Communication for Social Change: Communication and Malaria Initiative in Tanzania (COMMIT) case study

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Overview:

In 2005, the US Government chose the United Republic of Tanzania as one of three countries for the Presidents Malaria Initiative (PMI). The Communication and Malaria Initiative in Tanzania (COMMIT) was developed as part of this initiative with an aim to “promote a culture of correct malaria practices at the community level” as well as to “promote individuals’ beliefs that they can take the necessary steps to prevent and treat malaria” (World Health Organisation, 2012 p.47)

COMMIT’s partners include the Johns Hopkins Bloomberg School of Public Health Centre for Communication Programs; PSI; Jhpiego; PMI and over 65 Tanzanian non-government organisations (NGOs). These partners funded, researched, and collaborated with Tanzania’s existing National Malaria Control Program (NMCP) to develop their Behavioural change communication (BCC) strategy. The program was targeted at the individual, community and national level, with a primary focus on reaching isolated communities.

COMMIT was a 5 year initiative that integrated a multichannel approach in its

Communication strategy. COMMIT focused primarily on mass media and the Rural Communication initiative, which relied on community change agents to facilitate educational training and activities to raise the profile of Malaria and promote safe preventative measures.

 

Project Objectives

COMMIT is a behavioral change communication program designed to inform rural communities about the importance of Malaria prevention strategies by teaching them ways to implement simple practices in their daily life. Designed “to increase community awareness and demand for effective malaria treatment and prevention,” (Centre for Communication Programs, 2013, pg. 1) COMMIT’s objective is to reduce malaria-based deaths throughout Tanzania and create a permanent behavioural change in people attitudes towards the disease.

The Rural Communication initiative (RCI) was one of the main strategies of the project and targeted hard to reach areas isolated both culturally and geographically. In order to achieve this, COMMIT relied on over 65 non-government organizations (NGO’s) to facilitate over 1200 ‘community change agents.‘ These change agents travelled to rural villages making home visits; holding group discussions; and implementing malaria based prevention plans. This participatory approach allowed the agents collaborating with the community to create malaria awareness plans that could be implemented to everyday practices, based on community interaction and feedback. In addition, roadshows and other village level activities such as mobile video units were used to engage participants and promote discussion and beliefs, values and attitudes towards malaria (World Health Organisation, 2012).

 

Background and Context

Tanzania has a population of 44,928,923 million people (National Bureau of Statistics Ministry of Finance 2013) and malaria remains the primary national health concern (WHO 2013).

Estimates from the Malaria Operational plan suggest between 60 to 80 thousand malaria deaths occur annually with approximately 10 to 12 million cases reported of clinical malaria each year (2013). According to the Tanzania HIV/AIDS and Malaria Indicator Survey of 2011-12, Malaria still “remains an impediment to socioeconomic growth and welfare” (2013, p.2).

Malaria is a tropical disease caused by a parasite called Plasmodium and is transmitted through the bite of infected mosquitos. (WHO, 2013) Malaria symptoms include severe fevers, headaches and vomiting and usually emerge 10 – 15 after the bite from an infected mosquito (WHO, 2013). Malaria is a treatable disease, however if not effectively treated with artemisinin-based combination therapies it can become life threatening as the parasite disrupts blood supply to vital organs (WHO, 2013).

With nearly ¼ of Tanzanians affected yearly by this disease, there was an obvious need for a preventative treatment plan. In 2005, the international community recognised the need to intervene and helped design a new strategy. COMMIT was developed in 2005 in response to earlier malaria initiatives, with the purpose of integrating a new mass media based approach that targeted rural isolated communities (CCP, 2012).

 

Specific use of media

COMMIT used a multichannel approach in its communication strategy. It created a range of communication materials with a focus on two main aspects:

  • Mass media strategy
  • Rural Communication Initiative

Mass media

The media was used to raise awareness of malaria prevention, incorporating Shramm’s idea of mass communication as a tool to educate, and inspire a community. Mass media “can determine in large degree what people know and talk about” (Schramm, 2006, p.30) and is an effective way to reach communities geographically isolated in remote locations (schramm, 2006).

PataPata radio program is a10-minute radio program that was developed for children aged between 6-12. The program follows protagonist Kinara, her enemy Annie Anopheles and other characters as they learn about Malaria prevention (JHU Center for Communication Programs, 2012). The program was developed in 2011 as part of COMMIT’s behavioral change initiative, with an aim to “empower children to be change agents in Malaria prevention” (Ministry of Health and Social Welfare, 2013, p.46). Patapata includes 44 episodes and is broadcast nationally on Saturday mornings via 3 radio networks (Sevin, 2012). While previous malaria projects focused primarily on adults, this new, media based, approach was the first time children had been targeted to promote healthy practices and act as change agents for their community (Sevin, 2012).

Two minutes of wisdom was another program broadcast as part of COMMIT’s mass media strategy. Aired on national television and radio stations, this program featured famous Tanzanians discussing their experiences with Malaria and encouraged viewers to regularly use insect treated nets (ITN’s) when sleeping (Mgwabati, 2012). Combined with Patapata, this program was part of a strategy to create open dialogue among people. 

Rural Communication Initiative
When developing a mass media strategy, statistics and research revealed radio was the most accessible form of media available to communities (World Health Organisation, 2012). Over 2000 radios were distributed to rural villages across the country to help facilitate the ‘change agents’ in promoting malaria prevention strategies and raise awareness (World Health Organisation, 2010).

The rural communication initiative aimed to “radically change the behaviour of malaria prevention practices in isolated communities” and significantly reduce Malaria related health issues (Presidents Malaria Initiative, n.d).

In implementing this strategy, Commit worked with over 65 non-government organizations to assist community groups, to provide educational based learning activities. This initiative was designed to support the mass media strategy, with an emphasis on “disseminating messages of self-efficiency regarding the use of ITN’s” (CCP, 2012). At the local level, these ‘change agents’ worked to mobilize communities, through broadcasting and promoting messages on malaria in pregnancy, and case management and prevention.

 Constraints

This initiative has proved highly successful across Tanzania. In order to develop the project further, evaluations need to be made to improve certain areas. The following observations highlight areas for improvement:

  • Malaria initiates that incorporate the mass media to educate people are effective only if the people have appropriate ways to access these messages (Shramm, 2006). While the project has disseminated radios to rural communities in some villages, other communities may have been left out (WHO, 2012). Without a complete and thorough approach that reaches all states and communities, there will still be outbreaks of Malaria and the disease cannot be fully eradicated (WHO, 2012).
  • The Patapata radio program offered a unique way to educate children about the effects of Malaria (Mgwabati, 2012). While this program was seen as a success, there is minimal data to reveal the extent to how many changed their behaviour towards malaria prevention (WHO, 2012).
  • Tanzania is a relatively poor country with little access to technology in rural communities. While radio and mass media strategies that reflect a dominant approach offer a valid rationale for raising awareness, unless there are sufficient resources distributed, only a small minority are targeted, which doesn’t provide a large-scale solution (National Bureau of Statistics Ministry of Finance 2013).
  • Since the projects completion in 2012, the President’s Malaria Initiative has undertaken a review, which included a plan to disseminate more media channels throughout the country (President’s Malaria Initiative, n.d.). This highlights a need for a more methodical approach in the distribution of radios and media devices to rural communities WHO, 2012).
  • The projects main objective was to raise the profile of malaria awareness through mass media strategies (Centre for Communication Programs, 2011). This strategy relies heavily on the support of US and outside governments, and positions Tanzanians in a place of dependency, where they are heavily reliant on foreign aid for help, without developing strategies for sovereignty. At some point, the funding responsibility needs to transfer to national governments but that is far on the horizon. It is also imperative that Tanzania and its many in-country partners explore growing opportunities to further invest in the battle against malaria (National Bureau of Statistics Ministry of Finance 2013).

Impact/Social change

The COMMIT project significantly raised awareness of Malaria prevention practices across the country. While many Tanzanians are still at risk of contracting Malaria infections, this initiative has enabled people to understand the implications of malaria and teach them preventative measures to avoid the disease (WHO, 2012). COMMIT has helped improve general health in Tanzania in changing the perspective of Tanzanians in their views towards Malaria prevention.

We can see the following results:

In 2010, The Steadman/Synovate Omnibus Survey found the following results:

  • 73% of people had heard a malaria message on the radio within the previous month.
  • Of the 73%, 81% reported taking an action:
  • The phrase ‘Malaria Haikubaliki.’ (Translated as ‘Malaria is unacceptable’) h ad been heard by 91% of respondents
  • 68% of people surveyed could correctly finish the phrase Malaria Haikubaliki.
  • After listening to the Patapata childrens program, actions by children include convinving parents to buy ITN’s; asking parents to listen to the show with them; encouraging their family to sleep under insect treated nets and repairing damaged nets already used.
  • In 2007, household ownership of ITN’s was 38% across Mainland Tanzania. In 2010 household ownership increased to 63%.

 

In 2012, the 2011-12 THMIS survey found the following data:

  • 84% of women and 95% of men had heard the phrase ‘Malaria Haikubaliki via radio.
  • Malaria messages were commonly seen on TV, billboards, posters, leaflets and heard at community events, and by healthcare workers.
  • 26.4 million free long-lasting ITNS (LLINs) were been distributed to rural families. Project volunteers had visited every house, providing assistance in hanging them and to ensure nets were hung properly (PMITMO, 2013)
  • Also, the trend analysis demographic survey from 1999 – 2010 shows a significant decline in rural communities compared to city statistics. This confirms that malaria interventions are reaching these isolated areas and the more at risk population. (January 2012 Roll Back Malaria report of Progress and Impact series: Focus on Mainland Tanzania) (PMITMO, 2013)

 

Conclusion

The COMMIT project initiated the first phase of a media based Malaria strategy in Tanzania. This was effective is first rallying support and recognition of the importance of raising awareness and educating people about malaria management and prevention. Since the commencement of this project, new initiatives have been implemented, with the President’s Malaria Initiative being extended and revised in line with the UN’s Millennium development goals to completely eradicate malaria by 2014.

The Rural Communication Initiative has reached more than 8.8 million people with malaria messages (WHO, 2012). In two of COMMIT’s target regions, 65% of the residents had seen either a road show or mobile video unit presentation in 2008–2009. Importantly, 77% of those who had been exposed to malaria messages and events had put all their children under an ITN the previous night, while only 35% of those not exposed to the messages did so. These statistics highlight the immense success that COMMIT has had in raising the profile of Malaria in Tanzania.

 

a

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