A global review of the evidence on the social and behavioral drivers of demand for the maternal
and newborn health commodities was conducted and synthesized into summary tables for maternal and newborn health. This research was analyzed and described in a full report and spotlight brief. Background information and technical documents, such as technical briefs and links to key resources, are available for misoprostol, magnesium sulfate, and chlorhexidine.  

The situation analysis focuses on gaining a deeper understanding of the challenges and barriers to address within a specific context that influence the current demand and utilization of a priority RMNCH commodity, including individual knowledge, attitudes and behaviors of providers, end-users and other influencing audiences; social and cultural norms; potential constraints on and facilitators for individual and collective change; and media access and use by the intended audiences. It also examines the status of each commodity, including relevant policies, regulations, manufacturing, prices, supply-chains, and availability. In short, the situation analysis answers the question, “Where are we now?”

Conducting a situation analysis typically involves collating available data and resources and then convening a group of stakeholders to review and identify key information.

“Conducting a National Assessment on Demand Generation for Underutilized, Life-Saving Commodities: Guidance and Tools” provides guidance to country-based partners to carry out collection of relevant data. Sources of country-specific secondary data may include Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS), quantitative and qualitative research conducted by NGOs, or private sector market research, where available, such as Nielsen. RMNCH policies and guidelines may also assist in analyzing the situation.

The tool also provides semi-structured interview guides to collect information from key stakeholders, including RMNCH program staff within the Ministry of Health, procurement agencies, donors and other experts such as private sector wholesalers, manufacturers and academic institutions.

Lastly, the tool provides guidance in holding a stakeholder workshop to review the findings and reach consensus on implications and next steps for country activities.

If existing data, particularly on social and behavioral drivers, is not sufficient, is outdated, or does not provide enough insight into priority audiences, it may be necessary to conduct additional primary formative research through quantitative surveys or qualitative research methods such as focus group discussions, key informant interviews, and observation checklists. It may be especially important to conduct formative research around provider attitudes and other drivers to provider behavior, as this information is typically less available. If primary formative research is required, the findings should be analyzed prior to the start of strategy development. Guidance and tools to conduct formative research are provided in the additional resources listed.

The situation analysis has two main sections:

Health and Commodity Context:

An important part of the situation analysis is information on the health situation and the commodity context. This section examines the prevalence of postpartum hemorrhage, preeclampsia, and neonatal sepsis, recommended treatment protocols for all three conditions, and issues around commodity registration, prices, manufacturing, supply-chains, and point-of-access for end-users.

Audience and Communication Analysis:

The audience and communication analysis examines the social and behavioral drivers that facilitate or act as barriers to uptake of the commodity. Completing this section enables program managers to

• Determine potential audiences and their characteristics, those who influence them, and the drivers and barriers to behavior change.
• Identify potential communication resources, including communication channels, ongoing activities, and organizational and professional resources.
• Assess the environment to determine availability of products and services being promoted, accessibility, affordability and acceptability.
• Assess the social, economic and political conditions influencing behavior.

Illustrative questions are provided to guide a situation analysis for misoprostol, magnesium sulfate, and chlorhexidine.

Gender norms, cultural expectations, and roles of males and females within a community may be key barriers to increasing demand for misoprostol, magnesium sulfate, and chlorhexidine. Therefore, it is important to identify gender-related determinants of health behavior during the situation analysis in order to achieve successful program design and implementation.

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 the demand for and utilization of these commodities. The Guide includes guidance and a checklist on integrating gender into the situation analysis.

After developing a strong situation analysis, program managers should be able to identify the key implications or challenges from the data. What are the reasons that misoprostol, magnesium sulfate, and chlorhexidine are not being utilized? Are the commodities available? Are they affordable? Are they part of the national essential medicines list or standard delivery protocols? What do potential users – end-user, health care providers, and health educators – believe about the commodity? What is the potential market for commodities? Finally, select only a few key factors that the demand generation strategy will address. While it is tempting to address all factors, successful communication programs focus on the factors that will have the biggest impact given available resources.

Population Services International Global Social Marketing Department offers the following series of questions to guide the selection of strategic priorities:

Initial segmentation is often based on demographics, such as: age, sex, marital status, education level, socio-economic status, employment, and residence (urban/rural). Audiences can be further segmented by psychographics, which refer to people’s personalities, values, attitudes, interests, and lifestyles.

Audience profiles are the cornerstone of a communication strategy. Audience profiles first help bring to life and personify each audience segment, which subsequently guide communication messaging and activity planning. The profile should embody the characteristics of the specific audience, with a focus on telling the story of an imagined individual within the group who can neutrally represent the intended audience. Basing decisions on a representative, personalized example from a specific audience segment rather than a collection of statistics or a mass of anonymous people allows for more intimate knowledge of that audience segment and better defined and focused communication strategies. Therefore, the profile is important to ensure the messages are tailored to members of this selected group, resonate with them, and motivate them to take action.

Audience profiles for each audience segment are developed using the information collected in the situation analysis. The profile consists of a paragraph that should include details on current behaviors, motivation, emotions, values, and attitudes as well as socio-demographic information such as age, income level, religion, sex, and place of residence. The profile should exemplify the primary barriers to the desired behavior relative to the audience segment. The profile may include the name of this individual or a photo that represents this person to help visualize who this person is and tell his or her story. If the information gathered in the situation analysis lacks detail on a particular audience segment, additional research may need to be conducted to address the identified gaps. For example, for all provider audiences, it may be especially important to conduct formative research around provider attitudes and other drivers to provider behavior that could be used to better inform the audience profile and strategic design.

Characteristics of a good audience profile

• No two profiles will follow the same outline because the same data will not always be available for every 
group in every country.
• The best profiles include qualitative research as a source. Qualitative research will generate a wealth of in-depth audience insight.
• The profile should be a “living document”, meaning it is regularly updated when new information becomes available.

Source: PSI.org

As one of the cornerstones of the communication process, the audience profile helps guide our demand generation planning. For example, when making decisions about communication pieces or commodity distribution strategies, we should continually refer to the audience profile. The profile can aide in answering questions like:

• Where will our target audience learn about misoprostol, magnesium sulfate, and
  chlorhexidine?
• Would our target audience read about the evidence and treatment protocols for these
  commodities? How would they access such information?
• Where would our target audience want to access maternal and neonatal health
  commodities?
• Which of the determinants of behavior can we most effectively address?

Basing decisions on a representative example, the audience profile, from our target audience allows us to better define and focus demand generation strategies.

Source: PSI.org

Communication objectives are measurable statements that clearly and concisely state what the target audience should know (think), what they should believe (feel), and what they should do (behave) as well as the time frame required for the change. “SMART” objectives are Specific; Measurable; Attainable; Relevant; and Time-bound. Communication objectives should be derived from available evidence on the factors that drive or inhibit adoption by target users, as well as influencing audiences.

Positioning is the heart of the demand generation strategy and identifies the most compelling and unique benefit that the product offers the target audience. Positioning is often the emotional "hook" upon which the demand generation strategy hinges. Effective positioning moves beyond the functional benefits of the commodity and appeals to the target audience with emotional benefits.

Positioning presents the desired behavior in a way that is both persuasive and appealing to the target audience. It provides direction for developing a memorable identity, shapes the development of messages, and helps determine the communication channels to be used. Positioning ensures that messages have a consistent voice and that all planned activities reinforce each other for a cumulative effect.

As part of the positioning, a key promise is identified that highlights the main benefit associated with the proposed change. Changes in behavior, policies, and social norms are made only because there is a perceived benefit to those changes. The benefit must outweigh the personal cost of the change.

An accompanying support statement, also called a “reason to believe” in marketing, describes why the audience should believe the promise. This could be based on data, peer testimonials, a statement from a reliable source, or a demonstration. The key promise and support statement should include a balance of emotion and reason.

Key messages outline the core information that will be conveyed to audiences in all materials and activities. Messages cut across all channels, and must reinforce each other across these channels. When all approaches communicate iterative and harmonized key messages, effectiveness increases. Well-designed messages are specific to the audience of interest, and clearly reflect both a specific behavioral determinant and positioning. They also clearly describe the desired behavior, which must be “doable” for the audience. Key messages are not the text that appears in print materials (taglines), or the words that are used to define a campaign (slogans). Creative professionals are often hired to translate key messages into a creative brief, which is a document for creative agencies or internal teams that guides the development of communication materials or media products, including taglines and slogans.

It is important that key messages are always:

• Developed on the basis of country-specific formative research;
• Derived from context-specific, strategic choices regarding segmentation, targeting, and positioning;
• Addressed to known drivers of and barriers to behavior change in the country context; and
• Pre-tested with the target audience and refined based on audience engagement.