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

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C-CHANGE DRC Yaya Drabo Washington DC, 3 rd , JANUARY 2012

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Democratic Republic of Congo (DRC) is both one of the poorest nations in the world (with the second lowest GDP) and one of the richest (with mineral deposits worth $24 trillion). Its population of 70 million live in an area about four times the size of France. DRC has the world's second largest rainforest, second longest river, savannas, glaciated mountains, and few good roads. DRC is also remembered for "Africa's World War," which involved nine countries and killed 5.4 million people. Yaya Drabo is Chief of Party for the C-CHANGE project in the DRC. He invites you to learn why this country is so challenging to a social and behavior change program, and why it is so exciting.

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Page 1: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

C-CHANGE DRC Yaya Drabo

Washington DC, 3rd , JANUARY 2012

Page 2: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Speakers

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

Page 3: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Here is the DRC Located in in Central Africa

Page 4: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

• 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)

Page 5: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 6: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

…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

Page 7: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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.

Page 8: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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.

Page 9: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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.

Page 10: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Family planning

Malaria

HIV/AIDS

EXISTING PROGRAMS

Page 11: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Water and Sanitation

Maternal and Child Health

GBV/School

Tubercolis ( TB)

EXISTING PROGRAMS

Page 12: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

NEW PROGRAMS

Sexual and Gender-based violence/HIV/AIDS

Nutrition/HIV/AIDS

Prevention Mother-To-Child Transmission

Page 13: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 14: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 15: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 16: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 17: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

What is SBCC?

Social and Behavior Change Communication (SBCC)…

• Systematic and evidenced-based

Page 18: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

What is SBCC?

• Addresses social context, not just individual behavior

- Use in analysis and design

Page 19: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

What is SBCC?

• Employs various strategies for levels of intervention

Page 20: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

PNLP staff

SBCC Training in Katanga

Page 21: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Pretest training in Kinshasa

Page 22: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Pretest Briefing in the fields Mbuji-Mayi

Page 23: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

PNLP staff

SBCC training in South Kivu

Page 24: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

PNLP STAFF

SBCC training in Katanga

Page 25: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Some Products

Katanga Province’s SBCC Strategy

Page 26: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Some Products

South Kivu Province’s SBCC Strategy

Page 27: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 28: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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)

Page 29: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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*

Page 30: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Pretesting is key before producing the materials

Page 31: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

MalariaRadio spots in Mbuji-Mayi (Eastern Kasai)

Page 32: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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)

Page 33: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

PMI Launch in Mbuji-Mayi

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

Page 34: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

PMI LAUNCH

Amiral Zimmer after giving a bednet to a household member

Page 35: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 36: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 37: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 38: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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

Page 39: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

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!

Page 40: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

Discussion

Page 41: Challenges of Health Behavior Change in the Democratic Republic of Congo (DRC)

THANK YOU!!!