Communicate for Health Annual Report: Year 2 Cooperative Agreement No: AID-641-A-15-00003

Project dates: November 10, 2014 – November 30, 2019 Reporting Period: October 1, 2015 – September 30, 2016 Draft submission date: October 10, 2016

Communicate for Health Annual Report: Year 2 1

Table of Contents

Table of Contents ...... 2 Acronyms and Abbreviations ...... 3 Executive Summary ...... 5 Overview of Communicate for Health in Ghana ...... 7 Social and Behavior Change Communication and Media (ER1) ...... 9 Capacity Building (ER2) ...... 28 Development of One Local SBCC Organization to be a Recipient of USAID Funding (ER3) ...... 38 Monitoring and Evaluation ...... 42 Partnerships and Coordination ...... 49 Overview of what to expect in Year 3 ...... 58

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Acronyms and Abbreviations

AMEP Activity Monitoring and Evaluation Plan

BCS Behavior Change Support

CADP Change Agent Development Program

CARE Cooperative for Assistance and Relief Everywhere

CAT Capacity Assessment Tool

CBO Community-Based Organization

C-Change Communication for Change Project

CCF Change Challenge Fund

CRS Community Radio Station

DHIMS 2 District Health Information Management System 2

FAA Fixed Amount Award

FHD Family Health Division

FP Family Planning

GCRN Ghana Community Radio Network

GMCSP Ghana Maternal & Child Survival Project

GHS Ghana Health Service

GOG Government of Ghana

HDHC Healthy Districts and Healthy Communities

HP Health Promotion

HPD Health Promotion Department

HPNO Health, Population, and Nutrition Office

HPTO Health Promotion Technical Officer

HQ Headquarters

HR Human Resources

ICC-HP Inter-agency Coordinating Committee for Health Promotion

IO Information Officer

IPs Implementing Partners

IPC Interpersonal Communication

IT Information Technology

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IVR Interactive Voice Response

LLIN Long-lasting Insecticide-treated Net

M&E Monitoring and Evaluation

MCH Maternal and Child Health

MECOP Monitoring and Evaluation Community of Practice

MMDA Metropolitan, Municipal and District Assemblies

MOH Ministry of Health

NGO Non-Governmental Organization

PEPFAR President’s Emergency Plan for AIDS Relief

PMI President’s Malaria Initiative

PPE Personal Protective Equipment

PPME Policy, Planning, Monitoring, and Evaluation

PSA Public Service Announcement

RHPO Regional Health Promotion Officer

SBCC Social and Behavior Change Communication

SHOPS Strengthening Health Outcomes through the Private Sector

SPRING Strengthening Programs in Nutrition Globally

THPA Top Health Promoter Award

TOCAT Technical and Organizational Capacity Assessment Tool

TOHPz Technical Officers for Health Promotion

UNICEF United Nations Children's Fund

USAID United States Agency for International Development

USG United States Government

WASH Water, Sanitation, and Hygiene

WHO World Health Organization

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Executive Summary

The USAID Communicate for Heath project was awarded to FHI 360 on November 10, 2014. The present document summarizes activities, results, and challenges of Year 2 (YR 2) of the five-year project. Communicate for Heath is working with the Government of Ghana (GOG), Ghana Health Service Health Promotion Department (GHS/HPD), local Ghanaian partners, and international development partners to 1) Improve behavior change in family planning (FP), water, sanitation, and hygiene (WASH), nutrition, maternal and child health (MCH) and malaria prevention and case management; 2) Strengthen the capacity of GHS/HPD to effectively coordinate and deliver social and behavior change communication (SBCC) campaigns; and 3) Develop and strengthen the capacity of one SBCC local organization to receive direct USAID funding. Year 2 of the project saw major progress towards all three of Communication for Health’s Expected Results (ERs).

Improved behaviors that increase demand for key interventions (ER 1) In Year 2 the project launched the refreshed GoodLife, Live it Well campaign. The campaign embraces a Life Stage approach, addressing in an integrated fashion the perspectives and concerns of four key audience segments. Participatory Action Media workshops in four regions provided a solid formative research base for messages, concepts, and materials. The refreshed brand emphasizes collective responsibility for health and empowers different audiences to make health “an everyday thing”—a habit that can bring happiness and peace of mind.

To prepare for the launch, television and radio “teasers” were broadcast in English and local languages across six national television, five national radio and 19 regional radio stations. Orientation and planning meetings were carried out in all ten regions of the country with 1,299 participants. On July 28, Ghana’s Health Minister, Hon. Alexander Segbefia, oversaw the national launch, which was attended by over 700 dignitaries, stakeholders and community members and was covered heavily by both electronic and print media. A post-launch press conference received further substantial coverage. On September 20, the project organized a GoodLife, Live it Well celebration in Tamale for the northern regions of the country which was attended by over 800 people. Television and radio spots, ten posters, a brochure, cue cards, and multiple other media were distributed in connection with the GoodLife launch. Since the national launch and regional rollouts, broadcast of campaign radio and television advertisements have continued to air on primetime and peak-time programs such as morning shows, brunch, drive, news bulletins, soap operas, and print adverts have run in major newspapers.

Communicate for Health also participated in other key media activities in YR 2. These included broadcast of a family planning advocacy video documentary entitled Ghana on the Rise: Investing in Population and Development, or ENGAGE, on national TV (produced by the National Population Council (NPC) with support from the Population Reference Bureau). The project worked with UNICEF to raise public awareness about cholera and funded air time for messages. The project is also working with the NPC, Department for International Development (DFID), and Palladium on integration of new GoodLife messages into the popular Ghanaian soap opera series entitled You Only Live Once, or YOLO. Not counting national news coverage, 43,771 TV and radio spots, programs and interviews were aired during this reporting period.

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Finally, the project continued work with the GHS/HPD to update the National Health Communication Information Resource Centre. More than 20 organizations have contributed materials on a range of health topics. A platform for the inventory has been created.

Improved HPD technical and organizational capacity (ER 2) The first week-long Change Agent Development Program (CADP) designed to strengthen the technical capacities of select national, regional, and district-level staff was conducted for 23 SBCC practitioners in June of 2016. Pre- and post-training results showed significant improvements in total scores. The Set for Change (SfC) program was also launched in YR 2. The first cohort of ten Technical Officers for Health Promotion (TOHPz) were drawn from the district levels of the GHS. In additional three HPD staff completed a three-month internship program with the creative agency, Mullen Lowe. Finally, process was made towards establishing the Change Challenge Fund (CCF), a performance-based award to be made available to 10 to 15 CAPD or SfC graduates to apply their learning in real program settings. The final draft of the CCF guidelines has been shared with HPD for their inputs. The CCF will be launched in YR 3.

Improved technical and organizational capacity of one local SBCC organization (ER 3) In June 2016 the project conducted a two-stage competitive process to identify a local Ghanaian SBCC organization that will assume increasing technical and managerial responsibility for the project and will eventually transition to direct USAID funding. The Head of the HPD participated in reviewing the candidates. Based on predetermined selection criteria, the procurement committee agreed provisionally on a winning applicant, pending the outcome of a pre-award assessment and concurrence by USAID/Ghana.

Monitoring & Evaluation Communicate for Health finalized the project’s Activity Monitoring and Evaluation Plan (AMEP) and is awaiting approval by USAID. In December a working group including the project, Ghana Health Service Health Promotion Department (GHS/HPD), Family Health Division (FHD), and Policy Planning, Monitoring and Evaluation (PPME) incorporated new SBCC indicators and data collection tools/registers into the national web-based District Health Information Management System 2 (DHIMS 2)—a major achievement for Ghana. In February, the project completed the first of its planned mobile phone feedback surveys using interactive voice response (IVR) to assess audience recall of media messages. Amendments were approved for a mobile cohort survey to be launched in YR 3. A data quality assessment (DQA) was conducted by a team from USAID/HPNO and Evaluate for Health in June. The DQA resulted in several recommendations that will be followed up on in YR 3.

Partnerships and coordination In addition to the GHS and HPD, other partners that the project is actively working with include Systems for Health, SPRING, RING, VectorWorks, Evaluate for Health, NPC and UNICEF. Activities ranged from support for SBCC coordination at the national level and in the Northern Region, collaboration with WASH for Health on a draft strategic plan and materials, collaboration with VectorWorks on a school-based Long Lasting Insecticide-treated Net (LLIN) strategy, and major support for national health celebrations. These included multiple events for World Malaria Day, Child Health Week, World Breastfeeding week, and National Family Planning Week. Communicate for Health also supported work to further progress on the National Newborn Health Strategy and Action Plan.

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Overview of Communicate for Health in Ghana

INTRODUCTION On November 10, 2014, USAID-Ghana awarded FHI 360 and its consortium of partners (VOTO Mobile, Creative Storm Networks, and Ghana Community Radio Network) a five-year $18 million cooperative agreement to implement USAID’s Communicate for Heath project (C4H). The project seeks to improve the health and well-being of Ghanaians through a broad range of “above the line” mass media communication campaigns coupled with intensive capacity building programs. Communicate for Health is working with the Government of Ghana (GOG), the Ghana Health Service Health Promotion Department (GHS/HPD), local Ghanaian partners, and international development partners to improve behavior change in family planning (FP), water, sanitation, and hygiene (WASH), nutrition, maternal and child health (MCH), and malaria prevention and case management. In Year 3, HIV/AIDS will be added as a technical area. The project is responsible for strengthening the capacity of the GHS/HPD to effectively coordinate and deliver social and behavior change communication (SBCC) and health promotion (HP) campaigns,1 as well as developing and strengthening the capacity of one local organization to receive direct USAID funding. The project builds on USAID’s legacy of improving health and nutrition in Ghana, including support for improved health communication in the country.

This document describes activities and results for the second year (YR 2) of the project—October 1, 2015, through September 30, 2016. Project activities, life-of-project (LOP) mandatory results, and YR 2 outputs are presented by Activities and Sub-Activities.

COMMUNICATE FOR HEALTH RESULTS FRAMEWORK Communication for Health’s results framework is based on the theory of change model. The framework outlines how inputs and activities will contribute to outputs, intermediate results, expected results, and impact (Figure 1). Key inputs to achieving Expected Result #1: Improved behaviors that increase demand for key interventions, are FHI 360’s Life Stage Approach including launch of a refreshed GoodLife, Live it Well brand (including the rollout and scale-up of integrated health campaigns); collaboration and coordination of partners; and individual and organizational capacity to strategically plan, implement, monitor, and evaluate SBCC activities. SBCC messages will be better targeted at key audiences, and reach and frequency of messages will be increased. Communicate for Health will monitor changes in key behavioral determinants—specifically knowledge, skills, intention to act, and active seeking of health information. Improvements in health determinants will provide indications of whether the project is on target to achieve Expected Result #1. Increased demand—combined with improvements in availability of quality health services (achieved through partners)—will provide the foundation for increased use of services, healthier- home-based practices, and ultimately improved population health outcomes.

1 The terms SBCC and HP are used interchangeably in this report. Although the scope of the methodologies is not the same, both terms are used in Ghana to describe broad behavior change efforts and activities.

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FIGURE 1 Communicate for Health Results Framework

Communicate for Health’s approach to sustainable capacity strengthening will facilitate year-on-year improvements in key technical and organizational domains of both the HPD and the selected local organization. These improvements will contribute to achieving Expected Result #2: Strengthening HPD capacity, and Expected Result #3: Building the capacity of one local SBCC organization to effectively coordinate and deliver SBCC campaigns. Together, the three Expected Results will be synergistic: improved capacity of the HPD and the local SBCC organization will directly serve as inputs for achieving Expected Result #1 and will contribute to sustaining related impact beyond the life of the project.

The project works closely with other USAID implementing partners (IPs) including Systems for Health, WASH for Health, Evaluate for Health, Strengthening Health Outcomes through the Private Sector (SHOPS), the Maternal and Child Survival Project (MCSP), SPRING, RING, VectorWorks, as well as with UNICEF. Other GHS bodies including the National Population Council (NPC), National Malaria Control Program (NMCP), and various departments of the Family Health Division (FHD), including Nutrition and Reproductive and Child Health (RCH) and the Public Health Division (PHD) have also become important partners. Demand creation and use of health services including antenatal care (ANC), FP, immunizations, malaria case management, and use of products such as ORS/Zinc and long lasting insecticide treated nets (LLINs) will ultimately result in improved health outcomes for the country.

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SECTION 1 Social and Behavior Change Communication and Media (ER1)

BROADCAST OF MALARIA, FAMILY PLANNING, WASH AND DIARRHEA COMMUNICATION MATERIALS Prior to the launch of the refreshed GoodLife brand, Communicate for Health worked closely with the HPD to broadcast TV and radio spots inherited from the previous BCS project on Malaria, FP, WASH, and Diarrhea. A total of 1,481 spots were aired during prime time on major national radio (767 spots) and TV (714 spots) during the month of June, 2016 ensuring exposure to messages throughout the country. Audiences for the various media houses vary. Some of the stations transmit in English while others transmit solely in local languages. (See Table 1 for details.) In addition, 2,041 radio and TV spots were aired in October and November, 2015 free of charge in support of the project by various media houses. The cost share of this coverage is valued at $825,389 representing 31 percent of the total $2,700,000 in cost share that the project is expected to generate by 2019.

TABLE 1 National media coverage of Malaria, FP, WASH, and Diarrhea spots

MEDIA HOUSE LANGUAGE(S) TRANSMITTED BROADCAST PERIOD TOTAL # OF SPOTS AIRED

National Radio

PEACE FM Twi June 2016 220 JOY FM English June 2016 284 STARR FM English June 2016 140 Radio Ghana/ English, Twi, Ga, Ewe June 2016 123 OBONU Sub-total 767 National Television

GTV English, Twi, Ga, Ewe June 2016 57 UTV Twi June 2016 114 ADOM TV Twi June 2016 155 JOY NEWS English June 2016 155 JOY PRIME English June 2016 155 VIASAT 1 English June 2016 21 TV3 English June 2016 63 Sub-total 714 TV and Radio (All) English, Twi, Ga, Ewe Oct. – Nov., 2015 2,041 TOTAL SPOTS 3,522

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OVERVIEW OF THE GOODLIFE, LIVE IT WELL STORY GoodLife, Live it Well is a GHS health behavior change initiative first introduced in 2010 in the Greater Accra, Central, and Western Regions in partnership with USAID. At the time it was first launched, GoodLife was a multimedia campaign that encouraged self-reflection about what makes life “good,” linking personal happiness to the practice of healthy behaviors. It positioned health as a personal responsibility for happiness and wellbeing. The initial GoodLife campaign consisted of TV and radio spots, print media and a game show. An impact evaluation conducted in 2014 showed modest improvements in Antenatal Care (ANC) attendance, the proportion of children sleeping under LLINs, and the proportion of respondents who washed their hands with soap before preparing food. Good Life then: Generic Poster.

After six years, the campaign needed an upgrade—a new look, feel, tone, and emotion—to be consistent and recognizable, connecting with broad sections of the Ghanaian population.

Building on the original framework, and working closely with the GHS/HPD, Communication for Health held numerous stakeholder consultations with the GHS at the national and regional levels, with UNICEF, USAID, USAID Health IPs including Systems for Health, SPRING, WASH, RING—as well as with communities during pretesting.

YR 2 began with formative research for the refreshed brand and ended with a major national launch of the new GoodLife campaign in July and regional celebration in September. All aspects of the process were strongly collaborative—involving government and other key stakeholders as well as traditional leaders and communities. Details of this process are provided in the sections that follow.

The refreshed GoodLife, Life it Well brand is based on a Life Stage Approach, including the rollout and scale-up of integrated health campaigns, that are based on the perspectives and target the specific health concerns of four population segments:

 Parents/caregivers of children under five years  Adolescent boys and girls aged 15–17 years  Pregnant women and their partners (pregnant couples)  Young people and adults in relationships aged 19–35 years

Other Life Stages or sub stages may be considered over time as needed.

GoodLife, Live it Well draws under its canopy all of the GHS health interventions including FP, MNCH, nutrition, malaria, WASH, HIV/AIDs, and diseases of pandemic potential. The

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refreshed GoodLife brand is a trusted friend, faithful companion, and a guide that empowers different audiences, households, families, and communities to make health “an everyday thing”—a habit that can bring good health, happiness, peace of mind, and long life once an individual makes the healthy life choices promoted by the brand.

Key stakeholders had regular and active input into the development of the refreshed brand. Settings for this input included two Senior GHS Management meetings, District Director meetings in all ten regions, the FHD Annual Retreat, the GHS Annual Performance Review Meeting, the Annual National HPO Conference, and the National GHS Senior Management Conference. Other fora where the refreshed brand concepts and logo were presented as they evolved included meetings with senior staff at UNICEF and USAID, three USAID COP meetings, and with the ICC-HP and the USAID IP SBCC Coordination Committee in Northern Region. Although the process was lengthy, lasting more than ten months, it generated keen interest in the meaning of the refreshed brand and indisputable ownership by the GHS.

PARTICIPATORY FORMATIVE RESEARCH Communicate for Health conducted formative research for the refreshed brand from October through December, 2015. The project carried out four Action Media Workshops in the first quarter of YR 2 to develop audience-specific health communication messages and concepts based on the priority GoodLife Life Stages. Action Media is participatory approach that engages audiences in developing prototype communication messaging and campaign materials by gaining insights into the realities of audience lives, their hopes, and their aspirations for the future.

The process took place in phases and began with a meeting in Accra on October 26, 2015, with 32 staff from Communicate for Health, GHS/HPD and FHD, SPRING, Palladium, Creative Storm Network, VOTO Mobile, GCRN, and Mullen Lowe, during which the Life Stages concept and Action Media methodology were introduced. This was followed by a two-day Trainer of Trainers (TOT) on the Action Media approach, theory, and methodology by Dr. Warren Parker, an experienced HIV/AIDS and Public Health Action Media Workshop participants in Tamale performing Communications Specialist a dance to stamp out open defecation. based in South Africa.

Over about two-and-a-half months the combined teams conducted Action Media Workshops in the four regions using a structured process and standardized protocol. Each of the four-day workshops engaged approximately 15 participants from a specific Life Stage population segment. The GCRN

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leveraged its vast network of community radio stations in the regions to select the participants. Participants were engaged in critical thinking and problem-solving activities, which led towards the development of communication concepts and resources relevant to bringing about change in relation to health and social issues. This was achieved through a combination of sequenced discussions supported by games, role-plays, energisers, and large group and small group discussions.

Workshop regions, dates, and Life Stage groups were as follows:

 Tamale, Northern (November 2–6): Parents/caregivers of children under five  Wenchi, Brong Ahafo (November 30–December 4): Adolescent boys and girls aged 15–17 years  Winnega, Central (December 8–11): Pregnant women and their partners (pregnant couples)  Mepe, Volta (December 14–19): Young people and adults in relationships aged 19–35 years

The teams prepared preliminary reports on the results of the workshops. These were further analyzed and synthesized in January of 2016 by Dr. Parker. The consolidated reports, known as the Communicate for Health Life Stage Briefing Books, will serve as the key references for all Communicate for Health programming—including new content for the GoodLife, Live it Well campaign. The briefing books outline the context of communication for each Life Stage, principles and values, communication approach, and include a matrix detailing priority health outcomes, audiences, concepts, and recommended media.

The draft reports and briefing books have been widely distributed to GHS/HPD, Creative Storm, GCRN, NPC, and have informed content for the YOLO series (see below) and documentaries under production with Creative Storm Networks. Integrated cue cards and messaging for pregnant couples, newborn care, caregivers of under-fives, adolescents, and young adults in relationships (which are due to be printed in YR 3) were also informed by the reports.

THE REFRESHED GOODLIFE BRAND Key underlying themes and concepts emerging from the formative research included “peace of mind,” happiness, and the collectivist nature of the Ghanaian people to care for one another. The refreshed brand embraces a new idea of turning health behavior into habits and translates known health knowledge into “simple doable actions” such as … the regular and consistent use of insecticide treated nets; ensuring children are fully immunized by their first year of life to ensure their steady growth and development; and immediate breastfeeding within 30 minutes after delivery as well as practicing exclusive breastfeeding for the first six months of life and introducing the right foods at the right time to children at six months. The new GoodLife is thus about actions that lead individuals, families, and communities to make the right choices at every stage to protect personal health and the health of others. Beyond linking personal happiness to the practice of healthy behaviors, the new GoodLife highlights the community perspective of collective responsibility.

A brand manifesto has been developed to provide a framework for the GoodLife integrated communications. Also being finalized is a GoodLife brand manual that will serve as a guide for all

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stakeholders engaged in SBCC around the refreshed integrated GoodLife campaign. With the refreshed GoodLife launch (see story below) all stakeholders are encouraged to use the refreshed logo on any new SBCC materials and tools being developed with the GHS.

GOODLIFE TEASER CAMPAIGN Prior to the national launch, a “teaser campaign” featuring radio, TV, and the press was debuted in mid- July to create awareness for the impending campaign when the refreshed logo would be “revealed” and explained. One 45-second TV and radio teaser was produced and broadcast in English and four local languages across five national and 19 regional radio stations. Overall a total of 1,000 TV teaser spots were aired on five national TV stations, while 1,500 radio The Manifesto is an integral piece of the GoodLife teaser spots were broadcast. At the regional level the Brand Book teasers were broadcast in the Western, Central, Northern, and Volta Regions (see Table 2 below).

Media houses reported receiving calls from listeners requesting more information about the new campaign and the release date. Strategic placement of advertisements with various print media for a two-week period around the launch complemented the radio and TV advertisements. Three-quarter page and full-color advertisements were also placed weekly in the various national newspapers including the Daily Graphic, Mirror, Graphic, Showbiz, and Daily Guide.

TABLE 2 GoodLife Teaser spots aired on National Television, National Radio, and Regional Radio

BROADCAST OF TEASER SPOTS BY AREA NUMBER OF TEASER SPOTS AIRED

National Television Stations 1000

National Radio Stations 1500

Western Region 1200

Northern Region 1000

Central Region 800

Volta Region 800

TOTAL 6300*

NB: *The figures in the table were arrived at based on certified transmission certificates submitted by media houses

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NATIONAL LAUNCH OF THE REFRESHED GOODLIFE, LIVE IT WELL BRAND The national launch of the Refreshed GoodLife, Live it Well brand was held at the National Theatre on July 28 in Accra. Ghana’s Health Minister, Hon. Alexander Segbefia, launched the refreshed brand on behalf of Ghana’s President, His Excellency John Dramani Mahama, and called on Ghanaians to embrace the new GoodLife to improve their health and wellbeing. The new refreshed GoodLife Logo was unveiled in 3D fashion (watch video) to an estimated audience of about 700 people. Unveiling the GoodLife logo, Ambassador Robert P. Jackson reiterated the commitment of the Government and people of the United States of America to Ghana and praised Ghana’s Ministry of Health for the collaboration that has seen improvements in the health status of Ghanaians over the last decade (watch launch video).

Participants included high profile personalities and dignitaries, diplomats, Ministers of State, traditional leaders, celebrities, the Parliamentary Caucus on Health, health workers, students from health training institutions, representatives of Metropolitan, Municipal and District Assemblies (MMDAs), Ghana Education Service, nurses, midwives, women leaders, civil society groups, and school children. Others included representatives of USAID IPs, and the Country Representatives for UNICEF, UNFPA, and World Vision.

Ms. Susan Namondo Ngongi, UNICEF Representative for Ghana and Nana Ama Enyiamba III, Queen Mother of Mankessim traditional area made statements in support of the new GoodLife. (See Successes and Lessons Story No. 1 at the end of this section.) Performing sketches on Life Stages, the National Theatre Group thrilled the audience with innovative renditions of the different Life Stage contexts and key behaviors associated with each.

The launch event was covered by both electronic and print media. In particular, one of Communicate for Health’s media partners, JOY News, streamed a two-hour live television coverage of the event. The launch was also streamed live on social media at multitvworld.com and myjoyonline.com.

The following television stations covered the event: GTV, JOY News, Adom TV, UTV, TV Africa, TV3, Viasat 1, Metro TV, GH One TV, Kessben TV, and Light TV. More than 20 radio stations covered the event: Peace FM, Joy FM, Adom FM, Starr FM, Citi FM, GBC Radio, 3 FM, Radio Gold, Oman FM, Kasapa FM, Asempa FM, Radio Universe, Atinka FM, Bryt FM, Marhaba FM, Justice FM, Mercury FM, Lateinu FM, and Radio France Internationa. Numerous popular national dailies covered the event and produced feature articles and opinion editorials: Daily Graphic, Ghanaian Times, GNA, Finder, Financial Post, Public Agenda, Ghanaian Observer, Daily Guide, Independent Newspaper, and New Independent. Interviews with the Director General of the GHS, the Minister of Health, and the United States Ambassador were also included in the news coverage following the event.

POST GOODLIFE LAUNCH ACTIVITIES

National Level Following the successful launch of the refreshed GoodLife, Live it Well brand, a press conference was organized at the Accra International Press Centre on August 12 to sustain campaign momentum and allow the media to gain a deeper understanding of the key concepts underlying the brand and the rollout strategy. The conference was attended by the Deputy Director General of the GHS, the Director of Public Health, the Chief of Party (COP) and Deputy COP of Communicate for Health, and attended by close to 100 participants including journalists from 47 electronic and print media

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houses. The Deputy Director General of the GHS, Dr. Gloria Quansah-Asare, addressed the media and responded to questions.

TV and radio coverage was provided by GTV, UTV, TV Africa, TV3, Viasat 1, Metro TV, GH One TV, Kessben TV, Light TV, Peace FM, Starr FM, Citi FM, GBC Radio, 3 FM, Radio Gold, Oman FM, Kasapa FM, Asempa FM, Radio Universe, Atinka FM, Bryt FM, Marhaba FM, Justice FM, Mercury FM, Lateinu FM, and Radio France International. Print coverage was also supplied by the Daily Graphic, Ghanaian Times, GNA, Finder, Financial Post, Public Agenda, Ghanaian Observer, Daily Guide, Independent Newspaper, and New Independent.

Celebration of GoodLife, Live it Well in Tamale On September 20, a GoodLife, Live it Well celebration was organized in Tamale for the northern regions of the country as a follow-on to the Accra launch. The event afforded an opportunity for the GHS and the many USAID IPs, UNICEF, NGOs, and community leaders in the area to celebrate the launch. Over 800 participants attended the event including health workers, development partners, traditional leaders, students, women’s groups, and health directorates from the three northern regions. Ms Akua Kwateng-Addo, Director of the Health, Population and Nutrition Office (HPNO) at USAID, underscored the relevance of GoodLife and called on all stakeholders to embrace GoodLife to improve the health indicators for the northern sector. Media houses covering the event included GTV, TV3, Radio Savanna, Radio Justice, Bishara Radio, Zaa Radio, Filla FM, North Star FM, Atinka FM, Ridge FM, Ghanaian Times, and Daily Graphic. The Tamale event was also streamed live on Radio Savana and Justice FM in Tamale.

New GoodLife Media For the campaign launch, a 60-second GoodLife TV commercial and radio spot were produced in English and translated into four local Ghanaian languages. Eight-thousand sets of eight posters each featuring different Life Stages and core intervention areas including malaria, FP, RH and adolescents, ANC, breastfeeding, complementary feeding, newborn care, and regular checkups were developed and printed. In addition, four thousand copies of two posters featuring “healthy living” and “health services with a smile” were also produced. By the end of September 2016, 7,500 of the Life Stage posters and all of the healthy living and health services posters had been distributed nationwide. Other materials developed included brochures and Life Stage cue cards. In order to effectively promote the new brand, items including T-shirts, baseball caps, car stickers, lapel badges and buttons, and flexy and pull-up banners were developed for distribution at the launch and during GoodLife rollout orientations in all ten regions. Approval for the mounting of 42 billboards across the country was also received in YR 2 and these will be mounted in October of 2016 (including 14 in the

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Greater Accra Region, four in the Ashanti Region, four in the Central Region, six in the Western region, eight in the Northern Region, and another six in the Volta Region).

National, Regional and District Rollout of the Integrated GoodLife, Live it Well Brand As part of the GoodLife, Live it Well refreshed brand campaign rollout, orientation and planning meetings were carried out in all ten TABLE 3 regions of the country. Over a four- week period, 18 two-day meetings Participants of the regional GoodLife, Live it Well orientations and rollout (by region and sex) were organized, each with 59 to 74 participants. The work was carried REGION MALE FEMALE TOTAL out in close collaboration with Greater Accra 37 119 156 Systems for Heath, UNICEF, and Ashanti 81 78 159 other regional partners to enhance Brong Ahafo 83 69 152 opportunities to coordinate mass media efforts, community Central Region 69 74 143 mobilization, and interpersonal Eastern Region 88 75 163 communication activities led by other Northern Region 54 56 110 partners. Volta Region 63 82 145

In total, 1,299 participants were Western Region 75 45 120 oriented on the refreshed GoodLife, Upper East 48 27 75 Live it Well approach and Upper West 52 24 76 communication materials across the Total 650 649 1299 ten regions of Ghana. The participants included Regional and District Directors of Health Services, District Disease Control Officers, District Public Health Nurses, District Nutrition Officers, District HPOs, and TOHPz (See Table 3.)

Participants embraced the refreshed GoodLife, Live it Well campaign with enthusiasm and are ready to roll it out to all levels by integrating it into their ongoing and planned activities. GoodLife, Live it Well materials were distributed during the meetings for onward distribution to health facilities, networks, and community- based groups.

Broadcast of GoodLife, Live it Well TV and Radio Since the national launch and regional rollouts, broadcast of campaign radio and television advertisements have continued to air on primetime and peak-time programs such as morning shows, brunch, drive, news bulletins, and soap operas and print adverts have run in major newspapers. The spots began airing in English and four local languages immediately after the launch on July 28 and continued through September 30.

Major national television stations broadcasting the 45-second GoodLife reveal TV advertisements included five national TV, six national radio, and 19 regional radio stations. Translations of the reveal communication are underway to commence airing in other local Ghanaian languages. Tables 4 and 5 show details about the TV and radio broadcasts.

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TABLE 4 GoodLife reveal campaign: national radio and TV stations

MEDIA HOUSE LANGUAGE(S) TRANSMITTED TOTAL # OF SPOTS AIRED

National Radio PEACE FM Twi 1,250 JOY FM English 1,708 STARR FM English 1,140 GBC –Radio Ghana/Obonu English + Twi, Ga, Ewe, Dagbani 940 National Television GTV English + Twi, Ga, Ewe, Dagbani 449 UTV Twi 684 Multi TV Twi Adom TV 4,593 English Joy News & Joy Prime Viasat 1 English 492 TV3 English 450 TOTAL 11,706*

NB: *The figures in the table were arrived at based on certified transmission certificates submitted by media houses

TABLE 5 GoodLife reveal campaign: regional radio stations

MEDIA HOUSE LANGUAGE(S) TRANSMITTED TOTAL # OF SPOTS AIRED

Northern Radio Savanna Dagbani + English 1480 Radio Justice Dagbani + English 1315 Bishara FM Dagbani + English 1250 North Star FM Dagbani + English 1200 Gbantambo FM Dagbani + English 920 Central Radio Central Twi + English 600 Ahomka FM Twi + English 600 Eagle FM Twi + English 600 Cape FM Twi +English 600 Western Twin City Radio Twi + English 1472 ROK FM Twi 2080 Skyy Power Twi + English 650 Good News FM Twi + English 1600 Volta Volta Star Ewe + English 900 Lorlornyo FM Ewe + English 1750 Jubilee FM Ewe + English 2532 Victory FM Ewe + English 1200

Communicate for Health Annual Report: Year 2 17

MEDIA HOUSE LANGUAGE(S) TRANSMITTED TOTAL # OF SPOTS AIRED

Upper East Radio Upper East English 720 Upper West Upper West Radio English 720 TOTAL 22,189*

NB: *The figures in the table were arrived at based on certified transmission certificates submitted by media houses

Other Key Media Coverage

Family Planning Partner coordination meetings with the National Population Council (NPC) intensified during the year to identify opportunities to contribute to the Ghana Family Planning Costed Implementation Plan and to expand the reach of the GoodLife brand. As part of this collaboration, during June, Communicate for Health placed the 15-minute version of a FP advocacy video documentary entitled “Ghana on the Rise: Investing in Population and Development” or ENGAGE, on national TV. The video was produced by the NPC with support from the Population Reference Bureau. It was aired ten times in June and complemented by a total of seven live TV interviews on FP with GHS spokespeople identified by the NPC. Five live radio interview discussions were also broadcast. The live talk shows created a unique opportunity for callers to validate information and clarify any doubts or misconceptions surrounding FP services.

TABLE 6 National media coverage of the ENGAGE documentary

MEDIA HOUSE DOCUMENTARIES LANGUAGES FAMILY PLANNING BROADCAST INTERVIEWS CONDUCTED

National Television GTV 3 English 2 ADOM TV 2 English 1 JOY NEWS 2 English 1 JOY PRIME 1 English 1 VIASAT 1 1 English 1 TV3 1 English 1 Sub-total 10 7 National Radio PEACE FM - English 1 JOY FM - English 1 STARR FM - English 1 RADIO GHANA - English 1 OBONU - English 1 Sub-total 5 TOTAL 10 12

Communicate for Health Annual Report: Year 2 18

Cholera During the month of May, at the request of the Minister of Health and USAID, Communicate for Health and UNICEF worked together to raise public awareness about cholera and promote preventive action. UNICEF developed an entertaining animated TV program shortly under five minutes on cholera, featuring WASH messages. It was broadcast 32 times during prime time. Coverage details are included in Table 7 below.

TABLE 7 Media houses broadcasting cholera documentary in May

NATIONAL TELEVISION STATION LANGUAGE TOTAL # OF PROGRAMS AIRED

GTV English 5 ADOM TV English 6 JOY NEWS English 6 JOY PRIME English 6 VIASAT 1 English 4 TV3 English 5 TOTAL 32

You Only Live Once (YOLO) Other discussions with NPC included collaboration on the popular Ghanaian soap opera series entitled You Only Live Once, or YOLO—an entertaining TV series for adolescents and young adults with information on FP and adolescent RH. The first two seasons aired in 2015 and 2016 (13 episodes each) were developed by the NPC with Farm House Productions and with support from DFID and technical assistance from the Palladium Group. Communicate for Health is currently working closely with the NPC, DFID, and Palladium on the integration of new GoodLife messages into Season 3. While Seasons 1 and 2 were exclusively about young people and RH, the new season introduces GoodLife messages on nutrition, use of LLINs, washing hands with soap under running water, condom use, and avoiding risky behaviors like alcohol and drug abuse. Communicate for Health has contracted with Farm House Productions for the next 13 episodes; broadcasting on GTV and TV3 is being picked up by MTN.

The premiere of Season 3 took place on August 19 and 20 at the Accra Mall, Silver Bird Cinemas, and included broadcasts of the GoodLife, Live it Well reveal TV spot, personal testimonies by YOLO stars about the importance of GoodLife and protecting your dreams, and interviews by the Communicate for Health COP and NPC Director. More than 6,000 people attended the two days of premieres. During Seasons 1 and 2, YOLO was reported to receive more than 2 million hits per week on social media. A similar response is expected for Season 3.

ENGAGEMENT OF NEW REGIONAL RADIO STATIONS To expand and intensify the broadcast of radio spots and programs in the regions, the Communicate for Health Media Team worked closely with national and regional HPOs to negotiate for broadcast time with prominent radio stations in the USAID focus regions. In April 2016, the Media Team and HPD staff traveled to target regions to ensure strong regional radio coverage of health issues including the refreshed GoodLife campaign messages, particularly in the local languages. Hands-on

Communicate for Health Annual Report: Year 2 19

technical assistance was provided to HPOs on how to negotiate with the media for airtime and radio programming. The visit resulted in engaging 19 regional radio stations to provide comprehensive platforms for the broadcast of radio spots, PSAs, and other platforms for interactive interview discussions. The stations are being successfully monitored by the regional HPOs.

RESOURCE OF SBCC MATERIALS—PAST AND PRESENT The GHS/HPD has maintained a National Health Communication Information Resource Centre over many years. However, maintenance and updating of these materials has been inconsistent over time, and technology is now available to make materials more easily accessible to both government and nongovernmental SBCC professionals all over the country. Updating of this important archive is timely. Joint work by the HPD and Communicate for Health began in March of 2015 and significant progress was made in YR 2. More than 20 organizations have contributed materials on a range of health topics. A platform for the inventory has been created and updating and promoting of the contents will become a continuous process going forward. (See Successes and Lessons Story No. 2 on page 27.)

Summary Table of Expected Result #1: Life of Project Mandatory Results/Activities Major Year 2 Outputs/Progress and Achievements

Life of project mandatory result: Improved behavior changes: FP, WASH, nutrition, MCH, malaria prevention and case management

ACTIVITIES MAJOR Y2 OUTPUTS ACHIEVEMENTS Activity 1.1 An updated database Expanded initial list of 108 IE&C/SBCC materials collated by Expand distribution and catalogue for HPD and from other NGOs to a total of 200 materials. Twenty of new and existing 2016 of all SBCC and organizations were contacted in this process. Inventory covers technically accurate health promotion topics such as adolescent health/FP, MCH, breastfeeding, BCS/GHS/UNICEF- materials created nutrition, WASH, HIV/AIDS, Ebola, and intestinal worms. produced social and and available at the Formats include posters, leaflets, flipcharts, brochures, behavior change national and regional stickers, radio and TV spots, and videos on You Tube. Where communication levels access was not possible, contents were described and contact materials and tools details provided. Materials are currently saved on an external hard drive and will be available along with the UNICEF inventory. The inventory will be linked to Health Compass as well as the GHS webpage. Coordinated plan for The FHD is currently working with JICA to produce a new reprinting the Child combined Maternal Health Record Book and Child Health Health Record Book Record Book. JICA approached Communicate for Health in YR 2 for use in USAID for technical assistance and is interested in working with HPD priority regions on the design. The new MCH Record Book will contain developed with GoodLife, Live it Well messages. This activity is expected to be Systems for Health, completed in YR 3. HPD, and FHD; an estimated 313,057 record books are needed

Communicate for Health Annual Report: Year 2 20

Life of project mandatory result: Improved behavior changes: FP, WASH, nutrition, MCH, malaria prevention and case management

ACTIVITIES MAJOR Y2 OUTPUTS ACHIEVEMENTS Plan developed to Regional and national HP staff negotiated and secured airtime broadcast relevant with 19 regional radio stations including Volta (4), Western (4), SBCC and health Central (4), Northern (5), Upper East (1), and Upper West (1). promotion spots and programs produced Not including the news and special media coverage for by partners on FP, national celebrations (i.e. National FP Week, World Malaria nutrition, MCH, and Day) at least 43,771 spots, programs and interviews were aired malaria on 6 national TV, 5 national radio, and 19 regional radio stations. Programs broadcast include retained BCS and the refreshed GoodLife, Live it Well commercials, UNICEF- produced cholera documentaries, FP ENGAGE video documentaries, and live interviews.

First episode of the YOLO season 3 series was premiered. Communicate for Health played a pivotal role in reviewing the scripts for the episodes to reflect the GoodLife, Live it Well thematic areas as well as maintain the focus of the YOLO TV series, which promotes healthy sexual reproductive lifestyles among adolescents. This activity is being carried out in collaboration with FHD, NPC, Palladium Group, and DFID.

Supported 7 monthly GHS engagements with the media. Themes included 1) Healthy Lifestyles, 2) Preventing harmful use of alcohol, 3) Tuberculosis: “Let’s Stop TB Now” 4) Malaria: “End Malaria for Good, Invest in Malaria,” 5) Child Health Week: “Good Life, Start it Right,” 6) World Breastfeeding Week, 7) National FP Week: Family Planning- “it's your life, take control! It's an everyday thing.” Activity 1.2 At least 3 stake Held at least 25 stakeholder consultations with GHS Senior Expand and roll out holder engagement Directors, Family and Public Health Divisions, USAID Health IPs, the GoodLife, Live it workshops or and UNICEF to review and endorse creative executions for the Well brand and meetings completed refreshed GoodLife, Live it Well brand. create an integrated health campaign Strategic plan Pretested 3 creative concepts developed in YR 1 with rural and a. Conduct a including creative urban audiences in 4 regions (Northern, Greater Accra, Volta, series of design briefs for refreshed and Ashanti). Of the 3 concepts (GoodLife as a Kit, Companion workshops to GoodLife Campaign and as a Guide), Companion received an overwhelming develop the produced endorsement followed by GoodLife as guide. A blend of the overall strategic two preferred concepts (companion and guide) were adopted plan for the refreshed campaign. b. Develop Brand Book for the Brand Book including manifesto was produced and pretested creative brief refreshed Good Life and is nearing finalization. Brand Book has the endorsement of for Good Life, brand produced the Honorable Minister of Health, the Director General of the GHS, and ICC-HP Chair.

Communicate for Health Annual Report: Year 2 21

Life of project mandatory result: Improved behavior changes: FP, WASH, nutrition, MCH, malaria prevention and case management

ACTIVITIES MAJOR Y2 OUTPUTS ACHIEVEMENTS Live it Well Life Stages Four action media workshops were conducted with four life brand refresh framework stage audiences (parents/caregivers of under-fives, c. Develop developed adolescents, pregnant women and their partners, young adults creative briefs in relationship). Workshops were conducted by teams for Life Stages comprising HPD, Communicate for Health, Mullen Lowe, and Framework Ghana Community Radio Network (GCRN). Prior to this, teams underwent a two-day TOT with consultant Warren Parker in Accra. Four summary reports, four life stage briefing books, and a consolidated briefing book to inform all communication and messaging for each of the four main life stages are available. “The elderly” was identified by the GHS as a potential additional life stage. Activity 1.3 Audience-tested Three logo executions were developed and tested along with Refresh and refreshed brand interventions. A solid-edged, geometric design curved like a reposition the Good package (key leaf was preferred to other executions. Original colors of Life, Live it Well messages for each green, white, and gold of logo were maintained. Green brand including Life audience, brand represents life, wellness, growth, health, vitality; gold Stages identity, logo, represents optimism, happiness, and wealth; and white tagline, and color represents serenity, peace, victory, and purity. A blend of two scheme) and brand pretested creative teasers “Moments” and “# It's an everyday guidelines developed thing” connected well with target audiences, especially youth. Campaign slogan and tag line is “It’s an #everydaything.”

Refreshed GoodLife, Live it Well brand is now an overarching brand for all SBCC and HP activities of the GHS and partners. Activity 1.4 Existing BCS Good Retained BCS video and audio clips were aired between Facilitate integrated Life branded health October and November 2015 and June 2016 while awaiting the health campaign communication launch of the refreshed brand. In total 3,522 spots were aired. development materials and other Participants (including 4 Regional HPOs) in a GCRN workshop technically sound held in March, 2016, selected scenarios in the Trigger Sketch UNICEF and HPD Manual produced by BCS to begin drafting scripts for a materials reproduced community radio drama series. Scenarios selected included risk of unplanned pregnancy, men's involvement in contraceptive use, parent–child communication about sex, misconceptions about contraceptives, family planning, and teenage pregnancy.

One thousand copies of Trigger Sketch Manual have been reprinted and approximately 920 distributed as part of GoodLife rollouts. Audience–tested To date, 10 poster types, two TV reveals in English and Twi, integrated campaign and radio jingles in 5 languages (English, Twi, Ewe, Ga, and concept and Dagbani) have been developed and are being materials developed aired/published/disseminated. In consultation with GHS Program Managers, HPD, and USAID, cue cards have been developed with integrated messages tailored to each of the 4 main life stages including newborn care and will be ready for print in YR 3. To date 68,000 posters have been printed;

Communicate for Health Annual Report: Year 2 22

Life of project mandatory result: Improved behavior changes: FP, WASH, nutrition, MCH, malaria prevention and case management

ACTIVITIES MAJOR Y2 OUTPUTS ACHIEVEMENTS 64,000 were distributed during regional rollout and launch activities. Project website, Creative Storm began work on developing a social media Facebook site, and platform connected to the GoodLife, Live it Well brand. These related social media sites will be active in YR 3. developed

New materials Refreshed GoodLife teaser and reveal materials were aired on disseminated radio and television on primetime and peak-time slots such as through mass media, morning shows, brunch, drive, news bulletins, soap operas, new media, and and other major health and social programs that attract huge community channels listenership and viewership. A 45-second GoodLife reveal TV advertisement was aired in English and Twi across 5 national TV stations while a similar radio advertisement was broadcast on 6 national radio stations and 19 regional radio stations in English, Twi, Ga, Ewe, and Dagbani. Also airing is the GoodLife jingle.

In total, 28 GoodLife teasers and reveal press advertisements were strategically placed in Ghana’s top ranked newspapers for massive circulation and readership. Full-page color and half-page advertisements have been placed in the Daily Graphic, Mirror, Graphic Showbiz, Ghanaian Times, and Daily Guide

GCRN has begun working on translating the GoodLife reveal materials into 9 different languages. These will be aired on 10 community radio stations located in USAID priority regions. Audience-tested Work was initiated on campaign tool kits in YR 2 with Creative campaign tool kits Storm Network. Full implementation to be carried out in YR 3. available through websites and other knowledge management mechanisms Support tools (e.g., Creative Storm prepared four 60 second stories for radio and dramas, stories, TV on nutrition, reproductive health and malaria to begin technologies, airing in YR 3. Documentaries have been developed on new collaborations) born care and exclusive breastfeeding, to be shown on the developed Maternal Health Channel. An advocacy documentary on malaria to enhance domestic financing of the Malaria Control Program was produced with support from Communicate for Health. All of these materials will be officially approved by the GHS and USAID before broadcasting in YR 3. Campaign toolkits Systems for Health Regional Program Managers and SBCC and integrated into CHPS Community Mobilization Advisors participated in the activities of core and regional rollouts in the five priority USAID focus regions to kick Implementing start integrating campaign messages into its core activities Partners existing

Communicate for Health Annual Report: Year 2 23

Life of project mandatory result: Improved behavior changes: FP, WASH, nutrition, MCH, malaria prevention and case management

ACTIVITIES MAJOR Y2 OUTPUTS ACHIEVEMENTS community–based networks WASH for Health, No activities took place in in YR 2. Planned for YR 3. SPRING, Systems for Health, UNICEF, GMCSP, RING and other resource partners combine community level IPC and national mass/new media channels with links to services and interactive feedback mechanisms Activity 1.5 Campaign launched A national launch of the upgraded GoodLife, Live it Well Support campaign utilizing various campaign was held at the National Theatre, Accra, on July 28th rollout and scale-up platforms 2016. The launch was conducted by the Honorable Minister for at national, Health, Alexander Percival Segbefia, and attended by about regional, district, 700 people, including the US Ambassador, His Excellency and community Robert P. Jackson, USAID Deputy Director, the Director of levels HPNO, the Director and Deputy Director General/GHS, Country Representatives of UNICEF and UNFPA, heads of sector ministries, departments and agencies, representatives of IPs and NGOs, traditional and religious leaders, health workers, Queen Mothers, and organized groups such as market women, faith-based women’s associations, and school children.

The refreshed GoodLife, Live it Well brand was celebrated in the Northern region on September 20th 2016 and was attended by over 800 people including high-profile traditional leaders, Regional and District Directors of GHS from the three regions of the north, USAID IPs, UNICEF, World Vision, Catholic Relief Services, ACDEP, women’s associations, and faith-based organizations. Senior managers from USAID, UNICEF and GHS headquarters were in attendance.

Ten regional rollout orientations were held for 1,299 District Directors of Health Services, District Disease Control Officers, District Public Health Nurses, District Nutrition Officers, and District Health Promotion Officers/Focal Persons. Participants embraced the refreshed GoodLife, Live it Well campaign with a high level of enthusiasm, developed rollout plans, and have begun integrating these into planned activities. Facilitators for the regional rollouts underwent a one-day national TOT prior to the regional events.

A national press event was organized post launch to brief the media about the rationale and key message content of the GoodLife brand. It was addressed by the Deputy Director

Communicate for Health Annual Report: Year 2 24

Life of project mandatory result: Improved behavior changes: FP, WASH, nutrition, MCH, malaria prevention and case management

ACTIVITIES MAJOR Y2 OUTPUTS ACHIEVEMENTS General, GHS, and attended by over 100 officials from MoH, GHS and 47 media houses including print, radio, and TV. Three post launch interviews (2 TV and 1 radio) were also conducted by COP/DCOP and the Public Relations Officer of GHS and aired on the national news. Activity 1.6 Cohort study and A mobile cross-sectional feedback survey conducted in January Crowdsourcing cross sectional and February of 2016 assessed audience recall of a TV and audience feedback survey conducted radio blitz in 2015 of spots (on family planning, malaria, ORS- Zinc, and handwashing) inherited from the previous BCS project. Audience feedback will inform content and programing improvements. The survey showed good overall awareness of the previous GoodLife campaign (61% of those surveyed), a high recall of messages on malaria (81% of those), handwashing (79%), ORS-Zinc (71%), and FP (66%). Messages were also effective in driving information-seeking and -sharing for malaria (59% and 61% respectively), and for handwashing (61% and 60%) but not as well for ORS-Zinc (45% and 50%) and FP (48% and 38%).

Lessons learnt from the cross-sectional survey informed changes to the mobile cohort survey protocol. Approvals were obtained from the GHS Ethic Review Committee and FHI 360 Protection of Human Subjects Committee and the mobile cohort study will start in October 2017.

Communicate for Health Annual Report: Year 2 25

Successes and Lessons Story 1: Traditional Leaders Embrace GoodLife, Live it Well Introduction: In Ghana, traditional authorities are highly respected figures and community members look up to them as role models. Previous campaigns in the country have engaged traditional leaders (Chiefs and Queens) as champions for behavior change in their communities particularly at the local policy level.

In past years, traditional leaders played key roles in the Life Choices and Love Life Compassion campaigns. Communicate for Health is also engaging this group in the promotion of the refreshed GoodLife brand. They were involved right from the concept development stage, through pretesting of content and materials, to campaign launch and roll out. Many have demonstrated exceptional enthusiasm and commitment to the GoodLife brand and activities.

During concept and materials development: “Washing of hands is good to prevent During the concept development stage, diseases that we can see. I told my traditional leaders generated the drive for friends to wash their hands especially adoption of GoodLife as a “companion” and as a when they visit the toilet.” “guide.” During the field testing of materials, a – Traditional leader respected Muslim cleric, Sheik Elliasu, offered valuable inputs and also offered to personally embark on community sensitization exercises. Subsequently a supply of laminated posters was delivered to the Northern Region to support the efforts of ten Muslim, Christian, and traditional leaders who are using the materials to promote GoodLife messages to their constituents.

During National Launch and celebration in Tamale: Many traditional leaders including chiefs and queens attended the national launch of the refreshed GoodLife, Live it Well campaign in Accra on July 28 and celebration on September 20. In Accra, two queens thrilled the audience with statements on behalf of all traditional leaders. These were laced with facts and logic about malaria prevention, breastfeeding, and complementary feeding, along with handwashing with soap. The Communicate for Health project and its partners will continue to engage these powerful leaders to improve the reach and impact of programming.

“I sleep in a mosquito net and wash hands so many times so when I got pregnant, I did not fall sick. I am strong. Malaria used to worry me but now I am ok. I sleep under treated net.”

–Traditional leader

Communicate for Health Annual Report: Year 2 26

Successes and Lessons Story 2: Creating a Foundation for the Media Resource Center — The SBCC Inventory One of the main goals of the GHS/HPD is the revitalization of the National Health Communication Information Resource Centre. Key to this is the development of an inventory of SBCC materials in Ghana—an archive of materials developed in the country recently and over time.

Reviewing and expanding the collection. Work began to update the inventory in March 2015. HPD collated a list of 108 information, education and communication (IE&C) materials already in stock. Materials from the previous BCS project were reviewed with stakeholders from GHS, USAID, USAID IPs, and Civil Society Groups during a two-day workshop in YR 1 and subsequently added to the inventory. Participants determined which of the materials should be retained, retained with modification, or retired.

Communicate for Health expanded the inventory to include SBCC materials developed by other NGOs in Ghana. By the end of March 2016, 20 organizations had been visited and 92 materials added to the collection. Many of the partner organizations commented on the need for such a resource in Ghana and were enthusiastic to have their materials included.

Sample material profile pages Topics covered by the SBCC inventory: Currently the inventory covers a wide range of health topics including adolescent health, prevention of malaria, maternal and child health, breastfeeding, sexual and reproductive health/family planning, nutrition, WASH, HIV & AIDS, Ebola, and worms. Formats include virtually every medium, such as posters, leaflets, brochures, stickers, radio spots, TV spots, videos, and links to videos on YouTube. Where access to materials was not possible due to copyright, the content was described and contact details provided. UNICEF is planning to develop an inventory of its own materials. Once developed, the two inventories will be available through the resource centers.

Future development: Now that a format and platform for the inventory have been established, it will require continuous updating and expansion as new materials are created. A joint team of HPD and Communicate for Health staff will update the collection on regular basis. Communicate for Health also plans to explore the possibility of linking up with Health Compass, a website of SBCC resources managed by USAID’s Health Communications Collaborative Project (H3C). The collection will be an important piece of the upcoming HPD Resource Center based at Korle Bu as well as the virtual hubs in the regions.

Communicate for Health Annual Report: Year 2 27

SECTION 2 Capacity Building (ER2)

CAPACITY BUILDING SUPPORT PROGRAM OVERVIEW “Learning by doing” is an essential aspect of Communicate for Health’s capacity building approach with the HPD to increase its effectiveness in coordinating and delivering SBCC campaigns. Joint efforts between the project and the HPD interns help develop the brand at the creative firm, Mullen Lowe. HPD team were initiated in YR 1 and expanded in YR 2. Key activities included development of the SBCC training program in areas such as monitoring and evaluation, conduct of Action Media Workshops, and launch of job training/internships for HPD staff with project partners. These activities were complemented with structured and tailored capacity development programs—namely the Change Agent Development Program (CADP) and the Set for Change (SfC) Action Learning Sets.

Organizational and individual capacity assessments conducted in July of 2015 (YR 1) provided the basis for rolling out Communicate for Health’s capacity building strategy with the HPD. Highlights of priority areas identified that were incorporated into the CADP and SfC curricula included the following:

 Knowledge of relevant SBCC theories and models for situation analysis and program design  Development and design of comprehensive communication strategies  Tailoring message design and programming for different audience segments  Development of SMART communication objectives  Basic principles of how to develop effective messages and materials  Data collection and analysis of M&E data for improved SBCC planning  Documentation of best practices

Structural challenges highlighted by the assessments included the following:

 Non-recognition of the TOHPz by the District Health Management Team (DHMT)  Conflict between roles of TOHPz and other line officers such as the Community Health Nurses, Field Technicians, and Technical Officers who have been performing health promotion duties over the years

Communicate for Health Annual Report: Year 2 28

 Need to reposition HPD at the regions and districts and provide clarity about job roles and responsibilities (including HPO job descriptions)  Need for basic equipment such as office desks and chairs, computers, printers, a photocopier, scanners, and digital cameras

Based on these findings, an overall capacity building plan was developed and implementation was kick-started in YR 2. In addition to the CADP and the SfC Action Learning Sets, the plan includes identification of free online courses, support to individuals in creating personal development plans, stretch assignments, internships/practicums, peer mentoring, and various post-training supports for CADP and SfC graduates—including mobile phone messages, prompts to act and reminders, refresher tips, quizzes, and games to reinforce particular skills or actions on the job. The Change Challenge Fund (described below) is also an important element of the plan.

THE CHANGE AGENT DEVELOPMENT PROGRAM (CADP) The CADP is a one-week intensive program designed to fill identified capacity gaps and to strengthen the individual technical capacity of select national, regional, and district-level staff. It consists of technical presentations followed by questions and discussion, use of case studies, and practical group exercises. Content includes SBCC theory, formative assessment, how to work effectively with the media, community and social mobilization, working with community radio, use of mobile technology, and leadership and personal development skills. Participatory approaches and the integration of health priorities (current and emerging) in SBCC campaigns are important areas of focus.

The CADP curriculum is standardized and supported by participant and facilitator manuals.

The first CADP training was held June 27 to July 1, 2016, at Dodowa in the Greater Accra Region. The program was facilitated by the Senior Organizational Capacity Development Specialist of Communicate for Health, an experienced external consultant, and a range of local Ghanaian SBCC practitioners, academics, and staff of Communicate for Health and GHS/HPD.

Participation was competitive and 23 out of 25 selected HP practitioners completed the training (See Table 7 on the next page.) The program was launched by Dr. Patrick Aboagye, Director, GHS/FHD, and supported by Mrs. Grace Kafui Annan, Head of the HPD, and the Communicate for Health Project Chief of Party (COP). Certificates were awarded by Dr. Gloria Quansah Asare, the Deputy Director General of the GHS. Graduates were charged to mentor colleagues who could not participate in the training.

Participants were evaluated using standard assessment tools in order to measure improvement in their individual competencies as well as gauge the relevance, delivery, and understandability of the new course. Pre- and post-training results showed significant improvements in participants’ total scores (with a maximum possible of 30 points), ranging from 10 percent to 40 percent (See Figure 2 on page 31.)

Communicate for Health Annual Report: Year 2 29

TABLE 8 Selected CADP Applicants by Region

NAME REGION LEVEL TITLE

Esther Adu Greater Accra National Health Educator

Mercy Uzoma Tetteh Greater Accra National Health Educator

Naa Afaale Sackley Dagadu Greater Accra District Technical Officer

Pearl Dzordzordzi Greater Accra District Technical Officer

Felix Akudugu Greater Accra District Technical Officer

Vida Ntiwaa Gyasi Greater Accra Municipal Health Educator

Robin Appiah Ashanti District Health Educator

Emmanuel Opoku Ashanti District Technical Officer

Eric Kofi Oduro Amankwah Brong Ahafo District Health Educator Matthew Kobina Okor Central Regional Deputy Chief Health Educator Ahwireng Sally Baaba Owusu Addo Eastern District Health Educator

Mohammed Naeem Kpedau Upper East District Health Educator

Fatima Mohammed Northern District Technical Officer

Janet Kulah Northern District Technical Officer

Rahinatu Yakubu Northern Regional Health Educator

Daniel Bomfeh Western Regional Health Educator

Maakpe John V. Upper West Regional Health Educator

Edward Beyereh Upper West District Technical Officer

Edwina Kpintaatoobo Upper West District Technical Officer Bawakyillenuo Julius Upper West District Technical Officer Ngmentiere Eunice Teah Volta Regional Health Educator

Happy Alornu Volta District Technical Officer

Matilda Atsrim Volta District Technical Officer

Shine Gavey Volta District Technical Officer

Damba Mayebi Sampson Volta District Technical Officer

Communicate for Health Annual Report: Year 2 30

FIGURE 2 CADP first cohort pre- and post-training assessment scores

30

25

20

15

10

5 PREAND POST TEST SCORES

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 PARTICIPANT

PRE POST

Overall, participants rated the program highly in terms of appropriateness of content, delivery, and understandability.

The program has received overwhelming endorsement by and support from the leadership of the GHS. The Deputy Director General and Director, FHD, made a passionate appeal for the program to be offered to other health cadres at the forefront of health service delivery to enable them to lead and undertake stronger and more effective Dr. Patrick Aboagye (front row center), Director of Family Health Division, GHS, with participants during the opening ceremony of the first CAPD. SBCC programming.

THE SET FOR CHANGE PROGRAM The Set for Change (SfC) program was also launched in YR 2. The program is designed for TOHPz and consists of four two-day sessions spread over six to eight months.

The program is structured to help this new cadre of HP staff develop strategies and tactics to operate effectively in a complex environment, have the ability to deal with problems/challenges as they arise, learn to think critically, be proactive, and develop self-awareness and confidence about their own approaches and effectiveness.

SfC is a form of ‘peer to peer’ learning and capacity building that combines three main components:

 An action learning set process  Technical assistance inputs to fill gaps

Communicate for Health Annual Report: Year 2 31

 Personal development to improve individual effectiveness and promote continuing professional development

The first cohort of ten TOHPz were drawn from the district levels of the GHS. They met for an initial session July 4 and 5, 2016, at Dodowa. They elected to focus first on the following technical areas:

 SBCC principles and practices and current trends  Theoretical underpinnings of SBCC and the steps to develop, implement, and monitor an effective SBCC approach  Social mobilization  How culture and tradition shape us and influence what we do (with special emphasis on the spirit child belief of the people of Kassana Nankana in the Upper East Region of Ghana)  How to work effectively with the media  Working with mobile technology in health promotion

The remaining sessions for the first cohort of SfC participants will be held in the first quarter of YR 3. Two additional cohorts of ten TOHPz will also meet in YR 3.

THE INTERNSHIP PROGRAM In YR 2 three HPD staff completed a three-month internship program with Mullen Lowe, the creative agency working with Communicate for Health and the GHS/HPD to refresh the GoodLife, Live it well brand. The internship appointments allowed HPD staff to have direct experience working with a professional creative firm on brand development and materials design. The interns reported that the program was very useful—particularly the hands-on experience with the GoodLife campaign development, photo shooting, pretesting, and graphic design.

A draft internship manual and guidelines have been developed and shared with HPD for final inputs. The manual will provide an overall framework for future internships with additional Communicate for Health sub recipients, including Creative Storm Network, GCRN, and VOTO Mobile. The structured internship program will begin in the first quarter of YR 3. Adjustments so that HPD staff can work part time on the internship program while continuing with routine work schedules at HPD are being explored for the future.

THE CHANGE CHALLENGE FUND (CCF) Progress was made in YR 2 towards establishing the Change Challenge Fund (CCF). The CCF is a competitive performance-based opportunity to be made available to 10 to 15 CADP or SfC graduates so they can apply their learnings in real life settings. Successful applicants will each receive up to about six thousand Ghana Cedis (GHS 6,000) for one year to conceive of, develop, and implement small-scale innovative SBCC activities at the district or regional level to support the national GoodLife, Live it well campaign. The funds will be disbursed to beneficiaries through the Fixed Amount Award (FAA) for the HPD/FHD of GHS.

The final draft of the CCF guidelines has been shared with the HPD for their inputs. The CCF will be launched in YR 3 and will also be offered through the end of the project.

Communicate for Health Annual Report: Year 2 32

THE INTER-AGENCY COORDINATING COMMITTEE FOR HEALTH PROMOTION (ICC-HP) Coordination of health promotion strategies and plans at the national level is critical to ensure coverage and quality of campaigns and other activities, to avoid duplication of efforts, and to maximize potential impact with available resources. Working through the HPD, Communicate for Health has collaborated with UNICEF and WHO to reconstitute and revitalize the national Inter- Agency Coordinating Committee for Health Promotion (ICC-HP), centered at the HPD.

The Committee was formally re-launched in Accra in YR 2 on October 7, 2015. It is chaired by Professor Audrey Gadzekpo, Dean of the School of Information and Communication Studies, the University of Ghana–Legon. Vice chairperson is Dr. Mrs. Gloria Quansah-Asare, Deputy Director General of the GHS.

The ICC-HP has since held four meetings to discuss and take key decisions that affect and champion the course of HP in Ghana. Examples of activities and decisions taken in YR 2 include the following:

 Adoption of the terms of reference of the revitalized ICC-HP. The terms of reference describe the mandate of the ICC-HP, its overall responsibility, composition of membership, and duration of the tenure of office of the chairperson and the vice chairperson and the key roles of the committee.  Approval of the National Health Promotion Policy (NHPP), a document that sets forth the policy framework for health promotion practice in Ghana.  Approval of the National Health Promotion Strategy (NHPS), which serves as a guide and blue print for the key strategies and approaches to health promotion practice in Ghana.  Establishment of a task team to support the HPD to finalize the costing of the National Health Promotion Strategy, including identifying SBCC work underway or completed with other ministries, departments, and partners so that complementary activities and synergies are strengthened and duplication avoided. The launch and dissemination of the final NHPP and NHPS will take place in YR 3.  Reviewing and providing input into the refreshed GoodLife, Live it well brand including its official endorsement.

CAPACITY BUILDING WITH COMMUNICATE FOR HEALTH PARTNERS To date, capacity building with the project’s local partners has focused on supporting them to comply with the terms of their sub-awards, especially in meeting special award conditions. This has included assistance in developing accurate timesheets to track staff level of effort, requesting and liquidating project funds in a timely manner, updating or completing finance and administration policy manuals, and tracking cost share, among other investments.

In the second quarter of YR 2, Communicate for Health organized a Finance, Administration, and Grants Management training for GCRN to provide guidelines for managing their sub-award. The training also offered GCRN with the opportunity to address special award conditions (SACs) in their sub-award. FHI 360 and USAID financial rules and regulations were presented.

Communicate for Health Annual Report: Year 2 33

Summary Table of Expected Result #2: Life of Project Mandatory Results/Activities Major Year 2 Outputs/Progress and Achievements

Life of project mandatory result: HPD capacity strengthened for effectively coordinating and delivering social and behavior change communication and health promotion campaigns

ACTIVITIES MAJOR Y2 OUTPUTS PROGRESS AND ACHIEVEMENTS

Activity 2.1 Finalized HPD capacity Capacity assessment completed with 22 staff. Information used Conduct health strengthening plan to determine training needs and capacity strengthening plan. promotion capacity On-line courses for Free on-line courses will be made available to the CADP assessment of TOHPz facilitated and beneficiaries on Health Compass in YR 3. HPD supported by free access

HPD supported to Still under discussions to commence in YR 3. conduct gender integration assessment of HP programs in three regions

Activity 2.2 Institutional vision and This is work is now planned as part of the Fixed Award Amount Strengthen brand identity developed (FAA) with FHD/HPD for YR 3. leadership, repositioning, Formal launch of Health A draft Health Promotion Policy and Strategy were presented at and rebranding Promotion Policy and GHS annual regional review meetings. HPD was tasked to finalize National Strategy and the costing of the Strategy. The launch is planned to coincide Action Plan for Health with opening of the renovated HPD offices at Korle Bu in YR 3. Promotion

M&E Framework and Indicators for health promotion were incorporated into the formalized routine M&E national web-based DHIMS 2. (See 2.4 for more information.) indicators and data collection tools developed

Activity 2.3 Improved health The national ICC-HP has held four meetings. The 4th ICC-HP Improve promotion coordination meeting took place in June and was well attended with all national, through re-launch of the stakeholder agencies represented including the Deputy Director regional, and ICC-HP at national level General of GHS who doubles as the vice chairperson of the district committee. In YR 3 it is planned that this activity will be included coordination of Regional and district HP in the FAA with FHD/HPD. health officers oriented on promotion stakeholder engagement Support to strengthen and/or establish regional ICC- HPs in and community Volta, Western, and Greater Accra regions are planned as part of mobilization FAA with FHD/HPD in YR 3.

Communicate for Health Annual Report: Year 2 34

Life of project mandatory result: HPD capacity strengthened for effectively coordinating and delivering social and behavior change communication and health promotion campaigns

ACTIVITIES MAJOR Y2 OUTPUTS PROGRESS AND ACHIEVEMENTS

Activity 2.4 Finalized M&E HPD M&E framework with routine HP M&E indicators and data Develop a robust framework with collection tools were finalized and are awaiting USAID approval monitoring and formalized routine M&E before printing. evaluation HP indicators, data DHIOs and TOHPz were trained on HP data collection tools, framework for collection, and forms, and indicators. In total, 310 TOHPz and DHIOs were trained from Ashanti, Brong Ahafo, Volta, Western, and Greater national, supportive supervision Accra Regions. regional, and monitoring tools for Participants were introduced to DHIMS 2 and the new HP forms district health national, regional, and district HP activities customized for the platform, including tools for aggregating data promotion collected on a monthly and quarterly basis and for generating

pivot tables and charts.

UNICEF supported a national TOT for Regional HPOs and HIOs. For DHIOs, TOHPz and sub-district staff, trainings were conducted in Upper East, Upper West, Northern, Eastern and Central Regions. All 10 regions have now received the essential DHMIS 2 training for DHIOs and TOHPz.

HP activities and Reporting in DHIMS 2 will commence in YR 3 following printing indicators reported in of registers and opening of the platform for entry. DHIMS 2 and used for improved management decisions

Activity 2.5 CADP curriculum and The CADP curriculum and program materials and tools (including Establish a program materials & the facilitators manual, participant manual, and the overall Change Agent tools (e.g., gender capacity building support plan) were developed and utilized for Development integration, working with the first workshop held in YR 2. Program for the the media, participatory HPD staff community radio, In addition, motivational messages to reinforce learning will be sent to each participant from time to time. A task order with creative health campaign VOTO Mobile is under development in this regard for YR 3. development and delivery, motivational

message design,

community mobilization

and M&E) drafted using

adapted C-Change modules as appropriate

CADP delivered to 25 Twenty-three out of 25 selected HP practitioners participated in successful applicants at the CADP in YR 2. national and regional levels and to 35 TOHP (55 total)

Communicate for Health Annual Report: Year 2 35

Life of project mandatory result: HPD capacity strengthened for effectively coordinating and delivering social and behavior change communication and health promotion campaigns

ACTIVITIES MAJOR Y2 OUTPUTS PROGRESS AND ACHIEVEMENTS

Free online courses and Free on-line courses will be made available in YR 3 to the CADP programs for continuing beneficiaries who can access other capacity building programs to professional complement the CADP. development accessed and utilized

Stretch “on the job” Three HPD staff completed a three-month internship program internship placements with Mullen Lowe. A well-structured internship program that under the guidance and will provide the overall framework for implementation is being support of technical developed and will commence in YR 3. experts, partners, and creative agencies

Performance-based Change Challenge Fund (CCF) guidelines were drafted and grant program for shared with the HPD for final inputs. The mechanism for Change Agents designed implementing the CCF will be an FAA with FHD/HPD, to be and launched launched in YR 3.

Activity 2.6 Two cohorts of “Set for Ten TOHPz are participating in the first SfC cohort: one meeting Establish six Change” (SfC) action was held in YR 2 and the remaining 3 will be held in YR 3. independent learning sets, each “Set for Change” involving 10 TOHP for 4 Action Learning sessions (1.5 days each) Sets for TOHP held 6 weeks apart

Activity 2.7 Performance-based To be initiated in YR 3. (Opportunity to be given to 12–15 Initiate a Change Change Agent Challenge participants who present innovative proposals.) Agent Challenge grants disbursed to 12– Fund for 15 successful applicants To be initiated in YR 3. Final draft of the Change Challenge Fund performance- (CCF) guidelines has been shared with the HPD for final inputs. based grants Functional Change Agent Challenge Fund review board established

Activity 2.8 Community mobilization To be actively pursued in YR 3 in collaboration with Systems for Develop tools to tools to support Health and UNICEF. support engagement and community leverage national media mobilization campaign efforts

Activity 2.9 Computer- and mobile- A platform for the SBCC inventory has been created with 200 Develop SBCC optimized SBCC resource HP/SBCC materials. The center at the HPD office at Korle Bu and resource centers centers at Korle Bu and virtual hubs in the five USAID focus regions will be created in YR five regions 3.

Communicate for Health Annual Report: Year 2 36

Life of project mandatory result: HPD capacity strengthened for effectively coordinating and delivering social and behavior change communication and health promotion campaigns

ACTIVITIES MAJOR Y2 OUTPUTS PROGRESS AND ACHIEVEMENTS

Space for resource center at Korle Bu under renovation. Basic equipment such as desk top computers for virtual hubs to be procured in YR 3.

Activity 2.10 Criteria for Best Healthy Criteria for award drafted and to be finalized in YR3. Develop Health District, Best Healthy Promotion Community, and Top Awards Health Promoter Awards finalized

Award Best Healthy District, Best Healthy Community, and Top Health Promoter; publicly acknowledge these

Communicate for Health Annual Report: Year 2 37

SECTION 3 Development of One Local SBCC Organization to be a Recipient of USAID Funding (ER3)

OVERVIEW In YR 2 the Cooperative Agreement was modified with regard to Expected Result 3 so that the project is now required to develop the capacity of one local SBCC organization instead of two (both an SBCC organization and a social marketing organization) as initially required. Over time it is expected that the identified organization will assume increasing technical and managerial responsibility for the project and will eventually transition to direct funding from USAID/Ghana. It will collaborate with other project partners (Creative Storm Network, VOTO Mobile, and GCRN), GHS, HPD, UNICEF, and other health IPs to continue the development of The GoodLife, Live it Well branded programming and communications.

TENDER FOR AND IDENTIFICATION OF THE LOCAL SBCC ORGANIZATION In June 2016, the project prepared a solicitation request for applications/expression of interest (RFA/EOI) to identify an appropriate local Ghanaian-owned and -operated SBCC organization. The competitive process took place in two stages. Each candidate first provided its company profile, staffing structure, an overview of its governance and management, its strategic orientation and partnership approach, and references from previous projects. Those short-listed were then asked to give oral presentations.

Candidates were required to minimum requirements outlined below.

1. The organization must be Ghanaian-owned and –operated according to the following criteria:

 It must be organized under the laws of Ghana  It must have its principal place of business in Ghana  At least 75 percent of the organization’s senior staff as well as at least 75 percent of its total staff must be citizens or lawfully admitted permanent residents of Ghana  At least 51 percent of the members of the organization’s Board of Directors must be citizens or lawfully admitted permanent residents of Ghana

Communicate for Health Annual Report: Year 2 38

2. The organization should have demonstrable and current experience in at least two of the following areas:

 SBCC and brand development and management  Quantitative and qualitative market and audience research  Creative design, graphic arts, and materials development

3. The organization should have a track record of timely delivery of similar tasks and deliverables as indicated above.

The project received 14 applications in late July of 2016 that met the minimum requirements. Three finalists were then asked to give oral presentations in August outlining an SBCC campaign of their own design and linked to the Good Life, Live it Well brand, along with a budget.

In order to ensure greater ownership in the selection process, the Head of HPD participated with the project in reviewing the candidates and their presentations. Based on predetermined selection criteria (See box below), the procurement committee agreed provisionally on a winning applicant, pending the outcome of a pre-award assessment and concurrence by USAID/Ghana.

The contracting process is underway and will be concluded in the first quarter of YR 3.

ENGAGING THE LOCAL SBCC ORGANIZATION IN FY 2017 FHI 360 envisions the role of the selected SBCC organization will take shape in two phases. The first phase will focus on forming the partnership, assessing technical and institutional capacity, and developing a plan to enhance those capacities. The second phase will concentrate on developing, producing, and distributing SBCC programming relevant to the Communicate for Health project.

Phase 1 FHI 360 will facilitate self-assessments of the organizations capacities utilizing the C-Change SBCC- Final Selection Criteria Capacity Assessment Tool, which considers five areas: 1) for Local SBCC Organization situation analysis; 2) strategy development; 3) materials Stage 1: Application development; 4) implementation; and 5) monitoring and evaluation. In addition, an institutional self-assessment 1. Technical capacity and expertise (30 utilizes the Institutional Development Framework—an percent) 2. Past experience (30 percent) asset-based approach that also considers an institution’s 3. Proposed partnership approach for governance, human, management, financial, and external working with the Communication for resources. Health consortium, UNICEF, and the GHS/HPD (40 percent) FHI 360 and the SBCC organization will then develop an Stage 2: Oral Presentation action plan outlining mutual investments over a three- to six-month period designed to capitalize on identified 1. Technical quality and feasibility of proposed SBCC campaign (50 percent) strengths and address priority weaknesses. Activities will 2. Presentation materials and style include classroom-style workshops, on-the-job trainings, (40 percent) apprenticeships, and other action learning activities. The 3. Budget (10 percent) goal will not be to “remake” the organization from the

Communicate for Health Annual Report: Year 2 39

ground up, organize countless training workshops, or embed staff over the long term. Rather, FHI 360 will enhance capacities that are already there, strengthen what is needed, and empower the organization to carry out work under the project.

During this phase FHI 360 and the SBCC organization will also modify the initial sub agreement to include a multi-year grant with a ceiling amount of up to 2,000,000 Ghana Cedis to develop, produce, and distribute original SBCC programming in collaboration with the GHS/HPD, USAID and other stakeholders.

Phase 2 In phase 2 the organization will take the lead in SBCC programming on a range of health issues including FP, MCH, malaria, nutrition, WASH, and/or reproductive health. The formats for this programming will be determined based on the core competencies and competitive advantages of the local SBCC organization and could include:

 Radio: radio dramas, edu-entertainment formatted programs, documentaries, PSAs, news shows, and panel discussions  TV: edu-entertainment formatted programs, documentaries, PSAs, news shows, game shows, and panel discussions  Print: billboards, flip charts, posters, job aids, patient flyers, handbills, toys, and games  Social media: Facebook, What’s App, SMS, IVR, and Twitter  Community animation: Community health talks, street theater, and health fairs  Training: Training of front line health care workers in community mobilization skills, SBCC, and or other related health promotion-focused topics.

Communicate for Health Annual Report: Year 2 40

Summary Table of Expected Result #3: Life of Project Mandatory Results/Activities Major Year 2 Outputs/Progress and Achievements

Life of project mandatory result: HPD capacity strengthened for effectively coordinating and delivering social and behavior change communication and health promotion campaigns

ACTIVITIES MAJOR Y2 OUTPUTS PROGRESS AND ACHIEVEMENTS

Activity 3.1 Comprehensive Cooperative agreement with USAID modified to focus energy and Identify two strategy and resources on developing capacity of 1 local SBCC organization. organizations selection process for capacity developed for RFA/expression of interest was developed and advertised in building recruiting a local national dailies for prospective organizations to apply. SBCC organization for intensive capacity A bid Evaluation Committee comprising FHI 360/Communicate for building Health and HPD was formed; proposals were reviewed jointly based on criteria established in the RFP. In all, 14 firms submitted bids and 13 applications were evaluated. Three local SBCC organizations were shortlisted for the second stage of the selection process. Of the three that progressed to the final stage, the lead organization was determined to be ProLink in a joint bid with Infinity 970.

Selection is being finalized pending final negotiations, completion of a pre-assessment, and final concurrence from USAID.

Activity 3.2 Baseline assessment To be conducted in YR 3. Conduct of local SBCC organizational organization assessments completed

Activity 3.3 Organizational and To be conducted in YR 3. Build capacity capacity-building plan of and scoring criteria organizations completed for demonstrated competencies

Activity 3.4 To be developed in YR 3. Develop and implement exit strategy that empowers local governance and organizations

Communicate for Health Annual Report: Year 2 41

SECTION 4 Monitoring and Evaluation

THE ACTIVITY MONITORING AND EVALUATION PLAN (AMEP): The Communicate for Health Monitoring and Evaluation (M&E) team finalized the project’s Activity Monitoring and Evaluation Plan (AMEP) in the third quarter of YR 2 and is awaiting its approval by USAID. The revised plan reflects input provided during YR 1 by stakeholders (including GHS Program Officers and HPD) in setting targets for key indicators and addressing recommendations made by Evaluate for Health and USAID. Enhancements include: 1) provision of underlying assumptions for each indicator; 2) numerators and denominators where applicable; 3) routine HP indicators for inclusion in the District Health Information Management System (DHIMS); 4) data collection instruments; 5) a performance data table tracking achievements against targets; and 6) Performance Indicator Reference Sheets (PIRS).

CROSS SECTIONAL FEEDBACK SURVEY In February of 2016 the project completed the first in a series of planned mobile phone feedback surveys using interactive voice response (IVR) to assess audience recall of media messages. (See also Successes & Lessons Story # 3) The initial survey was designed to assess audience response to a blitz of the airwaves in YR 1, from July to September 2015, consisting of TV and radio spots inherited from the previous Behavior Change Support (BCS) project. (Some stations continued to air spots in October and December at no cost to the project.) Messages focused on FP, malaria, ORS-Zinc, and handwashing. The survey also elicited information on most trusted source of health information and preferred TV and radio stations. Audience feedback was used to inform content improvements and management decisions on programming. A total of 675 audience members were sampled in the five USAID priority regions. Respondents comprised youth aged 18–24, young adults aged 25–35, and pregnant women and women with children under five—the key Life Stage audience segments.2 The survey showed good overall awareness of the previous Good Life campaign brand (61 percent of those surveyed), and high recall of messages on malaria (81 percent), handwashing (79 percent), and ORS-Zinc (71 percent)—all of which exceeded the 70 percent recall targets set. Messages regarding FP achieved somewhat lower recall (66 percent). (See Figure 3 on the next page.) Among those who recalled messages, these were effective in driving information seeking and sharing especially for malaria (59 percent sought information and 61 percent shared information) and for handwashing (61 percent and 60 percent, respectively). Messages for ORS-Zinc were somewhat less effective (45 percent sought information and 50 percent shared information) as were messages regarding FP (48 percent sought information and 38 percent shared information). Only about one-third of all respondents reported visiting a health care provider as a result of hearing or seeing the campaign in the past two months. (However, many of the messages focused on home behaviors and did not require visiting a clinic.) (See Figure 4.)

2 NOTE: To limit survey length, Life Stage groups for youth and young adults received handwashing and FP question sets while pregnant women and females with child under 5 were randomly asked two of the four topical question sets.

Communicate for Health Annual Report: Year 2 42

FIGURE 3 Recall of previous GoodLife, Live it Well campaign messages among target audiences

100 81 79 70 70 70 71 70 70 80 61 66 60 40 20 0 GoodLife Malaria ORS-Zinc Hand Washing Family Planning (N=502) (N=72) (N=62) (N=407) (N=378)

TARGET ACHIEVED

NOTE: See footnote on previous page for explanation of Ns.

FIGURE 4 Actions taken after campaign exposure

(N=44) Visited Provider (N=52) (N=281) (N=246) (N=44) Sought Information (N=56) (N=292) (N=254) (N=44) Shared Information (N=51) (N=277) (N=239)

0 10 20 30 40 50 60 70

ORS-ZINC MALARIA WASH FAMILY PLANNING

NOTE: See footnote on previous page for explanation of Ns.

The survey findings were disseminated at different fora including USAID M&E Community of Practice, Knowledge Management Group, monthly joint HPD/Communicate for Health staff meetings, and training of Regional HPOs and IOs. Survey findings regarding preferred TV and radio stations informed selection of stations that were engaged for airing messages in some regions.

MOBILE COHORT SURVEY A mobile cohort survey was initially designed in YR 1 to measure exposure over time to GoodLife, Live it Well campaign messages and assess progress towards changes in behaviors and related determinants. Initial approval was obtained and amendments were submitted to the survey in 2015 and 2016. Both the FHI 360 Protection of Human Subjects Committee (PHSC) and the GHS Ethics Review Committee reviewed proposed modifications to the protocol and instruments and both

Communicate for Health Annual Report: Year 2 43

granted their approvals. The primary changes were to enroll male partners of pregnant women and mothers with children under five as an additional cohort; revision of the sample size of each Life Stage cohort downwards from 2,000 to 1,400; reduction of follow-up surveys from two to one; and revision of the data collection instruments following inputs from GHS program managers and WASH for Health.

The amendments were informed by lessons learned from the mobile feedback survey described above. In that survey, numerous calls had to be placed to fill required samples using Random Digit Dialing (RDD). A contract has been signed with VOTO Mobile to launch the study in October 2016.

DATA QUALITY ASSESSMENT (DQA) A data quality assessment (DQA) was conducted by a team from USAID/HPNO and Evaluate for Health in June 2016 to assess the project’s M&E systems for data collection, data management, data processing, and reporting. The DQA process measures five elements: validity, reliability, integrity, precision, and timeliness. In June the process focused on two indicators:

 Percent of audience who recall hearing or seeing a U.S. Government (USG)-supported FP/RH message (obtained from IVR surveys)  Number of target audiences reached with SBCC activities (obtained from DHIMS 2)

The DQA resulted in three major recommendations:

 Develop a user-friendly relational database to ensure data integrity. Discussions were initiated with Evaluate for Health on database options for implementation in YR 3.  Improve representativeness of IVR surveys through inclusion of adolescents under 18 years of age, if possible, or explore alternate survey methods to measure reach and recall with this audience segment. Alternate methodologies (such as special surveys with adolescents) are being explored.  Address under-reporting in feedback surveys by flagging survey completion at the point of last closed-ended question rather than eliciting suggestions for survey improvements. Subsequent audience feedback surveys will be revised accordingly.

HEALTH PROMOTION M&E SYSTEM In YR 1, Systems for Health, Evaluate for Health, Communicate for Health, GHS/HPD, FHD, and PPME formed a technical working group to begin the process of designing and developing a robust M&E framework, indicators, and data collection tools for SBCC in Ghana and incorporating these into DHIMS 2. (See also Successes & Lessons story No. 4.) This group met at least twice monthly between June and September of 2015. In YR 2 the team continued to review and finalize routine SBCC indicators and data collection tools/registers and their respective data dictionaries. In October and November of 2015 these tools were pretested in four regions, modified, and finally incorporated into the national web-based DHIMS 2 in December 2015. This was a historic step for SBCC in Ghana. To date few countries have incorporated SBCC indicators in their regular health information systems.

In January, UNICEF organized a TOT for regional HPOs and IOs and they in turn have facilitated district level trainings for a total of 310 district officers (Technical Officers for HP/Focal Persons and

Communicate for Health Annual Report: Year 2 44

HIOs). These sessions provided FIGURE 5 District officers trained on HP data collection tools by region hands-on training on data entry, editing, validation, and basic analysis, including creation of pivot tables and charts. In five regions (Ashanti, Brong Ahafo, Western, Volta, and Greater GREATER ACCRA ASHANTI Accra) the project piggybacked 54 69 these district-level with GoodLife, Live it Well rollout orientations. The distribution of trainees by WESTERN 56 region is presented in Figure 5. BRONG AHAFO 62

Systems for Health Regional VOLTA Officers participated in the 69 training of district officers in their focal regions and are expected to support implementation beginning in YR 3.

Communicate for Health will contribute to printing the registers to facilitate the initiation of data gathering and reporting. In YR 3 Communicate for Health will look at opportunities to support training in the new indicators and collection processes for sub-district and facility level staff and other levels, as appropriate. Meetings between the project, Systems for Health, and the HPD have also discussed how to integrate SBCC content into ongoing GHS coaching visits.

STRATEGIC INFORMATION/M&E WORKSHOP The Communicate for Health Senior M&E Advisor participated in the annual FHI 360 Global Strategic Information (SI)/M&E Technical Workshop in Senegal in late May of 2016. The five-day workshop brought together 53 participants and nine facilitators representing 24 country offices and discussed key SI/M&E approaches implemented by FHI 360 and partners in different countries. The project M&E Advisor presented on the topic Mobile Phone Monitoring and Evaluation for the Communicate for Health Integrated Health Program. Lessons learned during the workshop will benefit the project and in particular will feed into development of a routine DQA strategy for the project.

HPNO MONITORING AND EVALUATION COMMUNITY OF PRACTICE (MECOP) MEETINGS AND TRAININGS Staff of Communicate for Health and the HPD participated in quarterly MECOP meetings addressing a range of topics and contributing to broad M&E capacity strengthening. Invitations for these meetings went only to USAID HPNO IPs; however, Communicate for Health ensured the participation of the HPD. Communicate for Health had the privilege of hosting one of these meetings in November 2016, on the theme Performance Management: Target Setting, Data Demand, and Use. Both the project and HPD staff also participated in a three-day training on a cloud-based mapping platform, ArcGIS Online, organized by Evaluate for Health and focusing on techniques for map production using mock data.

Communicate for Health Annual Report: Year 2 45

Successes and Lessons Story 3: Incorporation of HP Tools and Indicators into DHIMS 2 An important goal of the HPD for several years has been to incorporate SBCC indicators into the DHIMS 2. Creating a systematic approach for collecting and analyzing these data—and using them to improve programing and target the use of limited resources—has been a challenge. Communicate for Health has been working with Evaluate for Health; Systems for Health; UNICEF; GHS/Policy Planning, Monitoring, and Evaluation (PPME); and GHS/FHD toward this goal. Capping approximately seven months of intensive work, the project and UNICEF jointly funded a “Boot Camp” in Koforidua in the Eastern region from December 14–17, 2015 to incorporate the HP indicators into DHIMS 2.

The result was definitions of 33 HP/SBCC indicators, “It has been a long journey but 22 of which will be captured routinely on a monthly finally we are now convinced that or quarterly basis by health staff at the facility and we have HP [SBCC] tools that can district levels and entered into the DHIMS 2 be reported monthly and quarterly platform. Highlights include the following: to help make decisions which are  Proportion of trainings conducted by HPD data driven.”  Proportion of HP personnel/focal persons –PPME staff member trained on HP protocols and guidelines  Number of proposals for funding SBCC activities submitted  Number of meetings organized to review HPD performance indicators  Number of monitoring/supervisory visits conducted  Number of evaluations conducted by HPD for key health behaviors  Number of target audiences reached with SBCC activities  Number of media houses engaged to undertake health promotion activities  Number of programs and messages aired/published by media houses  The number of SBCC events/ programs jointly held with partners  Number of active Health Promotion Champions (HPC)  Proportion of activities in the action plan implemented by HPCs

While these indicators are primarily concerned with capacity building and SBCC processes, behavior indicators will also be collected via surveys on an as-needed basis. A data collection tool has been created for this purpose, focusing on Percentage of community members practicing desired behaviors in health areas: Child Health, FP, RH, Nutrition, Adolescent and Reproductive Health, HIV/AIDS and Mental Health.

The Boot Camp concluded with a presentation to multiple stakeholders including regional officers on the HP M&E framework, data collection tools, and a demonstration of the DHIMS 2 platform. Yvonne Ampeh, the M&E focal point for HPD was nominated by the Head of HPD as the Best Worker for HPD for the year 2015 for her hard work and contribution towards this accomplishment.

Data will be validated, analyzed, and reported during GHS meetings, including regional performance reviews and FHD retreats, to inform decision making.

Communicate for Health Annual Report: Year 2 46

Successes and Lessons Story 4: Evidence-based Programming Using Mobile Technology— The VOTO Mobile Survey Experience Why use mobile phones for surveys? Traditional methods of data collection and processing are usually resource- and time-intensive. Complex logistical arrangements are needed to train data collectors, print tools, transport and supervise field workers, hire staff for data entry and analysis, and create systems to ensure data quality. In an effort to streamline this process, with the challenge of not being resourced for face-to-face or household level data collection, Communicate for Health partnered with VOTO Mobile in January and February of 2016 to conduct a cross- sectional survey using mobile phones with interactive voice VOTO Staff transcribing participants’ response (IVR) technology. audio feedback.

The approach was considered especially promising because Ghana has a high mobile phone penetration. In December 2015, according to the Ghana National Communication Authority, the country had 18 million phone subscribers, or about 66 percent of Ghanaian citizens. (The Pew Research Center reported somewhat higher mobile phone penetration rates in 2014, with 83 percent of Ghanaians surveyed saying they own a mobile phone.)

The purpose of the survey was to gauge audience reach and feedback on the original BCS Good Life, Live it Well campaign messages aired by the project. VOTO is a Ghana-based technology startup and social enterprise that helps clients share information and gather feedback through interactive SMS or voice calls in local languages.

The technology involved placing phone calls to participants with pre-recorded voice instructions and questions that can be answered through key pad presses on their own mobile phones. Participants do not incur airtime charges.

In the cross-sectional survey, random digit dialing (RDD) sampling was employed to generate potential Ghanaian mobile phone numbers. Since data entry was accomplished directly by the survey participants using their mobile phones, data entry and coding errors were minimized.

Reaching Life Stage audiences and filling sample quotas. The survey was fielded in two waves: from January 14–21, and from February 24–March 2, 2016. Response rate was monitored during the first phase and certain adjustments were made. Altogether 9,801 respondents selected a language to begin the survey, of which 2,249 completed demographic information. (A 20-30 percent response rate is considered in line with other reports of RDD response rates.)

Among these, 855 respondents were “eligible” for the survey (i.e., they fell into the four Life Stages) and 675 of those (or 79 percent) completed the survey.

As part of the survey design, participant quotas were established before survey launch to ensure minimum samples of audiences across the four Life Stages (males 18–35, females 18–35, females with children under 5 and pregnant women) as well as regions (Central, Greater Accra, Northern,

Communicate for Health Annual Report: Year 2 47

Volta, and Western). In total, 176 out of the 198 required quota slots were filled. Some quota sizes, especially those for males, were oversubscribed (63 percent were male and 37 percent were female). Quotas for pregnant women and caregivers of under-fives as well as persons living in two regions (Northern and Volta) were the hardest to fill and these audiences remained under represented at the time of data analysis (See Table 9 below).

Communicate for Health has been in discussions with USAID about the best way of ensuring that minimum samples for regions and Life Stages will be met in future surveys.

TABLE 9 Participation of Life Stage and Regional Audiences in the two Mobile Survey Waves

QUOTA # FILLED # FILLED TOTAL % DESCRIPTION SIZE WAVE 1A WAVE 1B* FILLED FILLED Females with a Child under age 5 from Central region 8 4 2 6 75% Females with a Child under age 5 from Greater 17 18 0 18 106% Accra region Females with a Child under age 5 from Northern region 8 1 2 3 38% Females with a Child under age 5 from Volta region 8 4 2 6 75% Females with a Child under age 5 from Western region 8 4 2 6 75% Female Young Adults from Central region 4 5 0 5 125% Female Young Adults from Greater Accra region 8 9 0 9 113% Female Young Adults from Northern region 4 2 2 4 100% Female Young Adults from Volta region 4 1 1 2 50% Female Young Adults from Western region 4 2 1 3 75% Female Youth from Central region 4 2 2 4 100% Female Youth from Greater Accra region 8 9 0 9 113% Female Youth from Northern region 4 3 1 4 100% Female Youth from Volta region 4 1 3 4 100% Female Youth from Western region 4 4 0 4 100% Male Young Adults from Central region 4 5 0 5 125% Male Young Adults from Greater Accra region 9 10 0 10 111% Male Young Adults from Northern region 4 5 0 5 125% Male Young Adults from Volta region 4 5 0 5 125% Male Young Adults from Western region 5 6 0 5 120% Male Youth from Central region 4 5 0 5 125% Male Youth from Greater Accra region 9 10 0 10 111% Male Youth from Northern region 4 5 0 5 125% Male Youth from Volta region 4 5 0 5 125% Male Youth from Western region 5 6 0 6 120% Pregnant Females from Central region 8 5 3 8 100% Pregnant Females from Greater Accra region 17 14 3 17 100% Pregnant Females from Northern region 8 2 1 3 38% Pregnant Females from Volta region 8 0 5 5 63% Pregnant Females from Western region 8 8 0 8 100%

* Quotas over filled in Wave 1b are not reported

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SECTION 5 Partnerships and Coordination

COLLABORATION AND COORDINATION WITH PARTNERS In YR 2, Communicate for Health continued to strengthen collaboration among a range of partners in pursuit of common SBCC goals. In addition to working closely with the GHS and HPD in all matters, the project worked regularly with Systems for Health, SPRING, RING, SHOPS, VectorWorks, Evaluate for Health, NPC, NMCP and UNICEF. Activities ranged from support for SBCC coordination, materials development and pretesting, strategic planning, and monitoring and evaluation to consultative meetings, document exchange and review, experience sharing, and leveraging of resources to carry out joint activities with the GHS.

MONTHLY JOINT PLANNING AND COORDINATION MEETINGS WITH HPD Joint monthly planning and coordination meetings with HPD have continued to drive project work plan activities. Fifteen meetings have been held since the start of the project, including one in the last quarter and six meetings in total during YR 2. Staff of Communicate for Health and of the HPD alternate taking minutes; these are reviewed and used as references during subsequent meetings. Over the last two quarters, meetings focused on planning for the launch and regional rollout of the refreshed GoodLife brand, launch of the CBSP for HPD, the Korle Bu office renovations and co- location, and efforts to strengthen the ICC-HP at the national and regional levels. The joint meetings have further consolidated the working relationships between Communicate for Health and the GHS/Heath Promotion Department.

NORTHERN REGION USAID IPS COORDINATION MEETINGS Three IP SBCC coordination meetings were held in Tamale in YR 2. Participating IPs included SPRING, RING, Systems for Health, WASH for Health, and Communicate for Health. The meetings were hosted in turns by the various IPs and coordinated by the Northern Regional GHS/HPD. Partners discussed strategies for implementing activities, common challenges, and shared lessons learned. Communicate for Health updated members on progress made on the GoodLife refresh and contracts signed with the Northern regional radio stations. Recommendations were made on how partners can collectively utilize the airtime. IPs mapped out cross-cutting areas and prioritized areas of SBCC support to work with the RHPO and TOHPs based in the region. The last meeting, held September 14 and hosted by Communicate for Health, focused on updates and preparations for the GoodLife celebration recently held in Tamale and discussions about the upcoming GoodLife brand book.

COORDINATION WITH SYSTEMS FOR HEALTH Communicate for Health delivered print-ready versions of the IPC job aids to Systems for Health and the Institutional Care Division of the GHS to facilitate their trainings of facility staff on infection prevention and control. The materials included job aids on hand hygiene, alcohol hand rub,

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preparation of chlorine, and Personal Protective Equipment (PPE). The project also worked with Systems for Health to develop talking points for the GHS on why sufadoxin pyrimethamine (SP) is important for pregnant women and worked to carry out World Malaria Day activities at the national level and in the USAID focus regions. Along with GCRN, the two projects collaborated to create demand for services offered at the Community-Based Health Planning and Services (CHPS) compounds and to promote optimal behaviors for FP, MCH, WASH, nutrition, and malaria prevention and case management.

COLLABORATION WITH WASH FOR HEALTH Two project teams participated in a Behavior Change Communication (BCC) Strategy formulation workshop organized by Global Communities—a USAID-funded Water, Sanitation, and Hygiene (WASH) for Health Project. The results of the workshop fed into the development of a draft BCC plan for WASH that proposed BCC materials required, a range of activities to be undertaken, and training needs of key groups, which has subsequently been circulated to partners for comment.

WORKING WITH VECTORWORKS Communicate for Health participated in two workshops featuring message development for Vector Works’ School based LLIN distribution strategy with the NMCP. Communicate for Health made inputs on both the LLIN distribution and BCC strategy documents. Upon the request of VectorWorks, Communicate for Health provided support for printing half of the 60,000 posters promoting regular LLIN use, which were distributed to primary schools throughout the country as part of a school based net distribution campaign.

SUPPORT FOR 2016 WORLD MALARIA DAY PRESS BRIEFING AND CELEBRATIONS Working with the National Malaria Control Program (NMCP) and Creative Storm Network, the project supported the development of a 30-minute malaria advocacy video documentary entitled Domestic Financing of Malaria—Role of Corporate Ghana, as well as a 6-minute abridged version. The documentary highlights the economic costs of malaria in Ghana and why the private sector should invest in national efforts to prevent and curb the disease—particularly given dwindling donor funding. (See also Successes and Lessons: Story #5)

As part of activities leading to the commemoration of the 2016 World Malaria Day Celebration on April 25, Communicate for Health provided an extensive platform for media coverage, particularly in USAID focus regions. The project coordinated pre-event publicity announcements and a total of 28 PSAs and ten interview discussions were held on various national radio stations including Radio Ghana, Peace FM, Joy FM, Starr FM, and Obonu FM. A total of 32 PSAs including 11 interviews were conducted across several national television stations including GTV, UTV, Adom TV, Joy News, TV3, and Viasat 1.

The World Malaria Day press briefing attracted over 150 participants, including traditional leaders, school children, women’s groups, and health professionals, as well as the key members of the press. Journalists from six television stations including GTV, Adom TV, Joy News, UTV, Metro TV, and Viasat 1; five national radio stations including Joy FM, Peace FM, Adom FM, Starr FM, and Oman FM; and the national newspapers covered the event. NMCP Program Manager, Dr. Constance Barte-Plange

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provided an overview of malaria in the Ghanaian context. She highlighted some key interventions employed by the NMCP to address malaria such as LLIN distribution and promotion; Indoor Residual Spraying; and Track, Test, and Treat for malaria case management. Communicate for Health supported HPOs in USAID focus regions to replicate the celebrations in their respective regions. The project provided communication support for interactive radio discussions and PSAs. In Western Region, 40 PSAs and eight interactive radio discussions on World Malaria Day were held on ROK FM, Twin City Radio, Good News Radio, and Skyy FM. In the Central Region, 80 PSAs were broadcast including eight interviews on Radio Central, Ahomka FM, Eagle FM, and Cape FM. In the Volta Region, eight interactive interview discussions were held on Volta Star Radio, Jubilee Radio, Lorlornyo FM, and Victory FM.

SUPPORT FOR 2016 CHILD HEALTH WEEK CELEBRATION Communicate for Health also provided support to FHD for Child Health Promotion Week, May 9–13, 2016, with the production and printing of 23,000 GoodLife, Start it Right posters and 23,400 brochures on child health. A total of 15 posters and 400 brochures were used by the GHS during the celebration and the remainder were given to the FHD for distribution to the regions and districts. Extensive publicity was provided on five national radio stations: Uniiq FM, Joy FM, Peace FM, Starr FM, and Obonu FM. Collectively these stations broadcast 50 PSAs and encouraged people to take advantage of all the free services available for young children (immunizations, baby weighing, and vitamin A). HPOs also collaborated with Ghana Community Radio Network to replicate Child Health Promotion Week programming on ten Community Radio Stations in Greater Accra, Northern, Volta and Central Regions.

SUPPORT FOR 2016 WORLD BREASTFEEDING WEEK A press briefing on World Breastfeeding Week was held July 25, 2016, at Cleaver House, Accra. The theme for the celebration was Breastfeeding: A Key to Sustainable Development. Mrs. Eunice Sackey, the GHS Program Coordinator for Breastfeeding, presented on the current situation of breastfeeding in Ghana.

A number of media houses covered the event: UTV, GTV, VIASAT1, TV Africa, TV3, Metro TV, and Multi TV—which also operates on Adom TV and Joy News. The press briefing was also covered by the following radio stations and print media houses: Joy FM, Adom FM, Peace FM, Radio XYZ, Radio Ghana, Kasapa FM, Daily Graphic, Ghanaian Times, GNA, The Finder, Public Agenda, and GhanaWeb.

COMMEMORATION OF 2016 FAMILY PLANNING WEEK AND PRESS BRIEFING Communicate for Health supported the celebration of the 2016 Family Planning Week. The celebration took place in the Central region and was commemorated on September 26 in Accra. The commemoration was organized to coincide with the GHS monthly press briefing and was on the theme: “Family Planning-it's your life, take control! It's an everyday thing.” The ceremony was attended by 164 participants and received wide media coverage. The project provided support in the form of GoodLife brochures and posters featuring FP and rental of the venue. Other USAID partners also participated and mounted stands, displayed their FP products, and promoted their services.

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5TH ANNUAL NATIONAL NEWBORN STAKEHOLDERS CONFERENCE The 5th Annual Newborn Stakeholders conference was held in Accra from July 26 to 28 on the theme; “Save me from ASPHYXIA: Help me Breath, Help me Live.” The goal of the conference was to assess progress being made on the National Newborn Health Strategy and Action Plan 2014 – 2018 and chart the way forward. The event also served as an opportunity to discuss progress on the Ghana National Newborn and Child Health Advocacy and Communication Strategy (2015 – 2019).

About 200 participants were present including Regional Health Directors and heads and representatives of various governmental and non-governmental organizations, academia, development partners, private sector, journalists, and civil society organizations working in the area of newborn care. Communicate for Health contributed to the planning and organization of the workshop by printing and mounting poster displays from all ten regions on newborn care issues and progress being made as well as the production of the conference program and banner. A short skit on newborn care and asphyxia presented by a local theatre troupe as part of the opening ceremony was likewise supported by the project.

ADDITIONAL COORDINATION WITH GHS AND RELATED PROGRAMS Communicate for Health provided ongoing technical assistance to the NMCP as part of its regular SBCC technical working group and Resource Mobilization technical group. It was actively engaged in the review of the NMCP’s malaria communication strategy. The project continued to be an active participant in the FHD Newborn Sub-committee. Due to its strong collaboration with the GHS, Communicate for Health was invited to present at this year’s Annual Health Sector Performance Review—a national event organized with all ten regions held each April—as well as the annual retreat of the FHD, held in May.

OTHER EVENTS, MEETINGS AND PRESENTATIONS

Drama Scriptwriting Workshop with GCRN Communicate for Health participated in a Drama Scriptwriting Workshop organized by GCRN from May 9 to 13, 2016, at the Institute of Local Government Studies. The purpose was to discuss and finalize the radio drama series drafted to address teenage pregnancy at the community level, as identified in a GCRN design workshop the previous quarter.

CO-LOCATION HIGHLIGHTS

Rehabilitation of Korle Bu Health Promotion Department Office Building In March 2016 USAID approved a modification to the Cooperative Agreement allowing the project to carry out construction on the GHS/HPD office building at Korle Bu. A competitive process was conducted to identify a contractor in the second quarter of the year and a contract was awarded in April. The Ghana Environmental Protection Agency (EPA) also completed an environmental impact assessment at the site and approved the rehabilitation works. A report is being prepared by the EPA for submission to USAID. Three project site meetings have been held following joint inspections of the work in progress. The GHS/HPD staff and staff of the GHS Estates Department responsible for supervising the construction have all expressed satisfaction with the progress and quality of work.

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Rehabilitation should be completed on schedule by November. It is expected that staff of Communicate for Health will co-locate with their counterparts at Korle Bu by December (See Table 10 below.)

TABLE 10 Updated schedule for rehabilitation of Korle Bu office building and co-location plan

DATE ACTIVITY RESPONSIBILITY

August 15 Mid review of rehabilitation work FHI 360 & GHS

November 30 Rehabilitation completed Contractor/GHS Estates/ Quantity Surveyor (QS)

December 10 Official hand over Contractor & GHS/FHI 360

December 15 Project staff co-locate at Korle Bu COP and Deputy COP, Communicate for Health

The co-location team includes the project’s Deputy COP and the Senior Organizational Development Specialist as well as two senior members of the HPD. The team advises Senior Management on important actions needed to ensure a smooth transition prior to, during and after co-location and provides regular documentation of the status of the Korle Bu office environment as part of the HPD work condition assessment.

CONTRACTS AND GRANTS MANAGEMENT

Fixed Amount Award (FAA) with GHS/HPD Mr. Keith Aulick, FHI 360 Technical Advisor for Leadership and Capacity Development, has been working with the HPD on behalf of the project to develop a Fixed Amount Award (FAA) that will enable HPD to take on stronger leadership of activities indicated in the Communicate for Health work plan. HPD developed and submitted a draft program description, output summary, budget, and budget notes for the FAA, with technical assistance to be provided onsite at the HPD office.

Thus far technical assistance to develop the FAA technical narrative, milestones, and detailed budget has been provided over nine sessions, each lasting approximately three hours. Topics to date have included how to develop a program description, how to develop output-based project budgets, how to write budget notes, and developing and negotiating new project agreements. In contrast with traditional grants, FAAs require a great degree of detail including cost justification and verification. To assist with this, job aids have been develop allowing HPD to estimate with a high degree of accuracy the fuel required to travel anywhere in Ghana and a methodology for estimating fuel prices up to 12 months in the future. Facilitation and coaching efforts have included traveling with the HPD team to obtain quotes for bus travel.

The FAA will be submitted to USAID for approval in the coming quarter.

A capacity strengthening plan centered around FAA administration will also be completed in the comping quarter. The capacity strengthening agenda, now under development in consultation with

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leaders from HPD and FHD, will likely include key compliance measures required under FAAs, documenting and reporting milestone achievements, and an orientation to programming at USAID Ghana. The plan will offer training and performance support to staff involved in activity planning, award management, and reporting for two to three staff from both HPD and the FHD.

CHALLENGES AND OPPORTUNITIES Key challenges and opportunities encountered during YR 2 are highlighted below.

Challenges Differences in operational systems and procedures between GHS/HPD and FHI 360: The HPD, Communicate for Health’s main GOG partner, has a different system of accountability and stewardship of resources. The HPD is currently required to follow FHI 360’s administrative structures and systems for disbursing and retiring funds for project activities. Although there were challenges in the beginning, improvements have been made during the year and more effort will be made in YR 3. In YR 2, Communicate for Health developed a standard operating procedures manual to clarify procedures and provided at least two orientation sessions to HPD staff.

Coordination with other GHS/FHD Departments and Divisions: The scope of Communicate for Health’s work requires effective coordination and engagement of different sectors and units within the GHS (such as Nutrition, MNCH, FP, EPI, Disease Surveillance, and Safe Motherhood). However, HPD staff believe that Communicate for Health activities fall within their specific mandate and are reluctant to include other divisions and departments in various activities (e.g., in training workshops). While HPD has focal points for various technical areas, direct participation of other technical units and departments is critical to ensure accurate content of SBCC strategies, messages and materials. Development of the GoodLife materials has been particularly challenging in this regard. Over the next several months more attention will be given to ensure the involvement of key managers within the FHD and Public Health Division of the GHS so that common goals for SBCC capacity building are achieved.

Opportunities Korle Bu Renovation: The goal of co-location for the GHS and FHI 360 will be achieved with completion of Korle Bu renovations. The building renovation presents a great opportunity to improve the current HPD work environment and morale, as well as relations among the GHS, Communicate for Health, and USAID. Deputy Chief Health Promotion Officer, Alhaji Abu Sufyan had this to say about the renovations: “Now co-location will be a reality; the auditorium will bring in needed revenue to enhance our work and the resource center once completed will help raise the visibility and profile of the Health Promotion Department.”

USAID IPs and other Partners Enthusiasm for GoodLife: Feedback received from various USAID IPs as well as UNICEF and other stakeholders has demonstrated broad goodwill toward embracing the refreshed GoodLife, Live it Well brand as the hallmark for future GHS health communications. UNICEF has pledged support for the new brand while Systems for Health, PSI, VectorWorks, MalariaCare, WASH for Health, SPRING, RING, and others have all endorsed the refreshed GoodLife logo as well as teasers and reveal materials. RING has expressed interest in integrating the GoodLife concepts and messages in their work on promoting good governance and livelihood development with district and local authorities in northern Ghana.

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Use of Mobile Technology (IVR) for Conducting Surveys: The project is blazing a new path with the use of mobile technologies using IVRs to collect data for health. Different institutions including the GHS, Evaluate for Health, and the USAID MECOP have requested the project’s Senior M&E Advisor to present and share the Communicate for Health experience. In the first quarter of YR 3, Communicate for Health will launch the first mobile cohort survey, applying lessons learned in the cross sectional survey and ensuring high quality data for monitoring program performance. The project will also explore opportunities for sharing this experience internationally during upcoming SBCC conferences and webinars and presentations at USAID Washington.

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Successes and Lessons Story 5: Production of Advocacy Documentary for Domestic Financing of Malaria Control Program

A stunning documentary and an hour-long radio program—both developed by Communicate for Health’s partners—are ensuring that malaria messages are reaching diverse audiences.

Investing to Tackle the Economic Burden of Malaria. Many people know that malaria is the biggest killer in Ghana and leading cause of mortality in children under five years and morbidity among pregnant women. However, fewer people are aware that (in 2014), the economic cost of malaria to businesses in Ghana was $6.6 million.

To support efforts by the GHS to enhance domestic financing of the NMCP, Communication for Health contracted with Creative Storm Networks (CSN) to produce a 30-minute documentary film— Ending Malaria for Good—to make a strong case for private sector support towards the goal of a malaria–free Ghana. Volta Region and Northern Region, two regions with extremely high incidence of malaria, were selected for filming. Most of the high profile interviews of business leaders, including Prince Kofi Amoabeng, President of UT Holdings and Dr. Joyce Aryee, former CEO of Ghana Chamber of Mines, were filmed in Greater Accra.

One of the highlights of production was aerial filming of the famous rice farms in Volta Region. Drone technology was used to capture the expansive farms, which unfortunately are also conducive to massive mosquito breeding. In Northern Ghana, the documentary focused on human stories to highlight the socio economic impact of malaria on ordinary citizens.

Preventing Malaria through Community Radio and Popular Engagement. Communicate for Health’s partner GCRN worked with ten community radio stations (CRS) to produce an hour-long program on the theme End Malaria for Good; Invest in the Future. The program focused on the following themes: 1) malaria kills, 2) prevent malaria and protect your family by sleeping under a treated net, and 3) when you are sick get tested for malaria and get appropriate treatment at the nearest CHPS compound or health facility.

The program used authentic stories and featured community voices, especially those of Most Affected and Well Informed Persons (MAWIPs) including nursing mothers, pregnant women, children, health workers and GHS Malaria Focal Persons. In telling the stories, communities took ownership of the process by featuring their own songs, proverbs, and local sounds.

The messages were backed by malaria jingles that were originally sponsored by UKAID and adapted for use by the community radio stations (CRSs). The program flowed in a logical way based on researched facts and materials (notes and audio recordings) and included two vox-pop interviews

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(with GHS/HPD staff and community members) and a 6-minute drama. The drama emphasized the need to sleep under an LLIN and to seek care from a health facility. The story featured a child who does not sleep under a treated net, falls sick, and is sent to a faith healer. Finally, the child is taken for health care at the clinic where desperate measures are taken and the dying child is saved.

Community members who phoned into the program on Radio Breezy expressed anger at the husband who sent his sick child to a faith healer instead of the hospital. One community member said, “This man did not exhibit the mark of a good father” and suggested that continuous education and counseling would help the public to handle such issues appropriately.

On one radio station (Radio Ada) resource persons explained the benefits of using an LLIN and how one should handle and take care of the net. Listeners then called in and stated that they now realized that the nets they were using had expired long ago. This revelation was brought to the attention of the Ada East District Disease Control Officer (Mr. Tetteh Onumah) who promised on live radio that the district would ensure that the problem was fixed quickly. True to his word, the district has begun distributing new LLINs to the communities within the Ada East District.

All ten CRSs carried out the Malaria Day Program as planned. Radio Dayi, however, went a step further and organized a quiz contest for school children and clean-up exercises in some listening communities. The station also distributed LLINs to communities and crowned the Malaria Day celebrations with a durbar. They worked in partnership with the GHS and three organizations (Check Health Services, Women for Peace, and Alliance Health Network) to obtain 500 LLINs; 400 of these were distributed freely to children under five in eight communities in the Volta region and the remaining were given out as prizes to community members who answered questions correctly during phone-in discussions.

TABLE 11 Community radio stations, broadcast coverage by district, and language of broadcast

REGION/ STATION BROADCAST DISTRICTS/ MUNICIPALS LANGUAGE

Greater Accra Radio Ada Ada East, Ada West, Ningo Prampram Dangbe Radio Emashie Ga West Ga Radio LaTeNu La Dade-Kotopon, Ledzokuku-Krowor Ga Central Radio Arise Twifo-Atti-Morkwa, Twifo-Heman-Lwr Denkyira Twi Radio Breezy Ajumako-Enyan-Esiam Fante Radio Peace Efutu, Gomoa East, Gomoa West, Ekumfi, Mfantseman Fante Volta Radio Dayi North Dayi, Kpando, South Dayi, Afadjato Ewe Northern Radio Lom Bunkpurugu, Yunyoo Gonja West, Central Gonja, North Gonja, Bole, Sawla-Tuna Radio PAD Gonja Kalba, Bole Radio Simli Tolon, Kumbungu, Savelugu, Nanton Dagbani

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SECTION 6 Overview of what to expect in Year 3

Below are key highlights of proposed activities for YR 3.

1. NEW GOODLIFE, LIVE IT WELL TV, RADIO AND PRINT MATERIALS BASED ON LIFE STAGES: During YR 3, Communicate for Health will prioritize the development of new GoodLife, Live it Well TV, radio, and print materials for key Life Stages. These will be distributed to the five USAID priority regions and districts. In the first quarter of the year the project will begin developing targeted integrated messages, phase out the old BCS programming, and develop additional tools and materials for each Life Stage audience.

The project will facilitate two GoodLife workshops to engage regional stakeholders, technical managers in the FHD and Public Health divisions of the GHS, as well as BCC advisors of USAID IPs in the development of new materials and tools. Materials such as posters, flip charts, job aids, games, sketches, stories, and proverbs will be adapted for audiences in the northern and southern sectors. The project will explore the possibility of adapting the Community Conversational toolkit for HIV (initially developed for the FHI 360 C-Change project) to the Ghanaian context. Materials development will continue to be rooted in human centered design.

The project will work with UNICEF and other USAID IPs to complete the review and creation of an online inventory of existing SBCC and community mobilization tools and training materials. Communicate for Health will also collaborate with the NPC, the Palladium Group, DFID, and the FHD to develop and produce new episodes of YOLO–You Only Live Once programming that promotes GoodLife, Live it Well messages and It’s an #everydaything interventions.

Working with partners Creative Storm Networks, GCRN, and VOTO Mobile, Communicate for Health will create a strong and vibrant social media platform to promote the GoodLife messages. The project will work with VOTO Mobile and Human Network International (HNI)/AIRTEL to expand the existing mobile technology platform that delivers tailored messages to Life Stage audiences via IVR and SMS, linking them to services with interactive feedback mechanisms through alerts and reminders.

In YR 3, Communicate for Health will create three new documentaries and nine 26-minute Maternal Health Channel programs to build awareness and support the operationalization of the National Advocacy, Communication, and Social Mobilization Strategy for Newborn and Child Health, the Family Planning Costed Implementation Plan (2016–2020) and the National Nutrition Strategy.

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Finally, the project will provide technical assistance to JICA and work with the HPD to redesign the maternal and child health record booklets.

2. HIV/AIDS PROGRAMMING: Beginning in YR 3, Communicate for Health will carry out work in collaboration with the PEPFAR team to produce HIV/AIDS programming. The project has been asked to offer technical assistance in two main areas:

 Coordinate with the USAID Strengthening the Care Continuum Project to review and update a core set of SBCC HIV materials with reference to 90-90-90 and Test & Start frameworks, as well as the standard operating procedures for Key Populations (KP). The project will work with key stakeholders to conduct a systematic review of existing SBCC materials for HIV/AIDS and update these as appropriate.  Conduct Action Media Workshops to explore rural community perspectives on KP related to the HIV care continuum—with emphasis on community support, access to services, and stigma and discrimination. At least six Action Media Workshops will be conducted with participants drawn from the HIV priority focus regions of Ashanti, Brong Ahafo, Eastern, Western, and Greater Accra regions. The results will be documented and a summary report prepared with recommendations for dissemination at appropriate fora.

3. CONTINUATION AND BROADENING OF THE HPD CAPACITY BUILDING SUPPORT PROGRAM (CBSP): Building on the work started in YR 2, Communicate for Health will work with the GHS/HPD to continue with the CADP and SfC Action Learning Sets for remaining cohorts, intensify and accelerate implementation of the Change Challenge Fund, establish an award scheme for Healthy Districts and Healthy Communities, and a Top Health Promoter Award . The Change Challenge Fund will be launched in YR 3. The project will work with staff of the FHD to facilitate training for regional HPOs in SBCC and on social and digital media.

4. INTENSIFY SBCC COORDINATION AND ENGAGEMENT WITH PRIORITY REGIONS: In YR 3, Communicate for Health will intensify collaboration with IPs working in the focus regions. The project will establish mechanisms for regular meetings to share ideas and join forces on the rollout of the GoodLife, Live it Well messages. Work in the Northern Region will be expanded/strengthened to other regions through collaboration with Systems for Health, MCSP, SPRING, RING, Peace Corps, and HealthKeepers to ensure messages and materials (including tools for IPC and community mobilization) reach the sub district and community levels for use by Community Health Officers, Community Health Nurses, and TOHPz. Such collaboration will complement Communicate for Health’s above the line media campaigns with local initiatives that build demand for health services and create an enabling environment for SBCC at the community and household levels. The role of the HPOs will be emphasized. The project will support development of a plan to strengthen capacities of the HPOs and TOHPs and help devise innovative ways to resource their activities. Communicate for Health will lead the process to integrate the

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national and regional HPD offices into the IPs’ work plans, to ensure HPD is properly positioned to support the SBCC agenda of various IPs working in the focus regions.

5. CO-LOCATION WITH HPD The proposed renovations works are expected to be completed by October. Following the completion and inauguration and/or ribbon cutting ceremony expected in November, the Communicate for Health staff will co-locate at Korle Bu which will deepen joint planning and integration of the teams.

6. NEW SBCC LOCAL ORGANIZATION ENGAGED Communicate for Health will formally engage the selected local SBCC NGO in capacity building and SBCC activities once USAID concurrence and approval have been received. The project will begin the process of conducting a capacity assessment and institutional strengthening while simultaneously working with the organization, together with HPD, to roll out the GoodLife, Live it Well campaign particularly in the five USAID focus regions.

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