By Boladale Nurat Akin-Kolapo, Society for Family Health Nigeria/PSI
The Expanded Social Marketing Project (ESMPIN), funded by USAID, improved the health of women and children in Nigeria by increasing use of modern family planning methods and child health. To achieve this, a team, including Society for Family Health (SFH) along with the Association for Reproductive and Family Health (ARFH), BBC Media Action (BBCMA) and Population Services International (PSI) worked to: increase access to family planning (FP), reproductive health and child health products; increase use of health products and practice of health behaviors; generate support from all sectors for social marketing as an important part of a total market approach; and improve the viability of local manufacture of key health products.
As an integrated project, ESMPIN had quality and scale as its implementation focus. The project therefore used several distinct channels to promote healthy practices among separate target groups in the areas of family planning, malaria, diarrhea and nutrition. The intervention strategies were implemented one at a time or together over a period of time with the aim of changing behavior. The project also used approaches proven over time to design and deliver these messages to the target groups.
To achieve scale, ESMPIN designed and implemented several approaches, some with a nationwide spread, while others focused on 22 states in Nigeria (including the Federal Capital Territory).
To increase the uptake of modern child spacing and child survival products, ESMPIN had to create demand for both information and the products themselves. Discovered during the research phase of the project, key health concerns of men and women of reproductive age and their health providers informed demand creation activities under ESMPIN. Activities were designed to address all ESMPIN health themes.
For family planning activities, ESMPIN collaborated with Family Health+, a project implemented by Marie Stopes Nigeria (MSI Nigeria), across various states where the project’s community level intervention was implemented. In Imo State, uptake of modern family planning methods, especially long acting reversible contraceptives (LARCs), had historically been very low. MSI Nigeria conducted provider trainings on LARCs, while ESMPIN generated demand for services. As a result of this collaboration, service uptake for all family planning products jumped from five in January, 2016, to 834 by June, 2016, and the method acceptance mix changed from zero to 68 LARCs.
So how did ESMPIN increase demand? The nature and content of the activities — including length of sessions and identifying community structures which can help harness for positive outcomes, among others — were also informed by the research. From large group to one-on-one instruction, and high-tech to low-tech solutions, the approaches included
1. Product Detailing
Healthcare providers were supported with product detailing and provision of information and education communication materials. Product detailing, which used provider behavior change communication (PBCC) techniques, helped to uncover and address provider concerns over each child spacing and child survival products promoted by the ESMPIN project. After these sessions, providers became motivated to freely offer services with these commodities.
2. Interpersonal Communication Agent Session
ESMPIN’s interpersonal communication agents were taught in one-on-one and one-to-group sessions where they learned to teach ESMPIN’s health themes to men and women of reproductive age. The agents were empowered to offer direct services or refer contacts seeking to change behavior to appropriate health facilities or service delivery points.
3. Health Provider Town Hall Meetings
ESMPIN held meetings with key community stakeholders and health care providers to create sustainable access to quality, affordable family planning services. The meetings focused on how providers would offer quality cost effective care, as well as creating advocates for the change in behaviors underscored in the ESMPIN integrated health project. As a result, community leaders, including religious and traditional leaders, began speaking in favor of ESMPIN health areas. Health care providers offered products at discounted rate while health facilities improved better product stocking practices and recorded better stocking patterns. Additionally, the attitude and commitment of providers at health facilities improved and previous issues, such as absenteeism, decreased.
4. Antenatal Clinic Sessions
Group Interpersonal Communication sessions targeted expectant and nursing mothers at special clinics on adopting healthy behaviors around ESMPN health areas. As a result of these sessions, the number of pregnant women going to health facilities increased dramatically and cases of malaria and fever recorded among pregnant women decreased. ANC meetings with pregnant women were a major outlet for distribution of Society for Family Health’s products for the intermittent preventive treatment of malaria.
5. Male Involvement Sessions
Special interpersonal communication sessions organized with groups of men within intervention communities engaged monthly on various topics with the sole aim of gaining greater male participation in family health. The main objective was to increase support among men for family planning and greater participation in women’s health. As a result, men expressed more willingness to allow their wives to visit health facilities for ANC session and became knowledgeable on family planning and reproductive health, and also, their commitment was a key achievement.
6. IEC & Promotional Materials
Posters were placed mostly at health facilities and service delivery points, while leaflets and fliers were shared with interpersonal communication contacts and handed to healthcare providers for their clients, as with promotional materials supporting specific ESMPIN health behavior or products.
7. Bulk SMS
Strategically framed messages meant to reinforce the key messages learned by interpersonal communication contacts and healthcare providers during the call or meeting sessions were sent out on monthly basis.
8. Wall Murals
Murals were painted within strategic locations of intervention communities. Acting as billboards, they served as a reminder to its members to uphold the healthy behaviors promoted by the project during implementation.
9. Mass Media
In-person efforts were supported by radio outreach with several programs. A 15-minute radio drama series aired twice a week in 4 Nigerian languages covered all ESMPIN health areas across Nigeria. A 15-minute radio magazine program called “Ya ta kene Arewa” aired in the northern Hausa-speaking part of the country, while several 60-second radio spots aired in four Nigerian languages across all Expanded Social Marketing Project in Nigeria health areas across the country.
Did it work?
As the five-year project comes to a close, the program has been exposed to rigorous measurement and evaluation. A one-off analysis of the impact of demand creation on malaria objectives was randomly done for Bauchi State, which charted the Intermittent Preventive Treatment uptake trend and Akwa Ibom State, researching Rapid Diagnostic Test use. The comparison was for six months before a select intervention period and six months into the intervention period. Health facility intermittent preventive treatment uptake results from Bauchi showed an average of 34% increase in Intermittent Preventive Treatment 1 uptake and 61% increase for Intermittent Preventive Treatment 2 uptake. Similarly, Rapid Diagnostic Test use in Akwa Ibom recorded an average increase of 391% within the intervention period.
As for demand creation using interpersonal communications agents, a total of 15,123,844 interpersonal communication contacts were recorded through the entire Cycles 1-10 of ESMPIN (at 102% of planned target) along with 598,037 redeemed family planning referrals (similarly at 80% of target).
For more information about the methods, standards, materials and outcomes of ESMPIN, please find the following online resources:
