The Drum Beat 42: The CHANGE Project - Approaches and Tools for CHANGE

The CHANGE Project is seeking to identify the major behavioural issues and develop and test solutions to crucial challenges in the areas of child health, maternal health and nutrition. CHANGE has compiled into a matrix of brief descriptions of new approaches and tools addressing gaps in the current array of methods for positive, health-related changes at the individual, household, community, institutional and policy levels. Some of those identified are highlighted below. CHANGE is seeking to expand the range of approaches and tools for possible inclusion in this matrix. Your suggestions would be most helpful. Please send to Mike Favin changeinfo@aed.org 

KINDS OF TOOLS 

1. Innovative new approaches to changing health behaviour
2. New methodological tools [such as research instruments]
3. Approaches and tools that need further development and then testing
4. Approaches and tools implemented with apparent success but that need to be evaluated

EXAMPLES OF APPROACHES AND TOOLS BEING CONSIDERED 

1. Community input on community health 

Introduction: Changing the paradigm of the health facility from a technical service to a health/social resource that is shared by the MOH (or other provider) and the community. 

Example: MotherCare in Cochambamba tried to mesh medical and community perceptions of quality pregnancy, delivery, and postpartum care. The project and its local partners undertook a major training/sensitizing exercise for teams of providers; made a number of physical modifications in services (e.g., drapes for privacy, new hospital wear for mothers and providers); and implemented a major communication activities to try to reduce the gap in perceptions. 

2. "Champion communities" 

Introduction: "Champion communities" are those that have had successful experiences in participating in a health/development project and have learned to implement and maintain collective actions and supportive environments for behavior change. These communities participate in exchange programs with other communities, either acting as hosts to visiting members of other communities, or sending delegations/representatives to other areas to explain how their community succeeded. 

Example: Africare and the UNDP have developed a detailed project proposal describing the transformation of the district of Dioro, Mali, home of the successful DIORO Approach used by its Child Survival Project click here for the Drum Beat on the Dioro Project, into the "Ripple (Replicating Innovative Practices, Programs and Leadership Experiences) Center". Also used in Vietnam. 

3. Community radio and program archives 

Introduction: Community radio is used for health development. In many settings illiteracy is high so radio is the only affordable medium that can reach large numbers of the population. Community radio is characterized by good access, public participation in production and decision making, and by listener financing. 

Example: Radio Douentza is a community radio station that serves the community of the Douentza area in Northern Mali, a semi-arid region of subsistence agriculture - most of the population are farmers or herders. This radio station addresses many issues, including health. 

4. Building community self-efficacy 

Introduction: Facilitates community planning and implementing of community health actions, such as a health fair, in order to learn planning and management skills as well as gain self-confidence. Process and product-oriented. Involves a variety of community members (individuals and groups), NGO's, government agencies and donors in step-by-step preparations for something that the community has agreed is worthwhile. 

Example: The Dioro Child Survival Project in Mali has a large community health fair that integrates change communication into all entertainment - theater, demonstrations, speeches, group discussions, contest, games, dances, songs, video showings, parades, exhibit rooms, information diffusion kiosks and health volunteer awards ceremonies. Health services are alos available - vaccinations, growth monitoring, prenatal care consultations, counseling services for family planning, HIV/AIDS, and other interventions. 

5. Counseling as negotiation 

Introduction: Interaction between health worker and mother (or other patient) is still typically a one-way conversation, with the provider transmitting information and the mother listening and maybe giving brief answers to one or two questions. TRaining and job aids are often part of the solution as well. Improving this interaction requires system changes that encourage and reward real conversation. The best counseling cards are designed so that the health worker can tailor the information provided to the specific needs of the client. The best counseling cards also facilitate negotiation, serving as a guide to a conversation. 

Example: Counseling cards (or flip charts) are job aids for facility or community-based health workers to ensure that priority, essential information is covered. Usually, the cards have photos or drawings on one side, for the mother or caretaker to see, and words, phrases or sentences on the other for the health worker to see. Now exploring a process in which there are more equal relationships such as side-by-side cards for more equal power between health worker and client. 

6. Cultural reminders 

Introduction: Reminders may be for individuals, families and or for communities. These may be (and usually are) a sheet of paper or some other material, but they may also be reminder visits, phone calls, e-mails, or, for example giving the husband or mother-in-law responsibility for reminding the mother to do something such as take her iron tablet daily. 

Example: In the Weaning Project in Indonesia (beginning in 1986) mothers received a large sheet of paper with feeding recommendations, expressed graphically, for each month of the child's first two years of life. Some reminder materials are produced in the form of prescription pads. They are used for counseling during a clinic or home visit (sometimes with a counselor marking the advice relevant to the particular mother), and then the mothers takes home the sheet to help her remember the advice. 

7. Cyber-Baobab: Telecommunication tools 

Introduction: Provide cellular phones and other telecommunications technology in rural and urban areas that have no or limited phone access. Phones would be provided as an income-generating activity either through a health institution or an individual entrepreneur. The phones serve as public pay phones, allowing all people in the community to call out and receive calls for a small price. The cell-phones could be used for various health-related activities, such as emergency-transport systems. 

Example: The Grameen Bank in Bangladesh has a goal of putting at least one cellular telephone in every one of Bangladesh's 65,000 villages by the year 2003 to improve the lives of people living in poor communities with no telephone service. People pay to send and receive messages at these small public telephones. Grameen's pilot program in 150 villages confirmed that the village phone concept is economically viable. 

8. Networking Marketing 

Introduction: Applying the "tupperware approach" to disseminating basic health consumables and information for their appropriate use in low and middle-income countries. The basic idea is that individuals market a small number of health products to their neighbours and support their neighbours' appropriate use of those products. Those products could be slightly more attractive that those available at government facilites [eg, flavoured ORS, coated vitamins]. 

Example: The concept derives from the experience of companies such as Tupperware, Amway, Mary Kay and Avon which use typical community members to sell good qulaity products to neighbours, with instruction on how to use them. 

9. First Households (Hearth Model) 

Introduction: The Hearth Model is a community-based, " positive deviant" approach to reducing malnutrition. Identifies "positive deviant" mothers whom, while typically poor, are atypically feeding, caring for, and appropriately seeking health care for their children in better ways than the majority of mothers. The program links these mothers to mothers of poorly nourished children. The model mothers (and/or minimally compensated program workers) might go to the homes of malnourished children and jointly prepare meals with their mothers. Over time, the children's mothers thus gain knowledge, skills, and confidence that, without spending a lot of money, they can prepare nutritious meals that will make their child visibly healthier. 

Example: Save the Children's programme in Vietnam reduced second and third degree malnutrition by 80 percent among tens of thousands of children under three years of age. Caretakers were able to sustain the enhanced nutritional status of these children as long as two years beyond their participation in the program. Younger siblings in the community, born after the program ended, enjoyed the same enhance nutritional status. 

10. YOUR SUGGESTIONS 

Click here and briefly describe tools and approaches that you would recommend using the format below:

• [i] Brief description
• [ii] Origins and field experience
• [iii] Contact person and email

Please send items for The Drum Beat to the Editor - Deborah Heimann dheimann@comminit.com

 

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