What doesn’t ?

“NOUS SOMMES TOUS DANS LE
MÊME BATEAU”

High Impact Behavioral Change at scale
USAID funded ‘Linkages project’ 1996-2006:
Promotion of Exclusive Breastfeeding, Optimal Feeding Practices.
Exclusive breastfeeding rates (EBF) increased at significant levels in the five country programs; Madagascar 28 percent - in 5 yrs, Zambia
17 percent- in 4 yrs,Ghana and Bolivia 10 percent in 3 yrs, Ethiopia a 20 percent increase in 2 years.
Spin-off programme BASICS in Benin showed a 26% increase in 4 years time.
Project population; Ghana 3.5 million, Madagascar 6.3 million
Limitation: sustainability , ownership

 multiple partners -coordinated strategies, collaborative plans, consensus building, scaling up
 multiple entry points:
- national: decision makers, academic staff,journalist
- district; hospital staff and administrators, health facility supervisors
- community; pregnant women, mothers of infants, fathers of infants, grandmothers, entire communities
 community based strategies
 behaviour change communication
- targeted precise messages to promote do-able actions, peer group support , women’s groups other community groups, saturation of primary audience with messages (modern, traditional media)
 capacity building
-government workers, NGO staff, community health workers
 monitoring and evaluation

• through intermediary of community based volunteers
• A ‘jungle’ of volunteers…

- Quality of work /motivation
- Sustainability
- Ownership

motivation presence supervision

• A ‘problem’ in every country, in every programme..but just a ‘challenge’ for some
• True volunteers or selected
• Should volunteers be paid or not ?
• Spirit of volunteerism ?
Alternatives ;
Mother’s clubs Red Cross Ghana, Nigeria
- Maman Visa – MCDI Benin

• Supervision by government staff
- no time
no interest…?
Going to scale without ensuring quality at community level

“Projects directed at women are lasting”
• Income-generating activities
• Saving schemes
• Literacy programmes
“Women's groups provide an especially powerful opportunity to share life-saving information and to increase demand for health care”.
“If you want to reach mothers and children, you have to use mothers..”

- MMD programme CARE Niger
- UNICEF Benin Community based Education
Programme; adopted as a National Policy for the
Promotion of Girls Education
- Association Munyu BF
- Groupement Naam BF

• CARE Niger developed in 1991 the MMD methodology of saving’s and credit which has been highly successful.
• Today 7000 association’s in six of Niger’s seven departments
• Benefiting more than 240.000 rural women
• MMD methodology is unique; does not provide external credit.
Methodology is derived from traditional savings method called
“tontine”- very different from micro-finance
• Sustainable because each group is autonomous. 95 % percent of groups formed continue their activities
• Impact: social and economic but most importantly enhancing women’s self-esteem
• They are often viewed as “having been educated”

• ‘On chante le chanson que vous aime ecouter...’
• So..now we are breastfeeding what are you going to give us ?
• ‘they told me I was appointed...’volunteer malaria, water..etc.’
• You have given us bicycles...but we need income generating activities to sustain our activities ?
• We need to become better listeners, to the true needs of the community...

Community-led development ?
O
(truly) participatory at all levels of the process;
- participatory diagnose
- community management of resources
- participatory analysis of results
Time flexibility…..
Good examples :
- Groupement NAAM BF
- WASH programmes
- Faith based organizations
Congo RDC, - Republic
- Plan Mali

An example of sustainability and ownership…
Guamina
Implementing NGO OF KENEYA CIWARA HEALTH PROJECT

KENEYA CIWARA HEALTH PROJECT
Funded by USAID led by CARE Mali - consortium of partners ; JHCCP,
Intrahealth, Action Against hunger and Groupe Pivot/ Sante
Programme works with 4000 community health volunteers in 7 of
Mali’s 8 regions reaches 30 % of the population.
Integral part of the Malian Government Health Program.
Decentralization process has given more of power of decision to the communities - project works directly in-line with this process
A five year project (2003-208):
Objective; to stimulate communities to demand for better quality health-services and to make them more responsible in solving their own health needs
Some results;
In 2006 97% children under age 1 vaccinated for DTP3
Children under 5 sleeping under ITN 9.7% in 2005 - 23.5% in 2006
76 % of women registered for antenatal care
50% of births attended by skilled personnel

QUALITY INDICATORS FOR SUCCESSFULL
COMMUNITY ENGAGEMENT PROGRAMMES

Presence and intensity of interaction between village volunteers and the supervising body (NGO, Government)

CBO endogenous to the region
 Ownership; using truly participatory methods at all levels of the process

Inclusion/participation
 Scale of the programme
 The type of volunteers used and effectiveness in reaching the target population of mothers and children 0-5 years.
 Using existing structures for communication (women’s groups, agricultural groups..)
 Saving schemes or other IGA included in the programme
 Sustainability after the programme has ended.

• Interpersonal Education, Peer education
• Exchange visits
• Community radio to re-enforce messages
• Traditional song, poems, theatre forum; more complicated issues: FGM, HIV/Aids
• Depending on the cultural context

Behavior change impact information is available at community level and can be used…
Observational data can be collected through community health workers

• Going to scale
• Ensuring quality on the ground
…a consortium of quality NGOs….