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IPC & community mobilization

As one expert notes, “People talking to people is still how the world’s standards change.” Approximately one-half of Alive & Thrive’s in-country implementation costs support interpersonal communication and community mobilization activities.

Interpersonal communication involves face-to-face conversations and activities between frontline workers and mothers or family members. Workers can personalize messages, introduce priority feeding practices at just the right time, demonstrate skills, and provide encouragement during home visits, support group meetings, and sessions at health centers.

Community mobilization includes one-on-one or group meetings to elicit support for feeding practices and for frontline workers’ activities. It aims to orient, train, and get the commitment of community leaders to take action in support of  mothers, families, and frontline workers. Community mobilization can help create new social norms and bring about lasting behavior change.

Distinctive features of Alive & Thrive’s interpersonal approach

  • Reaches large scale by setting targets for numbers of families to reach—in the millions
  • Builds on existing programs, helping align the agendas and materials of many program platforms
  • Encourages adoption and adaptation by broadly and openly sharing the model with other programs
  • Systematically improves frontline workers’ reach and performance through reasonable workload allocation, incentives, meetings, supportive supervision, refresher training, monitoring, and ongoing use of data
  • Focuses on behavior, with frontline workers and supervisors held accountable for behavior change
  • Encourages concrete actions by family members and community leaders to support mothers’ behaviors by shifting social norms

Process

Alive & Thrive’s process is built on principles of behavioral science, systems approaches, and social marketing.

  • Understand the situation through situational assessments, formative research, and health services utilization reviews
  • Focus and design by identifying priority behaviors (those that have the greatest health impact and are feasible for families to adopt) and finding ways to improve frontline worker performance  and secure commitments from community leaders
  • Create communication materials that fit the program’s behavioral objectives, capacities, and needs to support frontline workers; conduct multiple rounds of pretesting to ensure that the materials are readily understood, easy to handle, acceptable, appealing, and persuasive
  • Implement and monitor by training frontline workers to deliver quality counseling services and by conducting performance monitoring and supportive supervision to check quality and coverage
  • Use data for strategic adjustments by constantly feeding monitoring data back into program planning

Results

In three large countries, Alive & Thrive demonstrated that face-to-face activities were scalable, reaching millions of mothers and community members. Alive & Thrive data show that:

  • Dramatic changes in feeding practices happened fast, especially where interpersonal communication and community mobilization were implemented along with mass communication.
  • Interpersonal communication was efficacious in achieving dramatic increases in recommended feeding practices.  In Bangladesh and Viet Nam, a greater proportion of mothers practiced the recommended behaviors when they had face-to-face contact with frontline workers along with exposure to mass media messages than did mothers who only saw the TV spots.
  • Interpersonal communication reached approximately 3.7 million mothers of children under 2 years of age in program areas in three countries. Where A&T’s intensive interpersonal communication component was implemented, the majority of mothers with children under 2 years of age discussed infant and young child feeding with a frontline worker, at home or in a facility.

Lessons

  • A systems approach is essential. Quickly reaching scale with this labor-intensive interpersonal component requires health worker performance improvement, financing, partnerships, and logistics support.
  • Improving frontline worker performance needs more than training and a flipchart. A reasonable workload, performance recognition, and sustained support through direct contact with supervisors and peers at monthly or quarterly meetings are essential.
  • Behavioral theory improves design of interpersonal communication. With a focus on priority behaviors and their determinants, frontline workers’ activities can lead to improved feeding practices.
  • Accountability can keep the focus on behavior. Use of monitoring data, including mothers’ reported behaviors, can hold health managers and workers accountable for reach and for behavior change.
  • With multiple partners using the same interventions, societal norms begin to shift. The “low tech” nature of interpersonal counseling and community mobilization makes them readily adaptable to diverse programs. Large-scale reach becomes possible, and with scale the new behaviors are seen as “normal.”

Alive & Thrive
Generation 2


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