that emphasize
treating people properly.
 Include all religious holidays.
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Activities for Support Staff
Activity
Group discussion
21
Call to Actions
 Be welcoming, warm, and inviting to all clients
5.3.3. Community Based Service Providers (Health Extension Workers)
Audience Profile
Melat is a 35 years old HEW, who is married with two kids. She lives in Addis and
has an average income. She believes in the possibility of an HIV free child birth and
helps teach that in her community through her work. Her only fear is that she might
get harassed by men while she is moving around in the community for work. Thus far
she has a 10+3 years of education, and she hopes to be a doctor in the future. She
often misses opportunities to continue her education because of work. She has
experience working in the Addis and more rural areas. Her role model is the prime
minister. She watches a TV show about health regularly. She takes care of her family
but she is burned out at work. In the evenings she goes out to clubs at night to try and
forget about her frustration at work. She does not feel appreciated within her work
environment and that sometimes impacts how she interacts with clients. Mimi has a
large number of clients she visits on a daily basis, and gets frustrated by the limited
resources available for her work.
Communication Objectives
 Increase communication skills and knowledge among HEWs to improve their
capacity to promote ANC/PMTCT services.

Increase the percentage of pregnant women in the kebeles that access
ANC/PMTCT services and follow-up
Key Issues
 HEWs lack the necessary communication knowledge and skills that affect
their ability to conduct social mobilization that is necessary to bring a social
response to ANC and address social issues related to ANC/PMTCT.
 Pregnant women who attend ANC for their first visit often don’t return to
follow up due to poor linkages/referral systems, and HEWs losing contact
with them.
Providing optimal service can
assist in providing job satisfaction
and awards.

The better services you are able to
provide the better the outcome for
your clients. to access any services
can be easily discouraged at the
slightest hint of hostility.
Call to Actions
 Seek support from supervisors if necessary.
 Conduct community mobilization to increase number of ANC attendants.
22

Supporting Statement
 Supervisors may be able to provide
additional resources to best assist
clients.
Page
Key Promises and Support Statements
Key Promise
 Committing to supporting
pregnant women in your
communities will help build
rapport and trust from community
members


You play a vital role in the delivery of healthy babies
Engage all pregnant women in the community.
Page
23
Activities for Health Extension Workers
Activity
Details
Newsletter
 Updates of ANC/PMTCT services and
related articles that help HEWs build their
capacity and best ANC/PMTCT services.
 The newsletter should be printed according
to the number of HEWs and disseminated
constantly in a timely manner.
Audio Guide in a cassette format
 Should include steps/procedures that HEWs
(optional)
need to follow to provide services
 The guide should look like a quick reference
and informational tool
 It should be distributed to health extension
workers who have access to tape players or
tape recorders
Handbook in a guide format
 Should include steps/procedures that HEWs
(optional)
need to follow to provide services
 The guide should look like a quick reference
and informational tool
 The handbook should be distributed to
HEWs
Job Aids
 A job aid for ANC and PMTCT that is
tailored to HEWs; friendly and suitable
 The job aid should be prepared and
translated to appropriate languages and
distributed
ANC/PMTCT community
 A guide that helps HEWs to mobilize the
mobilization guide for
community for ANC/PMTCT services (deal
ANC/PMTCT services
with steps and process of CM)
 Trainings on how to mobilize the
community should be provided and the
guide can be distributed
Short films or short messages via
 Short films on ANC/PMTCT, family
Bluetooth
planning, etc. can be prepared and
transmitted through Bluetooth’s to HEW
mobiles
 Provide training on how to use this
technology and to have HEWs send
messages to fellow HEWs who might not
have received the messages