challenges of health behavior change in the democratic republic of congo (drc)

C-CHANGE DRC Yaya Drabo

Washington DC, 3rd , JANUARY 2012

Speakers

• Neil McKee (Introduction) • Yaya Drabo (Presenter)

Here is the DRC Located in in Central Africa

• Size: 2,345,410 sq km

– 80 times Belgium– 4 times France– 10 times my native country: BF

• 11 Provinces including Kinshasa the capitol that is the 1/3 of the country: equivalent of Mali or BF population!

• Shares borders with 9 countries Angola, Congo, Central African Republic, Uganda, Rwanda, Burundi, Tanzania, Zambia and Sudan)

A DIFFICULT COUNTRY…

• Mainly because of its size DRC is a very difficult country to work in

• Transportation is frustrating• Terrible roads: flying is the best way to reach

any town; no safety regulations • Everything is expensive: e.g., housing as well

as air plane tickets

…But a Fascinating One!

• DRC is like a God’s gift. The second largest rainforest in the worldThe second largest river in the world Each of the 10 Provinces has an unique

richness (cobalt, diamond, copper)Creatures found nowhere else in the world DRC is Africa’s most biologically rich country

C-Change assigment in DRC

GOAL :Increase positive behaviors and norms related to family planning (FP), HIV and AIDS, malaria, maternal and child health(MCH) tuberculosis(TB) and water and sanitation (WATSAN) through evidence-based SBCC programs.

C-Change assigment in DRC (2)

• OBJECTIF 1: Support National Level Coordination: increase coordination, participation, and ownership by the MOH, NGOs, and other stakeholders in national health programs

• OBJECTIF 2: Build SBCC Skills: Develop SBCC skills and competencies of the MOH, NGOs and partners to design, implement and evaluate SBCC programs with the aim of changing a range of health behaviors that will improve health status.

C-Change assigment in DRC (3)

• OBJECTIF 3: Develop Evidence-Based Interventions and Materials: Improve the quality and effectiveness of SBCC programs and materials by employing evidence-based process that addresses individual factors, community and gender norms , environmental influences in their design, and implementation.

Family planning

Malaria

HIV/AIDS

EXISTING PROGRAMS

Water and Sanitation

Maternal and Child Health

GBV/School

Tubercolis ( TB)

EXISTING PROGRAMS

NEW PROGRAMS

Sexual and Gender-based violence/HIV/AIDS

Nutrition/HIV/AIDS

Prevention Mother-To-Child Transmission

C-CHANGE PARTNERS National Partners ( MOH) Sub-Contractors USAID’s Project Partners

PNSR (Reproductive health) CARE/DRC PROVIC

PNLP ( Malaria) SFCG (Search for Common Ground)

PROSANI (USAID Bilateral project in the country)

Direction de l’Hygiene publique ( Villages et Assainis)[WATSAN]

IDI ( Initiatives pour le Developpement Integral)

PNLS (HIV/AIDS) Kinshasa’ School of Public Health

No formal agreement signed

Contract Memorandum of Understanding

BUDGET [Field support] 2009-2011

Fiscal years

FP/RH Malaria HIV

AIDSMCH WATSAN GBV

HIV TB TOTAL

FY 09 250,000 250,000 - 250,000 450,000 100,000 1,300,00

FY 10 600,000 1,847,000 500,000 250,000 500,000 - 3,697,000

FY 11 600,000 135,000 500,000 150,000 - 250,000 1,664,320

Total (1) 1,450,000 2,232,00 1,000,00 650,000 950,000 350,000 6,632,000

FY 12 Funding

340,900 314,650 113,400 130,900 46.970 717,500 -

Total (2) 8,296,320

OBJECTIVE 1: SUPPORT NATIONAL LEVEL

COORDINATION

• We work mainly at the national level in supporting 3 national programs:– PNLP ( National Malaria Control Program)– PNSR( National Reproductive Health Program )– PNLS ( National HIV/AIDS Program)

• Advocacy (PNSR and PNLP)• Coordination (support national and provincial working group PNLP)• Support the development and implementation of SBCC programs supported by

USAID related to FP, Malaria, HIV and AIDS, MCH and Water and Sanitation

OBJECTIVE 2 : BUILD SBCC SKILLS

• National Programs' staff• USAID’s project’s staff • NGO – SBCC Training ( 70 people trained from the 4 main

national supported, NGO and USAID partners )– SBCC Strategy development • National Malaria SBCC Strategy developed• National FP SBCC Strategy • 2 Provincial SBCC Strategy developed

What is SBCC?

Social and Behavior Change Communication (SBCC)…

• Systematic and evidenced-based

What is SBCC?

• Addresses social context, not just individual behavior

- Use in analysis and design

What is SBCC?

• Employs various strategies for levels of intervention

PNLP staff

SBCC Training in Katanga

Pretest training in Kinshasa

Pretest Briefing in the fields Mbuji-Mayi

PNLP staff

SBCC training in South Kivu

PNLP STAFF

SBCC training in Katanga

Some Products

Katanga Province’s SBCC Strategy

Some Products

South Kivu Province’s SBCC Strategy

OBJECTIVE 3: DEVELOP EVIDENCE-BASED INTERVENTIONS AND

MATERIALS

• The 2nd year we focused on developing new materials related to each key programs we are working on

• Here are the materials we developed during the second year of the project ( See Table)

• Each of the materials were pretested through our subcontractor, CARE

PRINT MATERIALS DEVELOPED BY C-CHANGE DRC

Programs Flipcharts Counseling cards

Job aids Brochures Leaflets Comic books

Message guide

Posters

FP x

Malaria X( 8)

X

Watsan X(10)

X X X(3)

MCH X

HIV X(10)

GBVSchool

X(2)

AUDIOVISUAL MATERIALS DEVELOPPED BY C-CHANGE DRC

AUDIO TV

Radio spots Interactive programs

Radio drama TV show TV series

HIV/AIDSX

(8) 5 languages

X(8)

French

X( 4 episodes)

X(2)

X*(1)

GBV/School X(3)

SwahiliTotal 43 8 4 2 1*

Pretesting is key before producing the materials

PRETESTS OF MATERIALS GBV/School Lubumbashi ( Katanga) comics books in school

MalariaRadio spots in Mbuji-Mayi (Eastern Kasai)

SPECIAL EVENTS

• Given our responsiveness USAID/DRC asked us to organize 3 big events. We did it successfully.

• PEPFAR technical meeting and stakeholder meeting• PMI launch in DRC in a province far from Kinshasa

where we have no presence• C-Change presence at the Kinshasa International Fair

(USAID 50th Anniversary)

PMI Launch in Mbuji-Mayi

Amiral Zimmer, US Ambassador in DRC and the DRC MOH Secretary general

PMI LAUNCH

Amiral Zimmer after giving a bednet to a household member

Amiral Zimmer, US Ambassador in DRC and the DRC MOH Secretary general distributing bednet at a Health Center

OTHER SPECIAL ACTIVITIES FOR USAID

• Facilitation of the communication component of the Malaria course held by the University of Kinshasa (Medical Faculty)

• Facilitation of the communication component of the MPH program of Kinshasa School of Public Health

HOW DID WE MAKE ALL THIS HAPPEN?

• Focus on quality SBCC• More technical staff recruited in a competitive

environment (6 new staff)• Personal factors based on confidence and

professionalism (I was fortunate to know the country and to have trained MOH staff in DRC and outside)

• Responsiveness to USAID requests• Committed staff

WHERE DID WE COME FROM?

• C-Change has started in March 2009 with only • Two technical persons ( one permanent and one

consultant) • The former COP resigned after one year • 2 days after my arrival he left• C-Change visibility as a SBCC project was low • Staff were not as much motivated ( no technical feed

back no staff meeting )• Difficult relationships with the Mission

CHALLENGING THE CHALLENGES!

• Working in DRC is a matter of challenging the challenges!

• In fact, our program is growing and we will need:– More space (Our Office that was seen as to big at

the beginning of the project is now too small!)– More staff– Effective ways to scale up. That is the next

“episode” with the upcoming Associated Award: 10 programs to run!

Discussion

THANK YOU!!!