mshaivitz – Demand Generation I-Kit for Underutilized, Life Saving Commodities

About the I-Kit

mshaivitz — Mon, 24 Mar 2014 09:00:09 +0000

The Demand Generation Implementation Kit, the “I-Kit”, is a step-by-step guide to developing communication strategies to increase demand for nine priority commodities, and provides cross-cutting tools, guidance and adaptable commodity-specific content. By using the I-Kit, country teams can fast-track implementation of demand generation interventions in order to accelerate progress towards MDGs 4 and 5.

What is the objective of the I-Kit?

The primary objective of the I-Kit is to support country teams to develop commodity-specific messaging and activities, tailored to the country context and utilizing country-specific data.

For countries that already have RMNCH communication plans and programs, the I-Kit can be used as a tool to integrate strategic and effective components specifically for the underutilized commodities. In countries that still need to create RMNCH communication plans, the I-Kit offers guidance and support to develop evidence-based, effective demand generation strategies.

Who should use the I-Kit?

The I-Kit was designed to be useful to multiple audiences. The I-Kit will support the efforts of communication professionals working directly on behavior change communication programs as well as other professionals working in RMNCH who need to create a demand generation component to support program activities. Staff from ministries of health, non-governmental organizations and community-based organizations will all find useful resources, information and examples.

What is the Final Product?

Users of the I-Kit will develop demand generation strategies for selected health areas or commodities that are country or context specific and can be integrated into existing national communication strategies and interventions for RMNCH.

What commodities are covered in the I-Kit?

The I-Kit provides adaptable commodity-specific content, such as audience profiles, objectives, messaging and implementation activities, for nine priority commodities, organized by three overarching health areas along the RMNCH continuum of care:

Family Planning

Contraceptive implants (for prevention of unintended pregnancy)
Female condoms (for prevention of unintended pregnancy and STIs/HIV)
Emergency contraception (for prevention of unintended pregnancy)

Maternal and Newborn Health

Misoprostol (for postpartum hemorrhage)
Magnesium sulfate (for pre-eclampsia/eclampsia)
Chlorhexidine (for newborn cord care)

Child Health

ORS and zinc (for diarrhea)
Amoxicillin (for childhood pneumonia)

How was the I-Kit developed?

The I-Kit was developed by the Health Communication Capacity Collaborative (HC3) at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU·CCP), with support from the RMNCH Trust Fund and the United States Agency for International Development (USAID), in partnership with Demand Generation Technical Resource Team members, including Population Services International (PSI), International Consortium on Emergency Contraception (ICEC), PATH, Jhpiego and other partners.

Discussion Board on I-Kit

Join the I-Kit discussion group on Springboard for Health Communication, an online social network for social and behavior change communication professions. Designed to foster a community of practitioners working to increase demand for health commodities, it is a space to share experiences using the I-Kit, ask questions of other users, and to discuss the challenges and opportunities in developing demand generation communication strategies.

Photos

All photos on the site are courtesy of Photoshare, unless otherwise noted.

Overview: Family Planning

mshaivitz — Wed, 12 Mar 2014 20:00:39 +0000

This section of the I-Kit provides guidance on completing the six steps of a communication strategy for three family planning commodities: contraceptive implants, female condoms, and emergency contraceptive pills.

Illustrative, adaptable content is provided for each step at the bottom of the page. By clicking on the links, 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 “core resources” in the right sidebar. The full strategy includes both guidance and illustrative content for the entire strategy.

The six steps are:

Step 1: Analyze the situation

Step 2: Define a vision

Step 3: Choose the target audiences

Step 4: Select key messages

Step 5: Determine activities and interventions

Step 6: Plan for monitoring and evaluation

In each step, further guidance and resources can be found in the right side bar. "Core resources" include suggested cross-cutting tools developed specifically to support demand generation programs for the life-saving RMNCH commodities. "Additional resources" include further tools and materials specific to that step. Examples of project materials from around the world can also be found under "Step 5: Determine activities and interventions".

Every country and context is different, and the content of your demand generation plan should be based on research and data from your local context. The adaptable content is offered as examples, and is not designed as a “one-size-fits-all” model.

By working through the six steps, using the illustrative examples as a foundation, users will develop commodity-specific messaging and activities, tailored to the country context, which can be integrated into existing communication strategies and interventions for RMNCH.

Overview: Maternal & Newborn Health

mshaivitz — Tue, 11 Mar 2014 20:35:13 +0000

Designing a Strategy for Maternal and Newborn Health

This section of the I-Kit provides guidance on completing the six steps of a communication strategy for three maternal and newborn health commodities: Magnesium sulfate, misoprostol and chlorhexidine.

The six steps are:

Step 1: Analyze the situation
Step 2: Define a vision
Step 3: Choose the target audiences
Step 4: Select key messages
Step 5: Determine activities and interventions
Step 6: Plan for monitoring and evaluation

By working through the six steps using the illustrative examples as a foundation, users will develop commodity-specific messaging and activities, tailored to the country context, which can be integrated into existing communication strategies and interventions for RMNCH.

Overview: Child Health

mshaivitz — Mon, 10 Mar 2014 17:32:44 +0000

This section of the I-Kit provides guidance on completing the six steps of a communication strategy for three child health commodities: ORS, zinc and amoxicillin.

The six steps are:

Many countries promote an integrated approach to child health, commonly known as Integrated Management of Childhood Illnesses (IMCI). The template guides you to design a strategy per commodity, while considering the broader operating context. If IMCI is the recommended approach in your country or context, design the demand generation strategies to use complementary communications channels and messages.

Step 5: Determine Activities and Interventions

mshaivitz — Thu, 06 Mar 2014 15:28:29 +0000

Activities and interventions allow for communication of key messages through a variety of communication approaches and channels. Well-designed demand generation programs include activities across a range of different intervention areas and communication channels to reinforce messages and reach the audience when they are most receptive to the message. An overview of the types of strategic approaches that can be used is available here.

Activities and channels should be carefully selected based upon type of messaging, ability to reach the intended audience through a variety of media/channels, timeline, cost, and available resources. It is helpful to refer to findings from the situation analysis to guide selection of activities and interventions. Some channels and activities may be better suited to addressing particular behaviors or behavioral determinants than others.

Theories are often used to guide the design of messaging content aimed at increasing demand for health services and commodities. However, it is less common that theories are used to guide the selection of the media through which those messages are conveyed. In fact, given that different media have different capacities and abilities to effectively transmit information, the medium and the message cannot be considered separately—one needs to select media and develop content in concert and in a way that optimizes both. A new “Theory-Based Framework for Media Selection in Demand Generation Programs” is a tool to assist program managers carrying out demand generation activities in identifying and selecting the appropriate media channels, including ICT and new media channels. More tools on choosing communication channels are provided in the additional resources.

Recommended communications channels, or intervention areas, for maternal and newborn health demand generation strategies include:

Mass Media

Mass media includes radio, television, print (newspapers and magazines), and outdoor signage (billboards, advertising on buses and taxis, etc.). Mass media is an excellent option to reach a wide audience, although it can be expensive and cost of production and purchase of airtime must be factored into budgeting. Television allows for storytelling, demonstrations of the desired behavior and, when well done, a TV spot can be highly memorable. In some countries television reaches all socio-economic sectors, while in other countries, TV is a luxury. Radio can also reach a wide audience, allow for storytelling and be memorable, especially when messages are linked with songs or jingles. In some countries, radio stations are targeted to specific audiences, which may be helpful when selecting the best ways to reach audience segments. Radio is typically less expensive than TV.

The effectiveness of print media varies widely by country and literacy rates must be considered. Print can be effective for advocacy efforts, especially when selecting newspapers read by decision-makers. Outdoor advertising reaches audiences based on geography and not based on demographics. The audience reached will likely see the message repeatedly if they pass by the outdoor media regularly.

Given the wide reach of mass media, with the potential to reach thousands of people, a small to moderate effect size will have a greater impact on public health than would an approach that has a large effect size but only reaches a small number of people. Thus mass media can have a major public health impact given its wide reach, when done well. However, not all messages are appropriate for all media, and may for example, be better suited to interpersonal communication or other channels.

Illustrative activities in the mass media domain are provided in the illustrative examples. Materials from mass media campaigns and other tools are also available in the additional resources.

ICT and New Media

Information and Communication Technologies (ICTs) are electronic, digital technologies that enable the creation and exchange of information. ICTs provide the platform for new media, such as web-based applications and social media sites, which, in comparison to traditional media like radio or television, are interactive and empowering. Given the global proliferation of mobile and wireless technologies, ICTs and new media have the potential to transform health communication and service delivery. ICTs and new media offer methods for connecting and mobilizing consumers and providers – even those living in hard-to-reach areas – and reaching them with up-to-date health information.

Examples of demand generation programs utilizing ICT and new media are presented in “Utilizing ICT in Demand Generation for Reproductive, Maternal, Newborn and Child Health: Three Case Studies and Recommendations for Future Programming” which presents key program design elements, evaluation data and lessons learned. Other tools and examples on the use of ICT and new media are also available in the additional resources.

Clinics, Pharmacies and Drug Shops

Demand generation activities focused on clinics, pharmacies and drug shops can be targeted both to providers and to clients. Effective activities targeting providers include medical detailing, provider training, and supportive supervision. For clients, the most common demand generation activity is high quality counseling. Additional activities targeted to clients include clinic-based small group education sessions and availability of print materials such as brochures and posters.

Counseling is a critical demand generation activity in clinics because the environment is ideal for communicating key messages. Counseling sessions are often one-to-one communication opportunities, which allow clients to ask questions and providers to tailor the information and key messages. Second, health care providers are typically trusted and influential sources of information, which lends credibility to the key messages. Counseling tools or job aids can be part of a demand generation plan, and are used to help clients and counselors improve their interactions. Service providers should be trained to use the tools and aids.

Illustrative activities in clinics, pharmacies and drug shops are provided in the illustrative examples. Materials from such activities and other tools are also available in the additional resources.

Community-based services and outreach

At the outset, it is important to note the differences between community-based services and community-based communication efforts, even though both approaches share many similarities.

Community-based outreach is generally face-to-face interaction with a target audience that aims to generate demand for commodities or services, or to change behavior. Community-based outreach can be conducted through interpersonal communication (IPC) in one-to-one or one-to-group counseling. Job aids such as flip charts and brochures are helpful communication tools for IPC workers, when they are culturally appropriate and designed to accommodate literacy levels, and their development or adaptation should be included in demand generation plans that contain IPC activities. Another community-based outreach approach is community mobilization, which is the process of bringing people together to share a vision, promote dialogue, build their capacity and take collective actions to address problems affecting the entire community. It makes people feel that they are a member of a community even if they are not directly affected by the issue.

Community-based services are the provision of health care services in communities, outside of clinics. Most community-based service programs include an IPC strategy to generate demand for the services.

Recent studies are showing that community-based services are effective for improving outcomes in health areas as diverse as post-partum hemorrhage and childhood pneumonia. Incorporating community-based strategies into a demand generation plan can be effective if community-based services are permitted in the context where you work. If community-based services are not permitted, you may consider adding advocacy for this strategy to the demand generation plan.

Illustrative activities in community-based services and outreach are provided in the illustrative examples. Materials from such activities and other tools are also available in the additional resources.

Structural Approaches

Structural approaches for demand generation include development and/or dissemination of policy and guidelines, advocacy with decision-makers, and pre-service training for providers. Scaling Up Lifesaving Commodities for Women, Children, and Newborns: An Advocacy Toolkit provides advocacy resources for utilizing the Commission platform to raise awareness and engage stakeholders in addressing commodity-related gaps in policy.

Illustrative activities for structural interventions are provided in the illustrative examples. Materials from such activities and other tools are also available in the additional resources.

Linkages with non-communication programs

Communication campaigns will be most successful when they link with programs that have an impact on demand. For maternal and neonatal health communication campaigns, two important program linkages are efforts to train health care providers to utilize misoprostol, magnesium sulfate and chlorhexidine and supply and distribution initiatives to ensure the availability of the commodities. The following are examples of additional programs with which demand generation programs should develop linkages:

Other maternal and newborn health/safe delivery programs that do not currently include misoprostol, magnesium sulfate and/or chlorhexidine
Quality of care improvement initiatives for service providers/clinics
Pre-service education and existing continuing education or in-service refresher training initiatives for clinical and non-clinical providers
Supply chain management and market shaping
Non-maternal and newborn health programs such as antenatal/postnatal care etc. (e.g. to provide counseling, disseminate materials) – at both the clinic and community levels

Public-Private Partnerships

Public Private Partnerships (PPPs) are sometimes an appropriate and effective way to increase resources, expand revenue streams, increase visibility and expand credibility for demand generation programs. Successful partnerships are engaging and mutually beneficial for both parties and consider the other partner’s relative comparative strengths. Each partner brings expertise to the table, but also each has constraints and competing demands, as well as opportunities to be explored.

“"The P for Partnership": Addressing the Role of Public Private Partnerships to Increase the Demand for RMNCH Commodities provides information and practical tools to help program managers determine how to develop PPPs to ultimately increase the demand for and utilization of these commodities. This tool provides a typology of PPP models along with step-by-step guidelines on how to select private sector companies and how to create effective partnerships for demand generation programs. By utilizing this tool, managers will be better equipped to engage the private sector and understand various types of partnerships for demand generation.

Other tools and examples on PPPs are also available in the additional resources.

Illustrative Activities and Interventions

Activities and Interventions for Misoprostol
Activities and Interventions for Magnesium Sulfate
Activities and Interventions 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

Misoprostol Magnesium Sulfate Chlorhexidine

Step 6: Plan for Monitoring and Evaluation

mshaivitz — Wed, 05 Mar 2014 15:20:20 +0000

Monitoring and evaluation (M&E) is a critical piece of any program activity because it provides data on the program’s progress towards achieving set goals and objectives.

Although planning for M&E should be included in the communication strategy, avoid developing a complete monitoring plan at the time of strategy development (indicators, sample, tools, who will monitor, frequency of data collection, etc.). At the time of strategy development, focus on the indicators that should be incorporated into the program's plan. M&E indicators should be developed based on formative research and should indicate whether the key messages and strategies are having the desired effect on the intended audience.

A full M&E plan should then be developed as a separate program document. Developing an M&E plan should outline what M&E indicators to track, how and when data will be collected, and what will happen to the data once it has been analyzed. A variety of data sources can be used to collect M&E data. It is important to assess the scope and context of the program to choose the most applicable methodology, as M&E activities vary in cost, staff, and technology requirements. While some lower-cost M&E options will allow for identification of trends in demand for services, they may not be able to provide additional insight into the causal effects of activities and the way in which the program worked. To measure cause and effect, larger program-specific data collection activities geared towards evaluation are needed. See below for examples of low and high cost options.

While the collection of M&E data tends to receive the most attention, it is also critical to have a process for analysis and review of the collected data. M&E data should be used to inform program changes and new program development. It is best to build these M&E review processes into existing program management activities to allow for regular dissemination of M&E indicators.

Data Sources/System

Low cost option

The low cost option will make use of existing data sources and opportunities to gain insight into the program and its associations with changes in demand or uptake of misoprostol, magnesium sulfate, and chlorhexidine. However, it will only allow for the identification of trends and will not allow for the attribution of change to a given program or to program activities. Illustrative data sources for a low cost option include:

Formative research for key messages, positioning, development of materials and media choice (focus groups with intended audiences and in-depth interviews with members of primary and influencing audiences)
Evaluation of communication campaigns (focus groups with intended audiences; in-depth interviews with primary and influencing audience members; adding questions to omnibus surveys on campaigns, messages and activities)
Service statistics (Information from clinics and providers such as referral cards and attendance sheets)
Communication channel statistics (Information from television or radio stations on listenership of mass media activities)
Omnibus surveys (Addition of questions related to program exposure and impact to omnibus surveys)
Provider self reported data (Small scale surveys among providers about services rendered and prescription practices; small-scale retail audits among pharmacies and rural drug shops on medicines requested and offered)
Demographic and Health surveys (Trends in maternal and newborn health approximately every five years)

High cost option

The high cost option will make use of representative program-specific surveys and other data collection methods to gain considerable insight into the effects of the program and the way in which it worked. Illustrative data sources for a high cost option include:

Formative research for key messages, positioning, development of materials and media choice (focus groups; in-depth interviews; photo narrative or observation with families or inside clinics, pharmacies, or with CHWs to observe and record)
Service statistics (Information from clinics and providers such as referral cards and attendance sheets)
Communication channel statistics (Information from television or radio stations on listenership of mass media activities)
Provider self-reported data (about services rendered, product and sales audits among wholesalers and government procurement agencies; retail audits at pharmacies and drug shops to check medicines requested and rendered)
Large, nationally representative program-specific surveys (focus on issues related to knowledge, perceptions, acceptability and use) – may include baseline survey, follow-up and endline to measure changes and outcomes
Client exit interviews (to assess whether counseling and health education took place on the availability and/or use of misoprostol, magnesium sulfate, chlorhexidine, and user satisfaction with services delivered including their perceptions, experience and intentions)

M&E indicators

M&E indicators should include process, output, outcome and impact indicators:

Process indicators: Measure the extent to which demand creation activities were implemented as planned.

Program Output Indicators: Measure (a) changes in audiences’ opportunity, ability and motivation to use the commodity, and (b) the extent to which these changes correlate with program exposure

Behavioral Outcome Indicators: Measure (a) changes in audiences’ behavior, and (b) the extent to which these changes correlate with program exposure

Health Impact Indicators: Measure changes in health outcomes

To increase the utility of M&E data, indicators should be disaggregated to facilitate more in-depth analysis of program performance. It is recommended that indicators are disaggregated by, for example, gender, geographic location, type of provider etc.

Common biases that programmers should be aware of when designing, implementing and interpreting M&E include:

Self-selection bias – for example, for example, a woman who has attended/is attending ANC services at a clinic may be more interested and willing to answer a survey about ANC services compared to someone who has no past experience in utilizing ANC.
Social desirability bias – following exposure to health promotion initiatives, intended audiences may feel pressured to give ‘right answers’ to survey questions, e.g. to report positive attitudes towards a commodity even though they do not really feel that way. As demand generation interventions are successful at shaping positive social norms, social desirability bias may become more of a challenge in M&E.

Illustrative Examples of M&E indicators

M&E indicators for Misoprostol
M&E indicators Magnesium Sulfate
M&E indicators for Chlorhexidine

About the Life-Saving Commodities in Maternal and Newborn Health

Misoprostol Magnesium Sulfate Chlorhexidine

Overview: Cross-Cutting Topics

mshaivitz — Sat, 01 Mar 2014 12:39:29 +0000

Gender

mshaivitz — Fri, 28 Feb 2014 12:41:46 +0000

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 demand and utilization. The Guide is designed to make demand generation messages more effective, stimulate awareness of the need for equity in gender roles, and improve equitable behaviors.

The information and tools provided in this Guide can be used throughout the different steps of the project cycle of any program seeking to improve the health of women and children through increasing the demand of RMNCH commodities. This Guide contains:

Definitions of each commodity paired with key influencers of demand
Gender and demand generation key concepts and definitions
Two useful frameworks for gender programming in RMNCH
- Gender Equality Continuum
- Social Ecological Model
Gender and Situational Analysis
- Checklist #1: Including Gender in Situation Analysis
Gender and Program Design and Implementation
- Checklist #2 : Integrating Gender Into Program Design and Implementation
- Checklist #3: Using the Gender Equality Continuum to Assess Integration of Gender in Programming
Gender and Monitoring and Evaluation
- Checklist #4: Is Gender Integrated into Monitoring and Evaluation?

For information on broad-based issues of gender equity or structural and policy domains that limit supply and access to services, along with other tools to support gender programming, see the Additional Resources section provided at the end of the Guide and on the right sidebar or in the Document Library.

Media Selection

mshaivitz — Thu, 27 Feb 2014 12:43:34 +0000

A Theory-Based Framework for Media Selection in Demand Generation Programs provides step-by-step information and practical tools to guide media selection (i.e. communication channels) using a theory-based approach. The Guide provides a theoretical foundation to guide the design, implementation and evaluation of media selection; with a specific focus on information communication technology (ICT) and new media channels, commonly referred to as e- and m-health.

This Guide contains:

Demand generation key concepts and definitions
Using Theory to Design Demand Generation Programs
- Media Richness
- Uses and Gratifications

TIMS: A New Theory-based Framework for Media Selection
- Applying the TIMS Framework
- Step 1: Media Richness
- Step 2: Uses and Gratifications
- Step 3: Overlapping Media

Primer on Media Richness Theory
Primer on Uses and Gratifications

For illustrative examples showcasing the use of ICT and new media in demand generation targeted at both providers and families see Utilizing ICT and New Media in Demand Generation for Reproductive, Maternal, Newborn and Child Health: Three Case Studies and Recommendations for Future Programming.

ICT and New Media

mshaivitz — Mon, 24 Feb 2014 12:57:18 +0000

“Utilizing ICT in Demand Generation for Reproductive, Maternal, Newborn and Child Health: Three Case Studies and Recommendations for Future Programming” highlights three case studies of programs that utilized information and communication technology (ICT) and new media, specifically mobile technology, as part of an integrated strategy to increase demand for RMNCH health commodities in low-resource settings. These illustrative examples showcase examples of ICT and new media targeted at both providers and families, and highlight the use of behavior change theory to guide media selection.

The three case studies are:

Case Study #1: Mobile Alliance for Maternal Action (MAMA)

The MAMA Program uses mobile technology to improve the health and nutrition outcomes among pregnant women and new mothers and their infants in Bangladesh and South Africa.

Case Study #2: The Ananya Program

Targeting providers and consumers, the Ananya Program uses mobile technology and mass media to increase the knowledge of health providers and educate consumers in an effort to generate demand for and utilization of maternal, infant and child health services in India.

Case Study #3: Mobile Technology for Community Health (MOTECH)

The MOTECH initiative aims to determine how to use mobile phones to increase the quantity and quality of prenatal and neonatal care in rural Ghana, with a goal of improving the health outcomes for mothers and their newborns. The ICT approach includes mobile technology aimed at both health providers and consumers.

Based on these case studies, recommendations for utilizing ICT in demand generation programs for RMNCH are provided.

For further information and tools related to ICT for demand generation, see the Additional Resources on the right sidebar or in the document library.