CHS Kenya National Communication Strategy for Community Health Services 2012 - 2017

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The Community health Services Kenya was started by the Ministry of Health in its quest to offer quality health services to all Kenyans. CHS Kenya offers health care services at community level to all Kenyans regardless of their social status.

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CHS Kenya National Communication Strategy for Community Health Services 2012 - 2017

  1. 1. Ministry of Public Health and Sanitation
  2. 2. i National Communication Strategy for Community Health Services Suggested citation: Ministry of Public Health and Sanitation, Republic of Kenya. National Communication Strategy for Community Health Services. Nairobi, Kenya: Government of Kenya; June 2012 @2012 Government of Kenya ENQUIRIES AND FEEDBACK: Direct all correspondence to: Division Head, Division of Community Health Services Ministry of Public Health and Sanitation P.0. B0X 30016 GPO Nairobi 00100, Kenya
  3. 3. v Acronyms and Abbreviations ACSM Advocacy Communication and Social Mobilization AIDS Acquired Immune Deficiency Syndrome ANC Ante Natal Care BCC Behaviour Change Communication CBO Community Based Organization CHC Community Health Committee CHEW Community Health Extension Worker CHS Community Health Strategy CHW Community Health Worker CORP Community Owned Resource Person CSO Civil Society Organization CU Community Unit DCH Department of Child Health DCHS Division of Community Health Services DHMT District Health Management Team DHP Department of Health Promotion DOMC Division of Malaria Control DON Division of Nutrition DRH Division of Reproductive Health FBO Faith Based Organization FM Frequency Modulation FP Family Planning GOK Government of Kenya HCP Health Care Provider HIV Human Immunodeficiency Virus ICC Interagency Coordinating Committee IEC Information Education Communication IPT Intermittent Presumptive Treatment IRS Insecticide Residual Spray JICA Japan International Cooperation Agency KEPH Kenya Essential Package for Health LLIN Long Lasting Insecticide Net MDGs Millennium Development Goals MNH Maternal and Neonatal Health MO Medical Officer MOH Ministry of Health
  4. 4. vi MOMS Ministry of Medical Services MOPHS Ministry of Public Health and Sanitation NACC National AIDS Control Council NCD Non Communicable Disease NGO Non-Governmental Organization NHSSP National Health Sector Strategic Plan PHMT Provincial Health Management Team RH Reproductive Health STI Sexually Transmitted Infection SWOT Strengths, Weaknesses, Opportunities and Threats TB Tuberculosis TWG Technical Working Group UN United Nations UNICEF United Nations Children’s Fund
  5. 5. vii AFYA YETU, JUKUMU LETU The Ministry of Public Health and Sanitation recognises and appreciates the development of this Communication Strategy which supports its responsibility of improving the health of the citizens by narrowing the gap between service provision and demand for services. This is with the ultimate goal of reducing ill-health by increasing the populationʼs knowledge of preventable health measures and bringing quality services closer and more accessible to the beneficiaries. The Ministryfurther recognize that community based communication focusing on behaviour change, disease prevention and access to safe water and basic care is the hub of level one health care provision. This Communication Strategy aims at scaling up provision and uptake of Community Health Services thus strengthening the social pillar for Kenyaʼs Vision 2030. It also aims at promoting preventive health care as opposed to curative interventions by promoting healthy individual lifestyles. In providing a framework for action, the Communication Strategy connects and mobilizes people around the common cause of promotion of health and prevention of diseases at community and individual levels. It aims at bringing about synergy and collaboration between individuals, communities, social networks, and policy makers through participatory activities and dialogue in order to develop an integrated and consolidated approach to communication in Community Health Services. The Ministry of Public Health and Sanitation is confident that this Communication Strategy will enhance service provision at the community level.All partners in the health sector and at all levels working with communities are encouraged to use this Communication Strategy as a tool for guiding communication activities in relation to provision of Community Health Services. Mark K. Bor, CBS Permanent Secretary, Ministry of Public Health and Sanitation Foreword
  6. 6. viii Preface The Constitution of Kenya states that every person has the right to the highest attainable standard of health, which includes the right to health care services for all. Through Vision 2030, the Government of Kenya has set out to improve the overall livelihoods of Kenyans by providing an efficient and high quality health care system Vision 2030 aims at shifting the bias of the National Health Bill from curative to preventive care. In order to achieve this, the Ministry of Public Health and Sanitation is implementing the Kenya Essential Package for Health (KEPH) which recognizes the community as a critical level of health service delivery. The Community Health Strategy approach was introduced to actualizeKEPH, with an overall goal of enhancing community access to health care in order to improve productivity and thus reduce poverty, hunger, child and maternal deaths, as well as improve education performance across all the development goals set out under the Vision 2030. The goal of the Community Health Strategy approach is to improve the health status of Kenyan communities through the initiation and implementation of life-cycle focused health actions at level one. The CCommunity based communication is thus thehub of level one health care provision. Community level activities focus on effective communication aimed at behaviour change, disease prevention, and access to basic care, safe water and sanitation. The communication at level one is meant to facilitate behaviour change of individuals and family/householdsthrough advocacy and social mobilization. It is envisaged that the implementation of thisCommunication Strategy will contribute towards the achievement of the health sectors goals and the Kenyaʼs Vision 2030; while also fulfilling the Governmentʼs responsibility to her citizens as spelt out in the constitution. It is my hope that this communication strategy will serve as a guide to all players in the health sector. stages of the life cycle. In effect, this shall enhance the attainment of the countryʼs Dr. John O. Odondi, OGW Head, Department of Primary Health Services AFYA YETU, JUKUMU LETU
  7. 7. ix AFYA YETU, JUKUMU LETU This National Communication Strategy for Community Health Services is a result of concerted efforts of many individuals and stakeholders.The Ministry of Public Health and Sanitation (MOPHS) wishes to acknowledge all those who were involved in one way or another in the development of this Strategy. We particularly thank the Advocacy Communication and Social Mobilization (ACSM) Technical Working Group (TWG) within the Division for overseeing and guiding the process of developing the Communication Strategy. Special thanks go to Japan International Cooperation Agency (JICA) ACSM team, United Nations Childrenʼs Fund (UNICEF), ACSM unit of the Division of Community Health Services (DCHS) and the Department of Health Promotion (DHP), for their day to day technical support and guidance. We wish to acknowledge the contributions of all stakeholders, both at National and Regional levels, who participated in the development of the Communication Strategy. The stakeholders included representatives from various organizations including MOPHS Departments and Divisions, Provincial Health Management Teams (PHMTs), District Health Management Teams (DHMTs), doctors, clinical officers, nurses, Public Health Officers (PHOs), community members, Community Health Extension Workers (CHEWs), Community Health Workers (CHWs), development partners, Non-Governmental Organizations (NGOs), and Community Based Organizations (CBOs). Appreciation is extended to Centre for Behaviour Change and Communication (CBCC) under Essence International for facilitating the development of this Strategy and providing consultancy services. The development of the Communication Strategy was made possible by the financial and technical support of JICA and UNICEF. Dr. James Mwitari Head, Division of Community Health Services Acknowledgement
  8. 8. AFYA YETU, JUKUMU LETU
  9. 9. xi  Increasing uptake of health services by all cohorts facilitated by transfer of knowledge and skills at household and community level. To achieve the above stated goal, five broad strategies will be employed: a) Strategy One: Advocacy to Policy Makers, Program Planners and Media b) Strategy Two: Capacity Strengthening in Management for Health Communication c) Strategy Three: Behaviour Change Communication d) Strategy Four: Mobilization and Coordination of Communication Partners and Stakeholders e) Strategy Five: CHS Knowledge Management and Documentation The strategy will be delivered in a phased approach where the policy makers, decision makers and program planners will be sensitised to this approach first so that the CHS communication programming can reflect the recommended rights based program design. Strengthening the ACSM structures, capacity and systems at all levels will ensure successful delivery of effective CHS communications. The ACSM coordination structures will be anchored within the existing CHS and National Health System to ensure consistency, better sector coordination and linkages from the National to the Sub-County and Community level. Monitoring and Evaluation will be a crucial component of this Communication Strategy. Assessing outcomes and impact of ACSM activities for CHS approach will be crucial in objectively establishing achievements of the Strategy and tracking performance of specific strategies employed. It will be paramount to adopt evidence based approach for of communication activities. This Communication Strategy is intended for use by the Division of Community Health Services (DCHS), Government departments and divisions, partners and stakeholders in implementing ACSM at the National, County and Sub-County and Community level. AFYA YETU, JUKUMU LETU
  10. 10. 1 Chapter 1 Introduction 1.1. Overview of Community Health Services In order to scale up the implementation of health services, MOPHS adopted the Kenya Essential Package for Health (KEPH) which recognized the community as a critical level of health service delivery. Communities are at the heart of the Ministry of Health’s Second National Health Sector Strategic Plan (NHSSP II) (Ministry of Health, 2005). The Community Health Strategy (CHS) was initiated in 2006 to fast track the establishment of Community Units (CUs) so as to bring services closer to the community, by empowering communities with health information and essential services (Ministry of Health, March 2007). The KEPH is designed as an integrated collection of cost-effective interventions that addresses common diseases, injuries and risk factors, including diagnostics and health services, to satisfy the demand for prevention and treatment of these conditions (Ministry of Health, 2006). 1.1.1. Goal and Objectives of Community Health Strategy According to the Community Strategy Implementation Guidelines for Managers (2007), the goal of the CHS is to improve the health status of Kenyan communities through the initiation and implementation of life-cycle focused health actions at level one by:  Providing level one services for all cohorts and socioeconomic groups, including the “differently-abled”, taking into account their needs and priorities.  Building the capacity of the Community Health Extension Workers (CHEWs) and Community Owned Resource Persons (CORPs) to provide services at level one. AFYA YETU, JUKUMU LETU
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  12. 12. 3 to 2 weeks of age), early childhood (2 weeks to 5 years), late childhood (6 to 12 years), youth and adolescent (13 to 24 years), adulthood (25 to 59 years), elderly (60 years and above) (Ministry of Health, March 2007). The Kenya Health Sector Strategic Plan 2012-2017 (MoPHS, 2012) has revised the cohorts from 6 to 5. Therefore the revised specific KEPHs cohorts whom this strategy focuses on are: 1. Pregnancy and the newborn (up to 28 days): The health services specific to this age-cohort across all the Policy Objectives 2. Childhood (29 days – 59 months): The health services specific to the early childhood period 3. Children and Youth (5 – 19 years): The time of life between childhood and maturity 4. Adulthood (20 – 59 years): The economically productive period of life 5. Elderly (60 years and above): The post – economically productive period of life This Communication Strategy is designed to address the communication needs of the different cohorts as well as policy and decision makers at all levels. 2. KEPH Service Package The conditions identified and included as KEPH level one services are those in which level one services can make the most significant contribution to the improvement of health and well-being of Kenyans. The table below gives a summary of the services offered at level one under the CHS approach based on the Strategic Plan 2012 – 2017. The message themes are designed to reflect key areas of intervention as well as the critical indicators defined in the monitoring and evaluation strategy. The communication matrix will build further on these message themes and define specific messages for the different cohorts. AFYA YETU, JUKUMU LETU
  13. 13. AFYA YETU, JUKUMU LETU
  14. 14. 5 Table 1: Summary of KEPH Service Package with message theme Services Intervention (Level 1 & 2) Message themes for level 1 Immunization  BCG, Polio, PCB10, Pentavalent, Measles, Yellow fever  Full course of immunization before first birthday Child Health  Deworming  Supplementation: Vitamin A, Zinc & other micronutrients  Weight monitoring  Breastfeeding and complimentary feeding  Acute diarrheal management with ORS and Zinc  Exclusive breastfeeding for first 6 months  Complimentary feeding after 6 months  Vitamin A supplementation every 6 months for 5 years  Growth monitoring every month  ORS and Zinc for diarrhoeal management Antenatal Care  Physical examination of pregnant mother  Tetanus vaccination  Supplementation: folic, calcium  Intermittent Presumptive Treatment for Malaria (IPT)  Antenatal profiling  Delivery plan  Referral to facility  At least 4 ANC visits  Prompt healthcare for complications of delivery  Accept and seek IPT during pregnancy  Have a delivery plan  Plan to deliver in a health facility Integrated Vector Management  Indoor Residual Spraying of malaria  LLIN distribution  Destruction of malaria breeding sites  Chemical control of household vectors (cockroaches, fleas, rodents)  Hand washing  Accept your house to be sprayed with IRS  Sleep under an LLIN every night  Recognise and seek early treatment for malaria  Adhere to malaria treatment Water and Sanitation Hygiene  Pit latrine/toilet use  Household water treatment  Hygiene promotion  Hand washing with soap at 4 critical times  Practice proper faecal disposal  Drink safe, clean and treated water
  15. 15. 6 Health education and promotion on non- communicable diseases  Education on referral of persons with NCDs  Community detection and diagnosis of NCDs  Refer community members with mental conditions, substance abuse Rehabilitation  Home visits for clients with NCDs  Community rehabilitation of persons with NCDs  Visit clients with NCDs and refer for rehabilitation Occupational therapy  Occupational rehabilitation amongst children and youth  Occupational rehabilitation amongst persons with mental conditions  Occupational rehabilitation amongst adults with disabilities  Visit clients needing occupational therapy and refer for rehabilitation Health Education and promotion  Basic first aid  Learn basic first aid skills  Health education on violence and injury prevention: Road Traffic accidents, Burns/Fires, Occupational injuries/accidents, Poisoning, Falls, Sports injuries, Drowning, Conflict/war, Female Genital mutilation, Self-inflicted injuries, Interpersonal injuries, Gender Based violence, Child maltreatment  Health education on prevention of communicable conditions; HIV, Malaria, Tuberculosis, Neglected Tropical Diseases, Diarrheal diseases, Infestations  Prevention of violence and injury  Prevention of communicable conditions o HIV/AIDS: Use condoms correctly and consistently o Malaria: sleep under an LLIN every night o Go for TB screening and testing  Health education on prevention of Non Communicable conditions; Mental illness health, Substance abuse, Diabetes Mellitus, Cardiovascular Diseases, Cancers, Oral health,  Have regular medical check-ups for early detection of diabetes, hypertension, cancer
  16. 16. 7 Sexual education  Sensitization of the community on safe sex practices  Targeted education methods for high risk groups o Adolescents, Sex workers, Uncircumcised men, Men who have Sex with Men, Intravenous Drug Users  Consistent and correct use of condoms  Faithfulness to one faithful partner  Abstinence and delay in sexual debut Substance abuse  Communication on harmful effects of tobacco use, effects of alcohol use and Substance abuse, effects of prescription drugs  Harmful effects of alcohol, tobacco, substance abuse, prescription drugs Physical activity  Health education on benefits of exercise  Health education on healthy eating  Engage in regular physical exercises for at least 30 minutes  Eat a balanced nutritious meal Nutritional services  Nutrition education and counselling  Community based growth monitoring  Micronutrient supplementation  Management of acute malnutrition  Health education on appropriate infant and young child feeding  Promotion of safe food handling  Eat a balanced diet  Pregnant mothers to eat extra portions of food  Exclusive breast feeding up to 6 months  Complimentary feeding after 6 months Population management  Information on benefits of child spacing  Awareness creation on the impact of population growth  Management of population movement particularly to informal settlements  Child spacing and timing is beneficial for mother and child  Referral for family planning method  Counselling and promotion of family planning
  17. 17. 8 3. Rights Based Approach KEPHs level one health communication is positioned as rights-based approach as enshrined in the new constitution. This strategy considers that all individuals have a right to relevant health information and services. The individual and communities include special groups like children, people with disabilities, youth, minority and marginalised groups. The communities have a right to receive healthcare services and information and the duty bearers have an obligation to fulfil these rights. The character of communication will be that of empowerment and motivation to enable community members, including special, groups take action. The KEPHs level one communications is sensitive to the different county contexts and unique communication needs. It provides direction on contextualization and adaptation of national communications to fit the local contexts which include geographical and literacy levels among others. To respond to the rights-based programming it is important that communication needs of the people with disability who may need sign language or braille IEC materials be catered for. The strategy will be delivered in a phased approach where policy makers, decision makers and program planners will be the first to be sensitised on the approach so that programming can be rights-based. 1.2. Background and Purpose of Development of the CHS Communication Strategy 1.2.1. Purpose of the CHS Communication Strategy Although the CHS was chosen as a tool for implementing KEPH, gaps in understanding the approach were experienced at all levels. In addition, challenges were faced in planning, implementation, monitoring and KEPH level one health communication will be positioned as rights based approach as enshrined in the constitution. AFYA YETU, JUKUMU LETU
  18. 18. 9 evaluation of ACSM activities, policy commitment as well as resource allocations for CHS including ACSM. The Communication Strategy was developed to address these challenges. The purpose of this Strategy, therefore, is to create a common understanding of the CHS approach among all stakeholders and partners including the Government of Kenya (GOK). The strategy also: a) Addresses communication gaps in order to encourage effective behaviour change by all target audiences. b) Facilitates the roll out of the CHS in the entire national and sub- national structures. c) Provides a clear and informed road map for the ACSM planning, implementation and monitoring of coherent and coordinated programming that will support and drive CHS and the services it offers. The Communication Strategy is intended for use by the DCHS, Government departments and divisions, partners and stakeholders in implementing ACSM at the National, County, Sub-County and Community levels. 1.2.2. Perspectives and Methods of Developing the CHS Communication Strategy 1. Process of CHS Communication Strategy Development The process of developing the Strategy was both consultative and participatory. Stakeholders at different levels, from the community to policy makers, were engaged in the process. The Communication Strategy will provide a clear and informed roadmap for the ACSM planning, implementation and monitoring of coherent, coordinated programming that will support and drive the CHS approach and the services it offers. AFYA YETU, JUKUMU LETU
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  20. 20. 11 challenges to current communication strategies (including strengths and weaknesses, existing opportunities and threats and resources). The findings of the situation analysis were presented to various stakeholders at a retreat held in June 2012. The stakeholders at this retreat included representatives from NGOs, District Heath Management Teams (DHMTs), Provincial Health Management Teams (PHMTs), development partners and MOPHS departments and divisions. Findings from the situation analysis were used by the stakeholders to identify key issues for the CHS Communication Strategy, audience segments, strategies and activities. 2. Alignment to Policies This Communication Strategy is designed to respond to the existing policy framework whose goal is the ‘attainment of the highest possible health standards in a manner responsive to the population needs’. The policy aims to achieve this goal through supporting provision of equitable, affordable and quality health and related services at the highest attainable standards to all Kenyans. The communication interventions are designed to focus on attaining two critical obligations of the health sector: Rights based approach to health, and ensuring health contribution to the country’s development. The policy documents that informed the development of this Communication Strategy included the Constitution of Kenya (Republic of Kenya, 2010), the Vision 2030 (Government of the Republic Kenya, 2007), the Kenya National Health Policy 2012 -2030, the Kenya Health Sector Strategic Plan 2012 to 2017 (MoPHS, December 2008) and Community Health Strategy among others. This Communication Strategy has aligned the messaging and interventions to the main articles in the Constitution of Kenya -2010 that highlight the rights based approach to health. Of particular mention are the rights to special groups in article 53 -57 who include children, people with disability, youth, minority and the marginalised; and article 174 which prescribes the aspects of devolution. In the devolved management of ACSM, this Strategy AFYA YETU, JUKUMU LETU
  21. 21. 12 envisions a National ACSM coordinating mechanism which will be tasked with providing ACSM technical assistance, capacity strengthening for counties as well as CHS advocacy. The County ACSM coordination mechanism will be tasked with ACSM implementation and contextualization of National level communications and supporting the Sub-County level communications. The Sub-County and Community levels are the critical levels of health service delivery where health promotion and education happens at the household and community levels. 3. Visualization of the CHS National Communication Strategy Policy Framework The diagram below illustrates the relation between CHS Communication Strategy and key national policies including Constitution of Kenya, Vision 2030, NHSSP III, KEPH, Community Health Strategy, Situation Analysis and Existing communication strategies. Figure 1: Visualization of CHS Communication Policy Framework AFYA YETU, JUKUMU LETU Constitution Vision 2030 Comprehensive National Health Policy CHS NHSSP II & III KEPH Communication Strategy Reflection Existing National Communication Strategies National Communication Strategy on CHS Results of Situation Analysis on CHS implementation Reflection
  22. 22. 13 1.3. Situation Analysis: Key Findings 1.3.1. Understanding of the CHS by Different Stakeholders 1. Understanding of the CHS by various stakeholders: Findings from the situation analysis indicated that the understanding and implementation of the CHS approach across board was not uniform. It was observed that those directly involved with the implementation of the CHS approach at National, Provincial and District level had a better understanding of its functions, structure, guidelines, activities and policy framework compared to health providers not directly involved with CHS.. It was also established that the understanding of the CHS approach both in the MOMS and MOPHS and partners was limited due to inadequate sensitization and a weak dissemination system. At the regional level it was established that understanding of the CHS by representatives of the PHMTs and DHMTs depended more on individual interest and motivation. Whereas some individuals interviewed clearly understood the CHS approach and their expected roles, others could not explain its goal, implementation structure and policies although they were aware of its existence. The understanding and support of the CHS was noted to be excellent in areas where there was direct involvement of the heads of provinces and Districts. 2. Understanding of CHS approach by health care workers: It was noted that health care workers at level three, four and five had a challenge in articulating the CHS, functions, and activities including some of the policy issues. The roles of the DCHS in implementing CHS and its functions were not clear to most these health workers. It was noted that health care workers at level three, four, and five had a challenge in articulating the CHS functions and activities including some of the policy issues. AFYA YETU, JUKUMU LETU
  23. 23. 14 1.3.2. Coordination and Existing Communication Strategies 1. Coordination of partners and stakeholders in implementation of communications for CHS: The Ministries of Health departments and divisions were identified as taking a leading role in the implementation of communication activities. Different focal persons at National, Provincial and District levels were tasked with the implementation of CHS activities including communication. Partners on the other hand provided the Ministries of Health with technical support in the implementation of CHS. It was、 however、 noted that there was limited coordination and collaboration in the various communication interventions being implemented at level one. 2. Existing Communication Strategies: Although the CHS did not have a communication strategy, different partners and stakeholders were actively implementing different components of level one service. Some departments, divisions and partners have developed communication strategies targeting different audiences and health areas for different levels. All the strategies reviewed showed consistency in audience segmentation with the communities as primary audiences. 1.3.3. Implementation of Communication Activities for Level One and Gaps Identified 1. Uniformity of implementation of communication activities by region: Some CHS activities including communication activities were being implemented at level one in all the five regions visited. These activities, however, varied from one region to another with more communication interventions targeting cohort 1, 2 and 3. 2. Implementation of disease prevention and control activities: While all regions reported extensive implementation of communications on HIV/AIDS, STI, TB and Malaria, none was reported for first aid and emergency preparedness, treatment of injuries and trauma. 3. Implementation of family health services: Family planning, immunization, community based referral and maternal and child care were the most AFYA YETU, JUKUMU LETU
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  25. 25. 16 7. Challenges in the pastoral and slum communities: In addition to challenges in disseminating health information to pastoral and slum communities, two key issues kept emerging; these are poor faecal disposal facilities and lack of water. Specifically, construction of permanent human waste disposal structures among the pastoral and nomadic communities and space requirements in the slums were reported as big challenges. These two communities also faced water challenges hence hindering the implementation of sanitation activities. 8. Community participation: While community health days were being reported in all regions, participation of all the community members was a challenge. 9. Technical and human resource capacity within MOPHS to implement communication activities for CHS: According to the various discussions, there was consensus on the inadequate technical capacity to plan, implement, monitor and evaluate communications. It was reported that communication experts were not being employed within the Ministry of Public Health and Sanitation. While the Department of Health Promotion (DHP) has health promotion experts, they have inadequate personnel to support the various communication needs of the Ministries. The Division of Community Health Services (DCHS) was identified as lacking capacity (both expertise and staffing) to implement ACSM interventions nationally. In some cases there was reported deployment of other cadres of health workers to head communication sections with basic or no communication training. 10. Working relationship between CHS focal persons and health promotion officers: It was observed that there is disjointed working relationship between the CHS focal persons and the health promotion officers at all levels with the latter being left out in the implementation of communication interventions. This was attributed to resource constraints in some cases and inadequate briefing and information sharing in others. AFYA YETU, JUKUMU LETU
  26. 26. 17 11. Partners’ technical and human resources capacities to implement ACSM activities for CHS: Partners were reported to have well-structured communication systems with enough qualified personnel. It was reported that some of the partners have been providing technical and financial assistance to MOMS and MOPHS to cater for communication needs. 12. Resource allocation: There is insufficient resource allocation from the Government for communication interventions and programming. In most cases funding support was provided by the partners in implementing communication activities both at National, County, Sub-County and Community levels. 1.4. Recommendations Based on the Findings of the Situation Analysis  Conduct a national branded campaign to create extensive awareness of the CHS and effective dissemination of the CHS strategy and policies within Ministries of Health, among partners and stakeholder to create common understanding of the CHS.  Prioritize communication interventions for level one in resource allocation to ensure full and effective implementation.  Establish a coordination mechanism at all levels to support coherence in implementation of all communication activities to address the inadequate synchronization within Ministries of Health departments, and partners on CHS implementation including communications.  Develop a comprehensive multi-faceted communication framework to guide all CHS communication activities at all levels: There exists no effective coordination framework for communication activities. Partners were reported to have well-structured communication systems with enough qualified personnel. AFYA YETU, JUKUMU LETU
  27. 27. 18  Support CHWs through provision of standardized and simplified messages which are contextualized to their regions: In most regions CHWs depend on communication interventions from various partners with no direct package from GOK.  Capacity strengthening in communication for the National, County and Sub-county communication teams and CHWs: Prioritization of capacity strengthening in communications planning, implementation, monitoring and evaluation is crucial to the success of communications for CHS.  Create an integrated CHS system which incorporates all health workers, within the ministries to ensure ownership by all.  There is need to have regular knowledge, attitude and practices assessments among the community to establish the actual situation before and after communication interventions: Currently there is inadequate comprehensive monitoring and evaluation plan for ACSM activities for CHS approach at all levels. In addition, there is limited documented evidence of effective strategies, channels or materials or best practices that can be replicated at level one.  There is need for an all-inclusive simple package of messages targeting all cohorts: There is need to establish standardised messages and approaches to guide the various players in communication implementation in order to create harmony and consistency. Guidelines should be provided on how to customise messages to fit the needs for each region of the country. 1.5. SWOT Analysis Respondents for the situation analysis identified the following Strengths, Weaknesses, Opportunities and Threats (SWOT) that the ACSM strategy for CHS can take into account. This strategy has attempted to build on the strengths and opportunities identified in the SWOT analysis. It has further designed strategies to address some of the weaknesses and threats identified. AFYA YETU, JUKUMU LETU
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  29. 29. 20 Chapter 2 CHS Communication Strategy 2.1. CHS Communication Strategy Goal The goal of CHS is to improve the health status of Kenyan communities. To achieve this goal, this Communication Strategy is aimed at:  Providing a clear and informed road map for communication planning, implementation and monitoring of coherent, coordinated programming that will support and drive the CHS and the services it offers.  Providing a framework for coordination of communication interventions for CHS and hence increasing the proportion of organizations collaborating with CHS in communication planning, implementation and monitoring and evaluation at National, County, Sub-County and Community levels.  Increasing awareness about the CHS approach at all levels hence creating common understanding within GOK and among different partners and stakeholders.  Building commitment from GOK and partners to provide resources for CHS including communication to ensure effective implementation and attainment of goals.  Providing capacity strengthening for CHS communication implementers at National, County and Sub-County levels to manage the ACSM program planning, implementation, monitoring and evaluation.  Increasing uptake of health services by all cohorts facilitated by transfer of knowledge and skills at household and community levels through Advocacy, Behaviour Change and Social Mobilization. 2.2. Broad Communication Strategies To Be Employed The CHS outlines community based communication as the hub of level one health care provision. Community level activities focus on effective communication aimed at behaviour change, disease prevention and health promotion. AFYA YETU, JUKUMU LETU AFYA YETU, JUKUMU LETU
  30. 30. 22 Figure 2: Socio-Ecological Model 2.4. Five Strategies of CHS Communication Strategy Based on the situation analysis, socio-ecological model and application of the three broad approaches: Advocacy, Social Mobilization and Behaviour Change, this document contains five strategies that will be employed to achieve the goals of CHS: 1. Strategy One: Advocacy to Policy Makers, Program Planners and Media Advocacy targeting policy makers, program planners and media will be planned and executed for CHS to raise political and social commitment as well as resources for service delivery to influence support or action for level one services at National, County, Sub-county and Community levels. 2. Strategy Two: Capacity Strengthening in Management for Health Communication Capacity strengthening in health communication will be conducted for ACSM focal teams at National, County, Sub-County and Community level to manage the ACSM program (planning, implementation, monitoring, and evaluation) at the different levels. AFYA YETU, JUKUMU LETU
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  33. 33. 25 Chapter 3 Strategy One: Advocacy to Policy Makers, Program Planners and Media 3.1. Objectives and Target Audiences This strategy is designed to reach out to key policy makers, program planners and the media at National, County and Sub-County level. It seeks to address four key issues that emerged from the situation analysis; these are lack of common understanding of the CHS approach, inadequate resources for CHS, inadequate engagement in the CHS approach by key stakeholders within the Ministries of Health and partners and lack of media engagement. Advocacy will be done at three focal points as outlined below: 1. Policy advocacy is aimed at promoting political and social commitment, mobilizing resources, and stimulating development of supportive CHS policies. It seeks to inform the relevant senior management, directors and all decision makers both within Government and among partners on the aims, strategies and activities of the level one strategy and how the CHS approach will improve service delivery and hence support in achievement of NHSSP II and NHSSP III which are in line with Kenya Vision 2030 and MDGs. 2. Program advocacy targets opinion leaders. It aims at promoting local action by explaining the role of the community and other influential people in the level one services strategy. It seeks to inform community leaders and other influential individuals about the aims, objectives, strategies and activities of the level one services strategy. Strategy One: Policy, program planners and media advocacy for CHS to raise political and social commitment as well as resources for service delivery to influence support or action for level one service at National, County, Sub- County and Community level. AFYA YETU, JUKUMU LETU
  34. 34. AFYA YETU, JUKUMU LETU
  35. 35. 27 3.2. Policy and Decision Makers Target Audiences Table 3 : Target Audiences for Advocacy: National, County, Sub-County levels LEVEL AUDIENCES SEGMENTS National Policy and Decision Makers Primary Audience  Heads of departments and divisions and staff of Ministries of Health at National level  Parliamentary health committee  UN Agencies, FBOs, NGOs implementing level one services  NACC Secondary Audience  Media  Interagency Coordinating Committees  Private sector  Professional bodies in health: Kenya Medical Association, Kenya Nurses Association  Ministry of Finance  Ministry of Agriculture  Ministry of Water  Ministry of Education County Level Decision Makers Primary Audience  County level MOPHS & MOMS, including Health Management Teams, Doctors, Nurses, Public Health Officers  Local political leaders, FBOs, NGOs implementing level one services Secondary Audience  Media  County level gatekeepers e.g. County administration Sub-County Level and Community level Decision Makers Primary Audience  Community leaders: Village elders, Chiefs, Elders, Religious leaders, Local politicians  CHEWs, CHCs, CHWs Secondary Audience  County and National policy makers of Ministries of Health  Level one implementing partners and stakeholders  Health care service providers  Local media AFYA YETU, JUKUMU LETU
  36. 36. 28 3.3. Communication Matrix for Decision Makers at Different Levels Table 4: National Level Policy and Decision Maker’s Communication Matrix Audience segments Desired changes Channel mix Tools and materials  Heads of departments and divisions and staff of MOMS and MOPHS at National level  Parliamentary health committee  UN agencies, FBOs, NGOs implementing level one services  Departmental heads/divisional heads (NCDs, disaster, disease surveillance, NACC, technical planning)  Awareness and understanding of the various components, activities and benefits of the CHS  Commitment by both Government and partners to provide resources and funds for level one services including ACSM  Improved dissemination and roll out of CHS approach  Participation, and support of MOMS and MOPHS in CHS approach  Formulation and enforcement of policies and guidelines that support CHS ACSM at all levels  Understanding of level one communication as rights based Mass media  CHS mass media branded campaigns  TV and Radio campaigns  Press conferences and briefings  Social media (Facebook, Twitter), Emails, E-shots, PDF of print adverts  CHS Symposiums/Conferences  Outdoor media: Billboards  TV and radio campaign materials  CHS promotional materials (T-shirts, caps, banners, badges, stickers, desk calendars, desk diaries, pens, flyers, etc.) Interpersonal  Meetings between various levels of Government and civil society organizations  Advocacy kit with a set of IEC materials  Media kits  Policy and advocacy papers
  37. 37. 29  Advocacy stakeholders and partners forums  Morning briefs & breakfast meetings  CHS Ambassadors  Media workshop  Sensitization guidelines for training journalists Activities  Develop and execute a mass media branded campaign through multiple channels to create awareness on the CHS approach including TV/Radio spots and talk shows  Develop CHS brand and brand application guidelines  Reposition and disseminate CHS approach afresh especially in areas with major gaps in understanding within Government and among other stakeholders  Develop and disseminate an advocacy kit with different materials targeted to the National, County Sub-County and Community leaders  Conduct stakeholder, partner and private sector forums at National, County, Sub-County and Community level  Implement a branded campaign with direct communications through social media, Emails, E-shots, PDF of print adverts  Place print adverts in newspapers, industry magazines and newsletters  Conduct regular CHS national symposia/conferences as a platform for sharing best practices, lessons learnt, successes, new information etc.  Conduct media workshops for select editors and journalist to sustain CHS spotlight and accurate analytical reporting  Develop and present policy papers to top level decision makers in Government and CSOs
  38. 38. 30  Conduct targeted meetings for health care providers and sensitization forums for the MOH staff on CHS approach, strategy, policies and their respective roles Table 5: County Level Decision Maker’s Communication Matrix Audience segments Desired changes Channel mix Tools and materials County level MOMS and MOPHS Local political leaders, FBOs, NGOs implementing level one services  Awareness and understanding of the various components, activities and benefits of the CHS approach  Commitment by County level partners to provide resources and funds for level one services including ACSM  Improved dissemination and roll out of CHS strategy and approach at County and Sub- County level  Participation, involvement and support of MOMS and MOPHS in CHS at County and Sub-County level Mass media  County level media engagement  CHS documentaries  County level media kits  CHS promotional materials (T-shirts, caps, banners, badges, stickers, desk calendars, desk diaries, pens, flyers, etc.)
  39. 39. 31 Audience segments Desired changes Channel mix Tools and materials  Improved information sharing on CHS within Government and among partners  Understanding of level one communication as rights based Interpersonal  Advocacy stakeholders and partner forums between various levels of Government, civil society organizations and private partners  Technical working forums  Dialogue meetings with key CHS players at County level  County media workshops for journalists  Advocacy kit with a set of IEC materials for County and Sub- County levels  Sensitization guide for training journalists at County level Community based  Launches, social gatherings, prize giving days, conventions  Fliers  Banners  Entertainment education (skits, music, poems, dramas, one on one presentations)
  40. 40. 32 Activities  Disseminate the advocacy kit with different materials targeted to the County leaders  Disseminate CHS and policy to County and Sub-County level  Conduct stakeholder and partner forums at County level geared at addressing CHS issues and coordination  Conduct regular County level symposiums as a platform for sharing best practices, lessons learnt, successes, new information etc.  Conduct County level media workshops for local journalist to keep CHS approach issues on the spotlight in the regions  Mobilize resources and technical assistance to support in community dialogue and health action days Table 6: Sub-County and Community Level Decision Maker’s Communication Matrix Audience segments Desired changes Channel mix Tools and materials Community leaders: Village elders, Chiefs, Elders, Religious leaders, Local politicians CHEWs CHCs CHWs  Good understanding of the CHS including components, activities and benefits of the CHS  Good understanding on their roles and responsibilities in level one service delivery  Uniformity in dissemination and roll out of CHS approach Interpersonal  Training and sensitization meetings with CHEWs, CHCs, CHWs  Advocacy kit with a set of IEC materials  CHS promotional materials (T-shirts, caps, banners, badges, stickers, desk calendars, desk diaries, pens, flyers, etc.)
  41. 41. 33 Audience segments Desired changes Channel mix Tools and materials  Clear understanding of level one communication as rights based Community based  Community dialogue with various leaders  Health action days  Advocacy kits for community leaders Mass media  Community Local Radio FM stations  Documentaries on CHS  Media kit on CHS approach Activities (for Sub-County level)  Disseminate the community leaders advocacy kit with different materials and accompanying CHS promotional materials  Conduct community leaders dialogue on CHS to enhance ownership and engagement  Advocate for local resources to support community interventions  Sensitization for CHEWs, CHCs, CHWs to build capacity on CHS in order to facilitate quality service and enhance their role in facilitating change
  42. 42. 34 Chapter 4 Strategy Two: Capacity Strengthening in Management for Health Communication 4.1. Objectives and Target Audience This strategy is aimed at addressing capacity strengthening issues identified in the situation analysis both through advocacy and training. These issues include; inadequate ACSM capacity in planning, implementing, monitoring and evaluation at National, County, Sub-County and Community level, low priority for health promotion, inadequate health promotion staff and high staff turnover. This section gives an analysis of target audiences, desired changes, interventions and materials needed. Table 7: Target Audiences for Health Communication Capacity Strengthening LEVEL AUDIENCES AUDIENCE SEGMENTS National (Advocacy for capacity strengthening) Primary Audience National policy and decision makers  Director of MOPHS  MOPHS human resource management and development  Head, department of health promotion  Development partners  Implementing partners National (Training ) Primary Audience CHS ACSM implementing teams at National levels  CHS ACSM unit and DHP  CHS TWG Strategy Two: Capacity strengthening of ACSM focal teams at National, County, Sub- County and Community level to manage the ACSM program (planning, implementing, monitoring and evaluation) at the different levels. AFYA YETU, JUKUMU LETU
  43. 43. AFYA YETU, JUKUMU LETU
  44. 44. 36 4.2. Communication Matrix for Strengthening Capacities in Program Management Table 8: Strengthening Capacities in Health Communication Program Management AUDIENCE SEGMENTS DESIRED CHANGES INTERVENTION TOOLS National policy and decision makers  Director of MOPHS  MOPHS human resource management and development  Head, Department of Health Promotion  Communication development partners  Communication implementing partners  Improved awareness of importance of ACSM in CHS and prioritization of health promotion  Allocate resources to strengthen capacity of CHS in communications  Support the CHS human resource needs to implement the communication strategy  Meetings to lobby for resources to strengthen the CHS ACSM capacity  Meetings to advocate for improved human resource needs for CHS ACSM  Fact sheets  Presentations  Capacity assessment findings
  45. 45. 37 AUDIENCE SEGMENTS DESIRED CHANGES INTERVENTION TOOLS CHS ACSM implementing teams at National and County levels  CHS ACSM Unit  CHS TWG including DHP  Strengthened capacity in planning, implementation, monitoring and evaluation at the national and county levels  Harmonized communication monitoring plans for communication activities at all levels  Improved capacity to design and conduct rights based communication programming  Communications competency based training  ACSM monitoring and evaluation competency training  CHS ACSM Competency based training manual  CHS ACSM National and County level practitioners guide  Communication guidelines CHS ACSM implementing teams at Sub County level  CHEWs  CHCs  CHWs  Strengthened capacity to plan and implement interpersonal communication interventions  Improved capacity to conduct ACSM monitoring and evaluation  Sub-County level ACSM competency based training with emphasis on implementation of interpersonal interventions  CHS ACSM Sub-County level practitioners guide
  46. 46. 38 AUDIENCE SEGMENTS DESIRED CHANGES INTERVENTION TOOLS  Improved capacity to conduct rights based communication programming  Orientation on CHS communication indicators Activities  Conduct ACSM capacity assessment at all DCHS levels to determine strengths and weaknesses in planning, designing, implementing, monitoring and evaluating communication programs  Design and develop an appropriate ACSM competency based training manual  Develop a tailored ACSM practitioners handbook that will guide implementation of ACSM all levels  Conduct the ACSM competency based training at all levels  Provide support supervision and technical assistance in the implementation and monitoring of ACSM at all levels
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  50. 50. 42 5.2. Communication Matrix for Behaviour Change for Each Cohort Table 10: Cohort 1: Pregnancy and the New-born (up to 28 days) Communication Matrix Audience segments Desired changes Channel mix Tools and materials Pregnant women and mothers with new- borns up to 28 days Pregnant women with special needs and disabilities  Go for at least 4 ANC visits during pregnancy  Develop a delivery/birth plan  Plan to deliver in a health facility under skilled care  Seek prompt care when you see danger signs in pregnancy and prompt healthcare for complications of delivery  Accept and seek IPT during pregnancy  Accept your house to be sprayed with IRS  Sleep under an LLIN every night for malaria prevention  Recognise and seek early treatment for malaria  Adhere to malaria treatment Interpersonal  Home visit by CHWs  Health talks by HCP at facility  Mother to mother support groups  Community dialogue cards/guide  Counselling flip chart  Sign language interpreters  IEC in braille Community based  Health action days  Outreach services  World health commemoration days  Banners  Fliers and brochures  Posters and low cost leaflets  Vehicle stickers
  51. 51. 43 Audience segments Desired changes Channel mix Tools and materials  Hand washing with soap at 4 critical times  Practice proper faecal disposal including children’s faeces  Drink safe, clean and treated water  Take children for full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, Measles)  Practice exclusive breast feeding for the first 6 months  Delay the baby’s bath for 24 hours and place the baby skin to skin with the mother to keep warm management between 24-48 hours  Learn basic first aid skills  Prevent violence and injury  Go for TB screening and testing  Keep off from the harmful effects of alcohol, substance abuse, prescription drugs Media  TV and Radio  Outdoor: talking walls, Billboards  Bus & Matatu branding
  52. 52. 44 Audience segments Desired changes Channel mix Tools and materials  Engage in regular physical exercises for at least 30 minutes  Eat a balance nutritious meal with extra portions  Practice child spacing and timing for at least 2 years  Referral for FP method especially modern FP Table 11: Cohort 2: Childhood (29 days to 59 months) Communication Matrix Audience segments Desired changes Channel mix Tools and materials Caregivers of children 29 days to 59 months Caregivers with special needs and disabilities  Practice exclusive breastfeeding for first 6 months  Complimentary feeding after 6 months and continue breastfeeding up to 24 months  Vitamin A supplementation every 6 months for 5 years  Growth monitoring every month up to 5 years Interpersonal  Home visits by CHWs  Health talks by HCP at facility  Mother to child support  Teacher to child health education  Community dialogue cards/guide  Counselling flip chart
  53. 53. 45 Audience segments Desired changes Channel mix Tools and materials Children 29 days to 59 months  ORS and Zinc for diarrhoeal management  Deworming every 6 months  Full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, Measles)  Sleep under an LLIN every night to prevent Malaria  Recognise and seek early treatment for malaria within the first 24 hours  Adhere to malaria treatment  Hand washing with soap at 4 critical times  Practice proper faecal disposal including proper disposal of children faeces  Drink safe, clean and treated water  Prevent violence and injury  Sign language interpreters  IEC in braille Community based  Health action days  Outreach services  World health commemoration days Media  TV and Radio  Outdoor: Talking walls, Billboards, Screen adverts  Bus & Matatu branding  Banners  Fliers and Brochures
  54. 54. 46 Table 12: Cohort 3: Children and Youth (6 to 12 years) Communication Matrix Audience segments Desired changes Channel mix Tools and materials Children in and out of school aged 6 to 12 years Children with special needs and disabilities Caregivers of children aged 6 to 12 years  Sleep under an LLIN every night for malaria prevention  Recognise and seek early treatment for Malaria  Adhere to malaria treatment  Hand washing with soap at 4 critical times  Practice proper faecal disposal  Drink safe, clean and treated water  Full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, Measles)  Learn basic first aid skills  Prevention of violence and injury  Eat a nutritious diet everyday  Abstinence and delay in sexual debut Interpersonal  Home visits by CHWs  Teacher to child support  Child to child education  School health clubs  Comprehensive school health programs  Sign language interpreters  IEC in braille  Job aid for teachers  IEC materials for children Community based  Outreach services  Interactive community theatre  Banners  IEC materials
  55. 55. 47 Audience segments Desired changes Channel mix Tools and materials  Increase knowledge of HIV/AIDS prevention and sexuality education Media  TV and Radio Table 13: Cohort 3: Youth 13 to 20 Years Communication Matrix Audience segments Desired changes Channel mix Tools and materials Male and female youth in and out of school Youth with special needs disabilities Youth Living with HIV/AIDS (YLWA)  Sleep under an LLIN every night  Recognise and seek early treatment for malaria  Adhere to malaria treatment  Hand washing with soap at 4 critical times  Practice proper faecal disposal with special attention to people with special needs/disabilities and the sick  Drink safe, clean and treated water  Practice personal hygiene including menstrual management  Identify symptoms and signs of mental conditions and refer Interpersonal  Peer education  School health clubs  Guidance and counselling in schools  Sign language interpreters  IEC in braille  Incorporation SRH/HIV in school curriculum that responds to needs of this cohort  Peer education guides  Peer counselling  Guidance and counselling guides for teachers  Job aids for teachers
  56. 56. 48 Audience segments Desired changes Channel mix Tools and materials  Visit clients with NCDs and refer for rehabilitation  Visit clients needing occupational therapy and refer for rehabilitation  Learn basic first aid skills  Prevention of violence and injury  Use condoms correctly and consistently for HIV prevention  Go for TB screening and testing  Abstinence and delay in sexual debut  Faithfulness to one faithful partner  Keep off from the harmful effects of alcohol, substance abuse, prescription drugs  Engage in regular physical exercises for at least 30 minutes  Eat a balanced nutritious meal  Child spacing and timing for at least 2 years  Referral for FP method  Parent –youth interactions Community based  Sports and extra- curricular activities  Interactive community theatre  Community video centres  Puppet shows  Road shows  Community based youth friendly centres  Fliers and brochures  T-Shirts, caps, bangles  Branded sports equipment Media  TV and Radio  Social media: Facebook, Twitter  TV and Radio materials  Comic books
  57. 57. 49 Audience segments Desired changes Channel mix Tools and materials  Seek testing and counselling  Reduction in number of youth having multiple sexual partners  Utilization of Reproductive Health and FP services  Delayed child bearing  Elimination of FGC and other harmful cultural practices  Outdoor; billboards  Local video clubs  Celebrity endorsement  Help lines (Calls/SMS) Table 14: Cohort 4: Adulthood (20 to 59 years) Communication Matrix Audience segments Desired changes Channel mix Tools and materials Men and women Men and women with special needs and  Have regular medical check-ups for early detection of diabetes, hypertension, cancer  Accept your house to be sprayed with IRS  Sleep under an LLIN every night Interpersonal  Household visits by CHWs  Sign language interpreters  IEC in braille  Community discussion guides
  58. 58. 50 Audience segments Desired changes Channel mix Tools and materials disabilities Caregivers of sick patients People Living with HIV/AIDS  Recognise and seek early treatment for malaria  Adhere to malaria treatment  Hand washing with soap at 4 critical times  Practice proper faecal disposal with special attention to people with special needs and disabilities and the sick  Practice personal hygiene including menstrual management  Drink safe, clean and treated water  Identify symptoms and signs of mental conditions refer  Visit clients with NCD and refer for rehabilitation  Visit clients needing occupational therapy and refer for rehabilitation  Learn basic first aid skills  Prevention of violence and injury  Reduction in number of sexual partners  Counselling on Menopause and Andropause Community based  Outreach services  Community dialogue  Health action days  Media  Women and men groups discussions  Interactive community theatre  Targeted FBO/Religious forums  Community dialogue discussion cards  Low cost easy to read leaflets  Community theatre tools Media  TV and Radio  Outdoor: Billboards, Talking walls  Videos at clinics and video joints  TV and Radio spots  Posters and Leaflets  Videos  Wall branding
  59. 59. 51 Audience segments Desired changes Channel mix Tools and materials  Go for TB screening and testing  Faithfulness to one faithful partner  Keep off from the harmful effects of alcohol, substance abuse, prescription drugs  Engage in regular physical exercises for at least 30 minutes  Eat a balanced nutritious meal  Child spacing and timing  Referral for FP method  Knowledge of HIV status and partner status  Use condoms correctly and consistently for HIV prevention  Adherence to ART treatment  Go for TB screening and treatment  Ensuring adherence to TB treatment regimens for those who are sick
  60. 60. 52 Table 15: Cohort 5: Elderly (60 years and above) Communication Matrix Audience segments Desired changes Channel mix Tools and materials Men and women 60 years and above Men and women with special needs and disabilities People Living with HIV  Have regular medical check-ups for early detection of diabetes, hypertension, cancer  Accept your house to be sprayed with IRS  Sleep under an LLIN every night  Recognise and seek early treatment for malaria  Adhere to Malaria treatment  Hand washing with soap at 4 critical times  Practice proper faecal disposal with special attention to mobility of elderly and people with special needs and disabilities  Drink safe, clean and treated water  Identify symptoms and signs of mental conditions and substance abuse and refer  Visit clients with NCD and refer for rehabilitation Interpersonal  Household visits by CHWs  Training for Health Workers, CHEWs, CHWs on needs of the elderly  Sign language interpreters  IEC in braille  Discussion guides with key messages for the elderly Community based  Community dialogue  Outreach services  Barazas  Leaflets with key messages for the elderly  Banners  Wall branding
  61. 61. 53 Audience segments Desired changes Channel mix Tools and materials  Visit clients needing occupational therapy and refer for rehabilitation  Go for TB screening and testing  Prevention of violence and injury  Learn basic first aid skills  Keep off from the harmful effects of alcohol, substance abuse, prescription drugs  Engage in regular physical exercises for at least 30 minutes  Eat a balanced nutritious meal  Knowledge of HIV status and encouraging partner to go for VCT  Faithfulness and correct and consistent use of condoms for HIV prevention  Adherence to ART treatment for those who are infected  Eating a nutritious and balanced diet Media  Print: Brochures, Fliers, Posters, Newspapers  TV and Radio  Mobile cinema  Print and Radio materials
  62. 62. 54 5.3. Behaviour Change Communication Activities for KEPH Level One  Conduct a rapid mapping of partners implementing level one communication interventions at National, County, Sub-County and Community level  Establish/strengthen the ACSM technical Sub-committee (or existing platform) of partners implementing communication interventions at level one for each cohort at National, County and Sub-County level  Develop a rights based communication plan that clearly incorporates all the multiple interventions supporting the CHWs’ involvement at household and community level to ensure coordination and synergy  Develop clear roles and responsibilities for partnership in the implementation of communications for CHS approach at National, County and Sub-County level  Develop and disseminate targeted standard messages for each cohort jointly with the key partners implementing communication at level one  Develop, produce and disseminate a toolkit with IEC materials appropriate for each cohort  Develop, produce and disseminate a toolkit with IEC materials for people with special needs and disabilities  Provide technical assistance in contextualization of messages and materials to different counties for level one  Provide technical assistance in the implementation and monitoring of communication interventions at household and community level  Develop CHS communication specific indicators for various activities and update as appropriate AFYA YETU, JUKUMU LETU
  63. 63. 55 Chapter 6 Strategy Four: Mobilization and Coordination of Communication Partners and Stakeholders 6.1. CHS ACSM Coordination Mechanism and Structures There is need for mobilization of different partners and stakeholders providing communication services at level one to ensure coordination and coherence, of programming that will support and drive the CHS approach and the services it offers. Through this strategy partners and stakeholders will be sensitized and motivated to work together in raising awareness and pooling resources. Community mobilization will be done to motivate and influence community members to take action and support initiatives that are beneficial to them. This will target interested organizations, individuals and health related sectors, along with NGOs, CBOs, professional associations and the private sector. Strengthening the ACSM structures, capacity and systems at all levels will ensure successful delivery of effective CHS communications. The ACSM coordination structures will be anchored within the existing CHS and National health system to ensure consistency, better sector coordination and linkages from the National to the Sub- County and Community level. There is need for partnership, collaboration and coordination to ensure success in the delivery of services. All partners and stakeholders need to board the CHS ‘vehicle’ to roll out communications at the community level. The coordination mechanism of ACSM activities for level one seeks to address the following critical issues that emerged from the situation analysis: a) Inadequate engagement of all partners and stakeholders, Strategy Four: Mobilization of different partners and stakeholders providing communication services at level one to ensure coordination and coherence in CHS communication programming. AFYA YETU, JUKUMU LETU
  64. 64. 56 b) Weak coordination framework of communications for level one services, c) Vertical and parallel programming of ACSM activities at level one, d) Inadequate communication guidelines, e) Communication interventions not being consistent, standardized and sustained. 6.2. National Level Coordination 6.2.1. Linkages with other Departments, Divisions and Partners The CHS fully addresses level one service delivery with complete structures and operationalized functions. The DCHS will be tasked with establishing a platform that will ensure smooth coordination of ACSM activities at all levels. Multi-Sectoral collaboration and coordination will take place at the ICC level. The National CHS ACSM TWG will be tasked with operationalizing the Communication Strategy and provide a platform for coordination of ACSM interventions for level one. All the departments, divisions and partners implementing communications at level one will be members of this TWG. The DHP will provide technical assistance at all levels in the operationalization of this Communication Strategy. This section defines roles and responsibilities of the ACSM structures at different levels. 6.2.2. Role of CHS ACSM TWG in the Implementation of the Communication Strategy The CHS ACSM TWG will be tasked with the following roles and responsibilities:  Coordinate the responsibilities, tasks and contributions of various ACSM partners and stakeholders  Set standards and guidelines for CHS ACSM  Provide assistance in harmonization of CHS ACSM messaging and IEC materials  Develop ACSM partnership plan to be adapted by Counties, to include roles and responsibilities AFYA YETU, JUKUMU LETU
  65. 65. 57  Develop a communication plan for CHS ACSM activities which include planning, implementation, monitoring and evaluation and reflects rights based programming  Resource mobilization for ACSM  Determine and develop CHS ACSM national campaigns  Determine who should form part of the ACSM coordination mechanism at the various levels  Support implementation of the ACSM conventions, meetings and forums at different levels 6.2.3. Role of DCHS ACSM Unit in the Implementation of the Communication Strategy Capacity building for the DCHS ACSM unit will be paramount to ensure that the communication activities are coordinated and managed effectively and continuously. The ACSM unit capacity and resources will be reviewed to help determine what skills and resources will be needed and how to obtain this. Due to the multiple and multi-level health issues addressed through the CHS, it is important to nurture partnerships to enhance synergy in implementation of ACSM activities and programs. Management of ACSM activities at the County, Sub-County and Community level will be an important function of this unit. A review of capacity, skills and resources at these levels will be important in informing ACSM capacity strengthening programs. To be able to support the roll out of this strategy, the ACSM unit will be tasked with the following roles and responsibilities:  Coordination of planning and implementation of CHS ACSM activities nationally  Monitoring, review and reporting of ACSM programming to DCHS All partners and stakeholders need to board the CHS ‘vehicle’ to roll out communications at the community level. AFYA YETU, JUKUMU LETU
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  71. 71. 63 Figure 5: ACSM Linkages and Coordination CHW, CHC Primary Healthcare Unit , Community Unit CHEW MOH, Partners & Stakeholder, Health Promotion Sub-County CHS Focal person MOH, Partners & Stakeholders, Health Promotion County CHS Focal person Departments, Divisions, Partners, DHP DCHS ACSM Unit AFYA YETU, JUKUMU LETU
  72. 72. 64 Chapter 7 Strategy Five: CHS Knowledge Management and Documentation 7.1. 0bjectives The purpose of the knowledge management strategy is to create a platform for strengthening information sharing, promoting data use and building skills. This is in an effort to address the current gaps of lack of adequate information and weak information dissemination in departments and divisions within Government and among stakeholders. Knowledge management is a platform designed for policy and decision makers at all levels, development and implementing partners, researchers and program managers. The following interventions are proposed to improve information sharing on CHS, promote data use and build skills. 7.2. Key Interventions 1. Publications and information materials directed to key stakeholders and partners: o Fact sheets on thematic issues produced in the format of Frequently Asked Questions (FAQs) which is targeted and easy to read o Newsletter/ Bulletins on best practices, success, lessons learnt, or key CHS events to be shared on a quarterly basis o Policy briefs and presentations o CHS research briefs 2. CHS website Strategy Five: Knowledge management, documentation and sharing of CHS best practices, lessons learnt, success stories and important information to catapult implementation and support for level one service delivery. AFYA YETU, JUKUMU LETU
  73. 73. 65 The CHS website will be designed to provide information about Division of Community Health Services including: o General overview of the division o Organizational structure o Contacts o News o Events calendar o Success stories and best practices 3. CHS portal The CHS portal will be designed to provide information on the following; o National Health Sector Policies and Guidelines o CHS policies and guidelines o Training resources for CHEWs, CHCs, CHWs o Monitoring and reporting tools and guidelines o Database of IEC/BCC toolkit with complete set of materials and messages by cohort and by county o Materials by CHS for the household level and other collated materials from partners and stakeholders targeted for level one o Evidence database and research articles related to CHS o Links to useful and complementing resources o Community units database with mapping of functional units o DCHS partners and stakeholders platform o Link to data sites e.g. Central Bureau of Statistics o Listserve/discussion forum 4. Community strategy documentaries The documentaries will highlight best practices, success stories and lessons learnt that can be used both for training and resource mobilization. 5. Engage media as a strategic partner. It is important to leverage the media as a partner so that they can cover CHS issues within the right context and over a sustained basis. This will require AFYA YETU, JUKUMU LETU
  74. 74. 66 production of tools that make it easy for media to cover CHS analytically. Media training workshops will be important to ensure accurate and quality reporting. 6. Customer relationship system The DCHS will be coordinating many partners and stakeholders for level one services and hence an effective relationship system will be critical, including a contacts database and mail management system. AFYA YETU, JUKUMU LETU
  75. 75. AFYA YETU, JUKUMU LETU
  76. 76. 68 Table 17: Implementation Plan ACTIVITIES PROCESS INDICATORS TIME SCHEDULE 2013 2014 2015 2016 2017 Ⅰ Ⅱ Ⅲ Ⅳ Ⅰ Ⅱ Ⅲ Ⅳ Ⅰ Ⅱ Ⅲ Ⅳ Ⅰ Ⅱ Ⅲ Ⅳ Ⅰ Ⅱ Ⅲ Ⅳ 1. Advocacy 1 Develop and execute a 4-month branded mass media campaign through multiple channels at national and county level to create awareness on the CHS approaches (At least 2 National TV programs,6 radio programs-national and local and billboards) Number of radio/TV shows on CHS conducted during the campaign period. 2. Develop and disseminate an advocacy kit with different materials targeted to the national, county and community leaders with information on CHS approach Number of materials on CHS distributed to the national, county and community leaders. 3. Conduct stakeholder forum, including partners and private sector at National, County and Sub-County level to provide highlights on CHS approach, success stories, address gaps and rally for support and resources. Number of participants in forums targeting stakeholders, development partners and private sectors at National, County and Sub-County level.
  77. 77. 69 4. Support the branded campaign with direct communications through social media (Facebook, twitter), emails, e-shorts, PDF of print adverts. Number of people reached the campaign. 5. Place print adverts in newspapers, industry magazines and newsletters. Number of newspapers, industry magazines and newsletters printed on CHS issues. 6. Conduct advocacy workshop for local media at National and County level to keep CHS approach issues on the spotlight. Number of local journalists participating in the workshops. 2. Health Communication Capacity Strengthening 1. Conduct the DCHS ACSM capacity assessment at all levels to determine strengths and weaknesses in planning, designing, implementing, monitoring and evaluating communication programs. Report on DCHS ACSM capacity assessment is in place. 2. Develop an appropriate ACSM competency based training manual based on needs identified. ACSM training manual is developed. 3. Develop tailored ACSM practitioners handbook that will guide implementation of ACSM at all levels ACSM practitioners’ handbook developed and disseminated at all levels. 4. Conduct the ACSM TOT competency based training at National and County level. Number of trained trainers.
  78. 78. 70 5. TOT to roll out the ACSM competency based training at all levels including community level. Number of ACSM practitioners trained. 6. Provide supportive supervision and technical assistance in the implementation and maintaining of ACSM at all level Number of supportive supervisions implemented. 3. BCC 1. Conduct a rapid mapping of partners implementing level one communication interventions at National, County, Sub-County and Community level. Report on rapid mapping is in place. 2. Hold a one-day workshop to develop a right-based communication plan that clearly incorporates all the multiple interventions supporting the CHWs involvement at household and community level to ensure coordination and synergy. Right-based communication plan (with clear roles/responsibilities of each partner) is developed. 3. Develop and disseminate a toolkit (e.g.: Job Aid) with materials appropriate for each cohort. Toolkit for each cohort are developed and disseminated. 4. Develop produce and disseminate a toolkit with IEC materials for people with special needs and disabilities. Toolkit for people with special needs/disabilities are developed and disseminated.
  79. 79. 71 5. Hold a retreat to support counties in contextualization of messages and materials for level one. Messages/materials for level one are contextualized at each county. 6. Conduct regular monitoring of communication interventions at household and community level. . Regular monitoring on Behavior Change indicators is conducted. 4. Mobilization and Coordination of Communication Partners 1. Establish/Strengthen the ACSM technical Sub-committee (or existing platform) of partners implementing communication interventions at level one for each cohort at National, County and Sub-County Level. Number of ACSM TWG operationalized (organized regularly with agenda) at National, County and Sub- County level. 2. Hold quarterly ACSM technical working groups for planning and coordination of the National communication plans. TWG meeting is held regularly. 3. Provide technical assistance to the counties in implementation of ACSM activities. Number of counties supported in communication planning, implementation and M&E. 5. CHS Knowledge management 1. Publications and information materials directed to key stakeholders and partners: fact sheets, bi-annual newsletters, policy briefs, research briefs. Number of publications
  80. 80. 72 2. Set up and manage CHS website. CHS Website is developed and updated regularly. 3. Develop a CHS portal and manage through to 2017 CHS portal is developed and managed constantly. 4. Produce CHS promotion video CHS promotion video is available to the public.
  81. 81. AFYA YETU, JUKUMU LETU
  82. 82. 74 Table 18: Summary of Key Messages Targeting Each Cohort for Behaviour Changes Desired Behaviour Changes (Key Messages) Cohort 1 Cohort 2 Cohort 3 Cohort 4 Cohort 55~12 13~19 1 Sleep under on LLIN every night ○ ○ ○ ○ ○ ○ 2 Recognize and seek early treatment for malaria within the first 24 hours ○ ○ ○ ○ ○ ○ 3 Adhere to malaria treatment ○ ○ ○ ○ ○ ○ 4 Hand washing with soap at 4 critical times ○ ○ ○ ○ ○ ○ 5 Practice proper faecal disposal including proper disposal of children faeces ○ ○ ○ ○ ○ ○ 6 Drink safe, clean and treated water ○ ○ ○ ○ ○ ○ 7 Prevention of violence and injury ○ ○ ○ ○ ○ ○ 8 At least 4 ANC visits ○ 9 Prompt healthcare for complications of delivery ○ 10 Have a delivery plan ○ 11 Plan to deliver in a health facility ○ 12 Seek prompt care when you see danger signs in pregnancy ○ 13 Accept and seek IPT during pregnancy ○ 14 Accept your house to be sprayed with IRS ○ ○ ○ 15 Full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, Measles) ○ ○ ○ 16 Exclusive breastfeeding for the first 6 months ○ ○ 17 Complementary feeding after 6 months and continue breastfeeding up to 24 months ○ ○ 18 Delay the baby's bath for 24 hours and place the baby skin to skin with the mother to keep worm between 24 -4828 hours ○ 19 Use condoms correctly and consistently ○ ○ ○ ○ 20 Go for TB screening and testing ○ ○ ○ 21 Keep off the harmful effects of alcohol, substance abuse, prescription drugs ○ ○ ○ 22 Engage in regular physical exercises for at least 30 minutes ○ ○ ○ 23 Eat a balanced nutritious meal with extra proteins ○ ○ ○
  83. 83. 75 Desired Behaviour Changes (Key Messages) Cohort 1 Cohort 2 Cohort 3 Cohort 4 Cohort 55~12 13~19 24 Child spacing and timing ○ ○ ○ 25 Referral for FP method ○ ○ ○ 26 Vitamin A supplementation every 6 months for 5 years ○ 27 Growth monitoring every month up to 5 years ○ 28 CRS and zinc for diarrheal management ○ 29 Deworming every 6 months ○ 30 Learn basic first aid skills ○ ○ 31 Eat a nutritious diet every day ○ ○ 32 Abstinence and delay in sexual debut ○ ○ 33 Increase knowledge of HIV/AIDS prevention and sex education ○ 34 Identify symptoms and signs of mental conditions and refer ○ ○ ○ 35 Visit clients with NCD and refer for rehabilitation ○ ○ ○ 36 Visit clients needing occupational therapy and refer for rehabilitation ○ ○ ○ 37 Faithfulness to one faithful partner ○ ○ 38 Seek testing and counseling ○ 39 Reduction in number of youth having multiple sexual partners ○ ○ 40 Utilization of RH and FP services ○ 41 Delayed child bearing ○ 42 Elimination of FGC and other harmful cultural practices. ○ 43 Have regular check-ups for early detection of diabetes, hypertension, cancer ○ ○ 44 Counseling on Menopause and Andropause ○ 45 Knowledge of HIV status and partner status ○ 46 Adherence to ART treatment ○ 47 Ensuring adherence to TB treatments for those who are sick ○ 48 Eating to nutritious and balanced diet ○
  84. 84. 76 Table 19: Objective Indicators for CHS ACSM Table 19 below provides objective indicators for behaviour changes through ACSM. The behaviour change objectives are in line with desired behaviour changes identified in the Communication Matrix for Behaviour change in Chapter 5 (5.2). The indicators in bold are identified in the M&E Plan on CHS while the indicators in Bold and Italics are not included in M&E Plan but in the 2nd Edition Indicators and Standard Operating Procedure Manual on Health Information System. Behaviour Change Objectives (Message Theme for Level 1) Objective Indicators Outcome Indicators Output Indicators 1. Sleep under on LLIN every night Number of pregnant women sleeping under Long-Lasting Insecticides Nets (LLIN) ・ Number of households with LLIN ・ Number of pregnant women reached with the information on importance of sleeping under LLIN Number of children sleeping under Long-Lasting Insecticides Net (LLIN) ・ Number of households with LLIN ・ Number of mothers reached with the information on importance of sleeping under LLIN 2. Recognize and seek early treatment for malaria within the first 24 hours Number of reported clinical malaria cases ・ Number of persons with information on malaria recognition and importance on early treatment ・ Number of facility reported clinical malaria 3. Adhere to malaria treatment. 4. Hand washing with soap at 4 critical times Portion of persons in the CU who practice hand washing with soap at least at 4 critical times ・ Portion of households having hand washing facilities ・ Number of persons sensitized on proper hand washing 5. Practice proper fecal disposal including proper Portion of households using latrines/toilet (on daily basis) ・Portion of households with proper faecal disposal structures
  85. 85. 77 Behaviour Change Objectives (Message Theme for Level 1) Objective Indicators Outcome Indicators Output Indicators disposal of children faeces ・ Number of persons sensitized on proper faecal disposal 6. Drink safe, clean and treated water Portion of households with water treatment methods ・Number of households sensitized on water treatment methods 7. Prevent violence and injury Number of reported violence and injuries ・ Number of persons sensitized on prevention of violence and injuries 8. Visit ANC clinic at least 4 times Proportion of pregnant women 8 months and above who attended 4th ANC clinic ・ Number of health facilities with ANC services ・ Number of pregnant women sensitized on the importance of ANC visits 9. Prompt healthcare for complications of delivery Number of pregnant women referred to health facilities for complications of delivery ・ Number of health facilities with Emergency Obstetric Care (EOC) services ・ Number of pregnant women who understand symptoms of complications of delivery 10.Have a delivery plan Number of mothers who delivered with delivery plan ・ Number of pregnant women sensitized on delivery with delivery plan 11.Deliver in a health facility Proportion of deliveries conducted by skilled health personnel ・ Number of health facilities with delivery services ・ Number of women sensitized on delivery in a health facility 12.Seek prompt care when you see in danger sign Number of pregnant women referred to health facilities for EOC ・ Number of health facilities with EOC services ・ Number of pregnant women who can identify danger sign 13.Accept and seek IPT during pregnancy Proportion of women provided with IPT 2 during the ANC visits ・ Number of pregnant women sensitized on IPT ・ Number of pregnant women reached with information on IPT
  86. 86. 78 Behaviour Change Objectives (Message Theme for Level 1) Objective Indicators Outcome Indicators Output Indicators 14.Accept your house to be sprayed with IRS Portion of households sprayed with IRS ・ Number of households sensitized on IRS ・ Number of households reached with the information on IRS 15.Full course of immunization before first birthday (BCG, PCB10, Pentavalent, Polio, Measles) Proportion of children younger than one year who were fully immunized ・ Number of mothers sensitized on immunization ・ Number of caregivers reached with information on vaccination 16.Exclusive breastfeeding for the first 6 months Percentage of infants less than 6 months old on exclusive breastfeeding ・ Number of mothers reached with information on breastfeeding and complementary feeding supplementary ・ Number of mothers sensitized on exclusive breastfeeding 17.Complementary feeding after 6 months and continue breastfeeding up to 24 months Number of mothers of infants aged between 6 months to 24 months with complementary feeding practices 18.Delay the baby’s bath for 24 hours and place the baby skin to skin with the mother to keep warm between 24 -48 hours Proportion of mothers practiced the proper bathing for her new-born baby ・ Number of mothers reached with information on proper bathing for her new-born baby 19.Go for TB screening and testing Percentage of HIV patients screened for TB ・Number of health facilities with TB screening and testing services ・ Number of persons reached with the information on TB screening and testing services ・ Number of HIV patients sensitized on TB screening
  87. 87. 79 Behaviour Change Objectives (Message Theme for Level 1) Objective Indicators Outcome Indicators Output Indicators and testing 20.Adhere to ART treatment Number of TB patients receiving ART treatment at health facilities ・ Number of health facilities with ART treatment services ・ Number of persons reached with the information on ART treatment ・ Number of HIV patients sensitized on ART treatment 21.Ensuring adherence to TB treatments for those who are sick TB case notification rate ・Number of health facilities with TB treatment services ・ Number of persons reached with the information on TB treatment 22.Keep off the harmful effects of alcohol, substance abuse, prescription drugs Level of drug and substance abuse ・ Number of persons reached with the information on harmful effects of alcohol, substance abuse, prescription drugs 23.Engage in regular physical exercises for at least 30 minutes Proportion of persons engaged in regular physical exercises for at least 30 minutes ・ Number of persons aware of regular physical exercises 24.Eat a balanced nutritious meal with extra proteins Proportion of persons practicing healthy eating habits ・ Number of households reached with the information on importance of proper nutritional habits ・ Number of persons aware of proper nutritional habits 25.Eat a nutritious diet every day 26.Eat nutritious and balanced diet 27.Abstinence and delay in sexual debut Number of children at age of sexual debut ・ Number of children aged between 6-19 reached with information on safe sexual practices
  88. 88. 80 Behaviour Change Objectives (Message Theme for Level 1) Objective Indicators Outcome Indicators Output Indicators ・ Proportion of children aged between 6-19 who are aware of the importance of abstinence and delay in sexual debut 28.Child spacing and timing is beneficial for mother and child Number of women of child bearing age receiving family planning commodities ・ Number of women sensitized on family planning ・ Number of women of child bearing age reached with the information on family planning methods 29.Delay child bearing 30.Refer for family planning method 31.Use Reproductive Health and Family Planning services Proportion of women in reproductive age using a modern method of contraception 32. Vitamin A supplementation every 6 months for 5 years Percentage of children aged 6 to 59 months receiving at least two doses of Vitamin A supplementation within one year ・ Number of caregivers sensitized on Vitamin A supplementation 33.Growth monitoring every month up to 5 years Percentage of children under 5 years who are attending CWC for growth monitoring for the first time ・ Number of caregivers sensitized on getting growth monitoring 34.ORS and zinc for diarrheal management Portion of children 0-59 months that had an episode of diarrhea who receive ORT ・ Number of children receiving ORS and Zinc 35.De-worming every 6 months Number of children under fives being de-wormed (1-14) ・ Number of caregivers reached with information on de-worming ・ Number of caregivers sensitized on de-worming 36.Learn basic first aid skills Number of injured persons who have been ・ Number of households trained in first aid
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