UNITY AND FAITH, PEACE AND PROGRESS Nigeria Federal Ministry of Health National Malaria Elimination Programme Malaria ACSM Guidelines: Strategic Framework and Implementation Guidelines for Advocacy, Communication and Social Mobilisation Programmes 2014 1 Nigeria Federal Ministry of Health/National Malaria Elimination Programme 2 Strategic Framework and Implementation Guide for Advocacy, Communication and Social Mobilisation (ACSM) Programmes Foreword Malaria is endemic in Nigeria and has continued to have a disturbing impact on the people of Nigeria. It also remains one of the leading causes of childhood and maternal morbidity, poverty, low productivity, and reduced school attendance in the country. Nearly all Nigerians (97 percent) are at risk of contracting the disease, while about half of the population will have at least one malaria attack per year. The current National Malaria Strategic Plan 2014-2020 aims at achieving the vision of a “malaria-free Nigeria.” The National Malaria Elimination Programme (NMEP), with its Roll Back Malaria (RBM) partners, has, in the last five years, distributed about 58 million long-lasting insectiside-treated nets (LLINs), as part of the universal LLIN campaigns to protect an estimated 29 million households. Access to free and/or highly subsidized ACTs also improved significantly both in the public and the private sector, and newer tools for diagnosis and prevention of malaria were deployed in the country, guided through evidences from research. Newer approaches have been used to channel focused interventions through the health system down to the community level, thereby increasing access to malaria commodities and services for all. Yet, part of the recurrent challenge has been the low uptake and utilization of malaria interventions. The need to increase demand, uptake and utilization of malaria interventions has therefore become critical. For this to happen, there is need for a more scientific and evidence-driven approach to malaria communication programming. Against this backdrop, the review and development of an evidence-informed National ACSM Guide is timely and also falls in line with the determination of the NMEP to standardize ACSM programming and ensure that ACSM activities are aligned with the priorities of the current strategic plan. The National ACSM Guide is a response to the collective desire of all stakeholders for an informed, user-friendly and, ultimately, more effective strategic document to guide organizations that are implementing malaria communication programmes at different levels in planning, developing, implementing, monitoring and evaluating a unified and cohesive behaviour change communication plan for malaria control interventions. It will serve as an invaluable resource and provide a stepping stone for programmers to get started in planning, managing and monitoring behaviour change for malaria at all levels. There are four key guides within the ACSM strategic document, which also represent the four important steps in the ACSM programming process, including: 1. Situation and Communication Analysis 2. “Think Big” Strategy Design Guide 3. “Act Now” Implementation Planning Guide 4. “Count It” Monitoring and Evaluation Planning Guide. The collection of these guides provides an overview of the ACSM programme planning process and its components—from planning to evaluating the success of communication efforts—and suggests strategic activities and key messages that can be used to reach different audiences. It is, therefore, with great pleasure that I present this National ACSM guide to you. I encourage all civil society organizations, development agencies and all who are involved in malaria communication programming in the country to use the ACSM Guide as a blueprint for designing and executing communication initiatives for malaria in the country. Dr. Khaliru Alhassan Minister of State and Supervising Minister of Health Federal Minister of Health 3 Nigeria Federal Ministry of Health/National Malaria Elimination Programme Acknowledgements The National ACSM Guide builds on effective communication for malaria programming, developing strategies on behaviour change communication at different levels. It is on this nore that the National Malaria Elimination Programme (NMEP) acknowledges the technical and financial support of the President’s Malaria Initiative (PMI)/Health Communication Capacity Collaborative (HC3) project funded by the United States Agency for International Development (USAID) and SuNMAP Project for making the development of this document possible. The support of the PMI/HC3 project in taking up the production of the initial copies of the document is appreciated. NMEP also expresses its gratitude to individuals and organizations that have contributed to the development of the National ACSM Guide. Special mention must be made of the dedication and commitment of the National ACSM Sub-Committee and all of the partners who made this a success. In the same vein, the untiring effort and technical expertise of the two consultants, Ian Tweedie and John Dada, in leading the entire process of developing the document are highly appreciated. The Government of Nigeria sincerely hopes that all efforts put into the development and production of this strategic document will bring about, among others, the much needed improvement in malaria communication for behavioural change toward eliminating malaria and ensuring a malaria-free Nigeria. Dr. Bridget Okoeguale Director, Public Health Federal Ministry of Health, Nigeria 4 Strategic Framework and Implementation Guide for Advocacy, Communication and Social Mobilisation (ACSM) Programmes Table of Contents ACRONYMS SECTION 1: OVERVIEW & INTRODUCTION SECTION 2: MALARIA ACSM GUIDES Situation and Communication Analysis Guide “Think Big” Strategy Design Guide “Think Big” Strategy Planning Worksheet Malaria Prevention: LLIN Malaria Prevention: MiP/IPTp Indoor Residual Spray (IRS) Diagnosis and Treatment Cross-Cutting Messages Step 7: Activities “Act Now” Implementation Planning Guide “Count It” Monitoring and Evaluation Planning Guide SECTION 3: APPENDIX I 5 Nigeria Federal Ministry of Health/National Malaria Elimination Programme Acronyms 6 Strategic Framework and Implementation Guide for Advocacy, Communication and Social Mobilisation (ACSM) Programmes 7 Nigeria Federal Ministry of Health/National Malaria Elimination Programme OVERVIEW & INTRODUCTION 8 Strategic Framework and Implementation Guide for Advocacy, Communication and Social Mobilisation (ACSM) Programmes Overview The Malaria Advocacy, Communication and Section 2 is the core of the guide and provides Social Mobilisation (ACSM) Guide includes three detailed and reference information on malaria issues major sections. Section 1 reviews some essential and practical step-by-step processes for developing a information that will help you maximize the use of comprehensive and detailed malaria ACSM strategy, this guide, covering: implementation and monitoring and evaluation • Background information about this document (M&E) plan customized to your area and needs. and how to use it. Section 2 includes four related sections in the chart • An overview of the role of communication in below. malaria programmes. • The use of behavioural theories and conceptual Section 3 is the enclosed CD Rom with electronic frameworks in ACSM programme design and files of worksheets, background documents and development. presentations, national and international malaria • A section on the use of national malaria branding strategies and guides for further reference, and more. and slogans. 1. Situation and Communication Analysis Guide Provides an overview of analyses to be conducted to provide a snapshot of the health situation and contex- tual issues that can influence health outcomes, as well as background on audience communication behaviour and existing malaria ACSM materials and activities. 2. “Think Big” Strategy Design Guide This section will guide your team through a step-by-step process to design a strategic malaria communication plan for achieving the goals and objectives of the National Malaria Strategic Plan (NMSP) 2014-2020 for your area, with specific focus on a malaria technical topic (e.g. long-lasting insecticide-treated nets (LLINs), IPTp, Case Management, etc), utilizing formative research; identifying communication domain (individual/commu- nity, service provider, advocacy), priority and secondary audiences, audience-specific behavioural objectives and communication objectives categorized by ideational factors; and a prioritized activity planning guide. 3. “Act Now” Implementation Planning Guide The “Act Now” Guide will guide your team through priority setting of domains, audiences, activities and messages in malaria communication. It will provide a step-by-step coordination and implementation guide to identify lead implementing organisations in your area for each activity, create content design teams, develop work plans, write activity briefs, select creative agencies and specialist personnel, and develop communica- tion materials and implement interventions. After having developed the “Think Big” Strategy, you will have generated a broad vision and list of poten- tial activities to implement. Priorities will need to be identified now, to move beyond a wish list of activities towards doable actions. Priority setting can be a painful and difficult process, because all of the issues are important. The challenge is that there are limited resources (financial, human, time, etc). Therefore, to make progress, we must make these hard decisions of priorities so that we can “ACT NOW” and get ACSM inter- ventions implemented. While we cannot do everything all at once, it will be important to remember that activities can be implemented in phases. So, what we cannot do this year can potentially be implemented in subsequent phases when resources are available. 4. “Count It” Monitoring and Evaluation Planning Guide One of the key challenges for Malaria ACSM in the country is for all programme planners and implementers to have a good grasp of ACSM M&E. At all levels, there are inadequate activities for M&E of ACSM (NMSP, 2014, p. 44). Experience indicates that challenges can be traced to several factors including (a) lack of clarity of what activities to report and the source of information. A standardised matrix for reporting ACSM activities at national, state and LGA levels will be of benefit to address the varying degrees of ambiguity in the type of activities to include in the ACSM monitoring and evaluation report. This Standardised Matrix on Malaria ACSM Monitoring and Evaluation takes into cognisance the current ACSM indicators in the NMSP and the Roll Back Malaria (RBM) Behaviour Change Communication (BCC) M&E working group, at the national and international levels. 9 Nigeria Federal Ministry of Health/National Malaria Elimination Programme Introduction A. Background 1. Social and Behaviour Change Communication (SBCC) Goals and Objectives 2. Health Education/Promotion The document is to serve as a guide for national, 3. Demand Creation (DC) state, LGA and other health communication and promotion professionals and designated officers The secondary audience for the guide are cadres of to design and implement malaria interventions professionals, partners and volunteers who perform that are consistent with national and international programme planning and implementation roles policies and standards. The malaria ACSM guide will for other components of malaria programme, or enhance the capacity of ACSM programme planners, who perform management and leadership roles implementers and stakeholders to develop and for malaria programme. These cadres are located in manage interventions that will contribute toward different components of malaria programme in the achievement of national objectives and targets for public, private and non-governmental organisation malaria elimination as set forth in the NMSP 2014- (NGO) sectors. They include: 2020 through: 1. Programme directors • An increase in political, leadership and resource 2. Programme coordinators support for malaria control commodities and 3. Components heads services. 4. Programme officers • An increase in awareness and knowledge 5. Mass media (managers, producers and reporters, of malaria problem, and the benefits of its as relevant) prevention and treatment. 6. Volunteers • Sustained promotion of positive attitudes, desirable norms, values and behaviour change The basic understanding of the process, content and regarding malaria and the recommended scope of the Malaria ACSM Guide by the secondary measures for its prevention and treatment. audience and the support it provides will, to a • Improved demand creation for testing all cases of large extent, determine the success of the ACSM fever before treatment. component of malaria programme. • Sustained promotion of desirable behaviour for malaria prevention and treatment at community, Situation Analysis household and individual levels. (Why the need for this document now?) • Improvement in the capacity of health service This guide is designed to respond to the needs providers to provide high-quality and client of the new NMSP 2014-2020. It is a reference to friendly health services for malaria prevention guide programme planners to design malaria and treatment. ACSM strategies and implementation plans aimed • Promotion of participation of the private sector, to help achieve the goals and objectives set forth civil society, community-based organisation and in the NMSP 2014-2020. The Federal Ministry of other volunteers in malaria programme. Health (FMOH) has responsibility for the National Malaria Programme through policy formation, Primary Audience setting standards, quality assurance, resource (Who this document is written for?) mobilisation, capacity development, epidemic The purpose of the guide and the cross-cutting control, coordination, research and M&E. A key tool nature of ACSM in development programmes implies for setting standards and quality assurance function that various cadre of professionals and volunteers of national programme is the development of the will find the document useful as they strive for NMSP. Several NMSPs have been developed since improvement in the quality of malaria programming. malaria programme initiatives started in Nigeria. The recently expired NMSP (2009-2013) shifted focus The primary audience for the guide is the cadre of from targeting vulnerable groups to focus attention health communication and promotion practitioners on universal coverage of key interventions for at the national, state and LGA levels involved with prevention and control of malaria. the malaria programme. This cadre has the primary responsibility to develop plans and implement, In year 2013, the FMOH indicated interest and monitor and evaluate ACSM activities for malaria determination to deepen the scope of malaria elimination. The cadres include professionally trained programme and improve on the outcomes and specialists, officers or designees in: impact of programme through another shift of 10