Behavior Change Communication (BCC) Strategy

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Behavior Change Communication (BCC) Strategy
Pakistan Safe Drinking Water and
Hygiene Promotion Project (PSDW-HPP)
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Basic Facts

• 4,900 children under age of five die worldwide
  each day from infectious diarrhea due to unsafe
  drinking water
• Diarrhea caused by unsafe water, inadequate
  sanitation, and poor hygiene accounts for 15 to
  18 percent of child deaths annually
• In Pakistan, diarrheal diseases are estimated to
  kill 200,000 children under age of five/year (548
  per day)

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Background of GOP Water Projects

• In 2001, the Ministry of Environment presented
  National Environmental Action Plan in which one
  of the core areas of NEAP is Clean Drinking
  Water.
• Pakistan, as a signatory to the Millennium
  Development Goals (MDGs), has committed to meet
  the targets set at the World Summit on
  Sustainable Development in 2002 through
• Providing access to safe drinking water
  adequate sanitation for maximum population by the
  year 2015

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Clean Drinking Water Initiative (CDWI)

• PC-1 for a project, CDWI was approved to install
  445 water purification plants of 2,000 gallons
  per hour capacity at each District and Tehsil of
  the country to provide clean drinking water to
  the masses.
• CLEAN DRINKING WATER FOR ALL (CDWA)
• Realizing the utility of clean drinking water
  another project namely, Clean Drinking Water for
  All was approved to install 6,035 water
  purification plants, one at each Union Council of
  Pakistan at a project cost of Rs. 7,871.740
  million.

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Pakistan Safe Drinking Water and Hygiene
Promotion (PSDW-HPP) ProjectObjective

• To provide technical assistance in hygiene and
  sanitation promotion, BCC, and community
  mobilization, along with extensive capacity
  building in order to complement Pakistan's
  substantial investments in hardware for safe
  drinking water.

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Project Geographical Coverage 28 Districts, 6
FATA Agencies and 6 Frontier RegionsPopulation-
30 million peopleNationwide media
campaignFundingUSAID 17.9 million for three
years
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Project Components

• Implement a comprehensive hygiene and sanitation
  promotion strategy reaching 30 million people
• Institutional capacity and comprehensive
  technical review
• Monitoring and evaluation

Stages

• Strategy development January 2007- March 2007
• Implementation April 2007-June 2009

• Implementation Mechanism

• Technical assistance
• Grants to non-governmental organizations (NGOs)

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Development of a Successful BCC Strategy

• It is essential to identify and understand
  different elements that can have an impact,
  positive or negative, on an individuals
  willingness and ability to adopt a new practice.
  
• While BCC can be quite effective, it does not
  operate in isolation and it can be undermined
  both by an insufficient understanding of how
  initiatives and activities support communication
  and, in turn, how communication supports these
  same initiatives and activities.

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Framework for Designing the BCC Strategy
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Process of Developing the BCC Strategy

• Desk Review Nov-Dec 2006
• Lack of prevalence of hand washing with soap
• Lack of information on barriers and facilitators
• Lack of awareness on causes of diarrhea-
  appreciation of seriousness considerably higher
• Need for more research focusing on specific
  groups, in specific settings, on specific
  activities

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Formative Research December 2006

• Rural Urban Six locations Lahore, Lasbela,
  Muzaffarbad, Mansehra, Thatta, Mohmand Agency
• Techniques FGDs (mothers, teachers, and health
  service providers), In-depth Interviews (Molvis),
  Observation and Trials for Improved Practices
  (TIPS) - mothers, fathers and school children)
• Respondents Mothers/fathers with children under
  five years old, primary school children,
  teachers, Molvis, and lady health workers (LHWs)
• Groups Mostly low socio economic strata, with
  low education

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Findings..

• Current behaviors/practices what are they
  doing?
• Barriers and Facilitators for primary and
  secondary groups
• Key influencers what and how can they act??
• Target groups aspirations, perceptions and
  information needs
• Recommendations and voices captured from
  primary and support groups prioritization of
  messages
• Target group specific materials. Resources and
  channels of information

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Going Beyond Research BCC Strategy and Plan-
April 2007

• Formative Research Provided
• Set of key recommendations which helped us to
  move forward
• Develop a BCC Framework the identification of
  highest success areas
• A set of feasible behaviors
• Intervention Design and ME
• BCC plans for mothers and fathers
• What can the channels do and how will they do it

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BCC Strategy Recommends

1. Cooperation within the family and among community
   members is critical to the successful adoption of
   key hygiene practices.

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BCC Strategy Recommends

• Cluster behavior promotion approach, in three
  intervention areas
• access to hardware
• hygiene promotion
• enabling environment

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BCC Strategy Recommends

• 3. Women are critical to the success of hygiene
  promotion program. Dynamic female-to-female
  interactions designs should be given priority
  consideration.

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BCC Strategy Recommends

• 4. For safe storage of drinking water, the
  practices of
• using a long-handled scoop to remove water or
  pouring out drinking water should be promoted as
  key behaviors.

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BCC Strategy Recommends

• 5. Hand washing should focus on hand washing with
  soap at two critical times before eating and
  preparation of foods and after defecation.

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BCC Strategy Recommends

• 6. Water purification should focus on two stages
  (1) on awareness and knowledge of the need to
  purify home water sources, and (2) on two
  practices that provide acceptable, mutually
  reinforcing options.

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BCC Strategy Recommends

• 7. Safe feces disposal should focus on households
  with latrines, where reinforcement of present
  positive latrine use could be combined with the
  hand washing with soap behavior. Where latrines
  are not available and where open defecation
  occurs, feces should be buried.

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BCC Strategy Recommends

• 8. Emotion based approach The attributes of
  strength and beauty should be used repeatedly and
  often as they are strong motivators for changing
  behaviors.  They should be considered as part of
  the unifying theme of all materials produced.

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BCC Strategy Recommends

• 9. Develop a new female cadre of volunteer
  hygiene promoters to reinforce and facilities the
  desired behavior among mothers.

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BCC Strategy Recommends

• 10. Involve primary school children as they can
  be motivators and supporters of desired behaviors
  within the household.

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BCC Strategy Recommends

• 11. The Imams should be considered as an
  excellent communication channel for husbands and
  other community members.

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BCC Strategy Recommends

• 12. Mothers have placed an equal amount of
  importance on how messages are passed, as on
  what messages are passed. There should be
  emphasis on this tone in all its materials,
  media, and training.

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BCC Strategy Recommends

• 13. Initiate possible social marketing
  initiatives with soap manufacturers.

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BCC Strategy Recommends

• 14. Initiate possible social marketing
  initiatives with water purification manufacturers
  for
• promotion or enhancement of acceptable products
  for purification
• creation of distribution channels through local
  faith-based organizations (FBOs) and
  community-based organizations (CBOs),
• dirty water demonstrations
• school fairs

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Behavior Change Communication Strategy-

• BCC strategy is the basis over which the whole
  hygiene promotion component of the project was
  built on
• Emotion-based approach
• Targets four key stakeholder groups
• Community
• Schools
• Mass Media
• Private Sector

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BCC Strategy- From Theory to Action

• Primary Target Audience
• Mothers and fathers of children under five years
• Channels to Reach Target Audience
• Hygiene Promoters
• Religious leaders--- Molvis/Imams
• Doctors
• Women volunteers
• Teachers
• Students of grade four
• Local NGOs/CBOs
• Media
• Private sector partners

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BCC Plan.Touching the family through integrated,
multiple activities
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HP Activities in Communities-Mother Father
group sessions-Interactive Theater-Melas-Word
of mouth activities-Physician-provided
certificates-Activities and education at
Mosques-
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Fun, interactive learning activities for grade
four students in schools- Students as message
carriers to their parents- Ten activities-form
the learning component- Teacher activity book-
Promotional material w/private sector partners-
Student monitoring of assignments- Calendar take
home to reinforce messages for mothers
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Project Website www.safewaterpak.com
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A Way Forward.National BCC Strategy

• PSDW-HP project with the assistance of USAID
  will coordinate with MOE, MOSI UNICEF to
  develop a National BCC Strategy for the water
  and sanitation sectors.

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• Thank You