USAID/ Systems For Better Health Strategy for Community-level Social and Behavioral Change Communications Interventions

June 2017

This publication was produced for review by the United States Agency for International Development. It was prepared by Abt Associates for the USAID Systems for Better Health activity.

Contract No: AID-OAA-I-14-0003 Order No: AID-611-TO-16-00001 GUC Mechanism

Submitted to: William Kanweka Contracting Officer’s Representative USAID Zambia

Prepared by: Abt Associates Inc.

In collaboration with: American College of Nurse-Midwives Akros Inc. BroadReach Institute for Training and Education Initiatives Inc. Imperial Health Sciences

Save the Children Contents

Acronyms ...... ii 1. Introduction ...... 3 1.1 Background ...... 3 1.2 Rationale for Social and Behavioral Change Communication Strategy ...... 3 2. Methodology ...... 4 3. Situational Analysis ...... 4 3.1 Health-related Knowledge, Attitudes, Practices and Norms (Demographic Health Survey 2013-2014) ...... 4 3.2 Community Health Structures ...... 6 3.3 Status of SBCC implementation structures ...... 6 4. SBH SBCC Strategy ...... 8 4.1 Framework and Objectives ...... 8 4.1.1 Objective 1: Strengthening SBCC-related documents, frameworks, and materials ...... 8 4.1.2 Objective 2: Strengthening SBCC-related structures at all levels ...... 9 4.1.3 Objective 3: Supporting effective implementation of SBCC activities ...... 10 Annex I: List of Stakeholders Consulted ...... 12 Annex II: List of Documents Consulted ...... 14

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Acronyms

AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral Therapy CBO Community-based Organization CBV Community Based Volunteer CDA Community Development Assistant CHA Community Health Assistant HCC Health Center Committee HIV Human Immunodeficiency Virus HMIS Health Management Information System MNCH Maternal, Neonatal, and Child Health MOH Ministry of Health MOCDSW Ministry of Community Development and Social Welfare NFNC National Food and Nutrition Commission NGO Non-governmental Organizations NHC Neighborhood Health Committee NHSP National Health Strategic Plan SBCC Social and Behavioral Change Communications SBH Systems for Better Health SMAG Safe Motherhood Action Groups TWG Technical Working Group USAID United States Agency for International Development

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1. Introduction

1.1 Background Systems for Better Health (SBH) is a five-year United States Agency for International Development (USAID) project in Zambia that aims to improve health outcomes for Zambians through strengthening the health systems that underpin the delivery of high quality health services. The project also seeks to increase the utilization of high impact health interventions in HIV, family planning, maternal, newborn and child health including nutrition at district and community levels. The objective of SBH is to assist the Ministry of Health (MOH) in 20 target districts in five provinces (Table 1) to: • Increase retention of HIV patients on antiretroviral therapy (ART) to 85 percent; • Increase the use of modern contraceptives by 10 percent; • Increase the proportion of deliveries assisted by a medically trained provider by at least 20 percent; and • Increase the proportion of fully immunized children aged 12 to 23 months to at least 80 percent. To achieve this objective, SBH provides technical, financial, logistical and administrative assistance to the MOH at the national, provincial, and district levels. The project also works to strengthen the capacity of non-governmental and community-based organizations (NGOs and CBOs) to foster healthy behaviors and to deliver selected health services in remote areas.

Table 1: SBH target provinces and districts Province Central Copperbelt Eastern Southern Districts Shibuyunji Livingstone Mkushi Lusaka Monze Luangwa Gwembe Chililabombwe Chikankata At the central MOH, SBH seconds a Community Health Specialist to the Directorate of Health Promotion, Environment and Social Determinants who collaborates with his MOH counterparts to put in place policies and guidelines for strengthening community and health facility linkages. At the district level, SBH embeds health systems strengthening specialists who collaborate with the District Health Office Health Promotions Officers to implement the national policies that enhance positive social and behavioral change in the communities. 1.2 Rationale for Social and Behavioral Change Communication Strategy Communities, families and individuals play a crucial role in the provision of public health services aimed at reducing morbidity and mortality from ill health and diseases. Health promotion and education interventions empower individuals, families, and communities with appropriate knowledge, understanding and attitudes which support healthy life styles and behaviors to prevent diseases and ill health. As highlighted in the Zambia National Health Strategic Plan (NHSP) 2011-2015 mid-term review, the main challenges to improving health outcomes are poor health-seeking behaviors, non- availability of full time health promotion officers at district level, limited funding for social and

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behavioral change communications (SBCC), limited community partnerships, and weak monitoring, evaluation and research of SBCC interventions. Over the last fifteen years, USAID has been supporting the Zambian Government’s efforts to implement SBCC strategies through various implementing partners using mass media channels such as radio, television and print, along with community channels such as interactive sessions and theater. Given recent shifts in USAID/Zambia programming for SBCC, and in light of the IMPACT SBCC Project cancellation, SBH received a contract modification related to Task 3: Provide technical and financial assistance to the GRZ and community-based organizations to increase the quality, availability, and use of priority health services at the community level in targeted districts. Under the revised Sub-task 3.3: Implement community level SBCC interventions to increase utilization of high impact health services, SBH has been asked to implement effective interventions to mobilize communities to change inappropriate health behaviors to healthy ones and increase the demand for high impact practices in target districts. In doing so, SBH must design and implement a cohesive strategy to identify and address health systems barriers to care, including cultural or economic barriers, provider bias, or false rumors and misinformation about family planning, nutrition, maternal, neonatal and child health (MNCH), and HIV practices. The purpose of this document is to clearly outline how the project will cost effectively support the MOH to strengthen SBCC interventions implemented by target districts, other implementing partners, and NGOs and CBOs.

2. Methodology

To inform the development of the SBCC strategy, SBH carried out key informant interviews with relevant organizations, institutions, and projects (see list of stakeholders consulted in Annex I). The project also conducted a field visit to in Central Province, where the team visited two communities and conducted a workshop with SBH counterparts working on community-level efforts to learn about the participants’ priority issues and needs related to SBCC. In addition, the team conducted a desktop review of a number of research, program, and guidance documents (see Annex 2 for a full listing of these resources).

3. Situational Analysis

3.1 Health-related Knowledge, Attitudes, Practices and Norms (Demographic Health Survey 2013-2014) While Zambia continues to make significant progress in improving health indicators across family planning, HIV/AIDS, nutrition, and MNCH, important challenges still remain. Despite relatively high awareness and knowledge about preventing unintended pregnancy, HIV/AIDS, and other major illnesses such as diarrhea, these statistics often do not translate into effective prevention and health- seeking behaviors. The most recent Demographic and Health Survey in Zambia (2013-2014) highlights a number of areas requiring attention via community-based SBCC interventions.

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Half of Zambia’s population is under the age of 15, so young people are an important audience segment for SBCC efforts. Seventeen percent of girls aged15-19 are married, and 45% of all women marry by the age of 18. More than half of all married women have a child by the age of 20, and 29% of girls ages 15-19 are mothers or pregnant with their first child. While the total fertility rate is 5.3, women state on average that the ideal number of children is 4.7, and men prefer 5.0 children. The use of modern contraceptive methods continues to grow, and prevalence is now 49%. However, 21% of women have an unmet need for family planning – 14% for spacing and 7% for limiting births. Among women who did not use family planning in the past 12 months, they report that community health workers discussed family planning with them only 8% of the time. Much progress has been made in ensuring that pregnant women are assisted by skilled providers when they are pregnant and give birth. Ninety six percent of women are receiving antenatal care from a skilled provider, and 63% of women giving birth received postnatal care within the first two days of delivery. However, significant challenges remain in accessing quality care. In addition to environmental factors such as lack of transport and long distances to facilities, 33.7% of women report that providers with rude attitudes are an obstacle to care. The primary killers of young children are pneumonia, diarrhea and malaria. One in every 22 children die in the first year of life, and one in every 13 die before the age of five. Progress is mixed in addressing these challenges. For example, two-thirds of children with diarrhea are receiving treatment at a healthcare facility, and 70% of them receive oral rehydration therapy, but 30% are being treated with antibiotics, which is not the recommended therapy. Forty percent of children under five are stunted, and only 11% of children 6-23 months old are fed appropriately in compliance with the Infant and Young Child Feeding practices guidelines. Almost 100% of children born in the past two years were breastfed, with the median duration 20.1 months. The nutritional status of Zambian children has generally improved since 2001-02. Stunting or underweight has decreased, while wasting has remained unchanged. Zambia’s HIV prevalence rate is 13% among the population 15-49 years old and women have a higher rate (15%) than men (11%). Geographically, Copperbelt has the highest rate in the country (18%) and has the lowest (6%). Comprehensive knowledge of HIV among 15-49 year olds is 42% for women and 49% for men. The vast majority of men and women know that using condoms during sexual intercourse, abstaining from sex, and being faithful to an uninfected partner are ways to prevent HIV. In addition, 78% of women (and 58% of men) know that HIV can be transmitted through breastmilk. Half of all respondents know that a healthy-looking person can have HIV and reject at least two of the most common misconceptions (you can get HIV by sharing food, through mosquito bites, and from supernatural means). When asked about the respondent’s own perceived risk for HIV, 16.8% of women said they are at high risk, and 17.2% said they are at medium risk. For men, the proportions are 14.8% and 14.2% respectively. Youth have the lowest levels of HIV-related knowledge compared to other age groups, with 41.5% of young women and 46.7% of young men demonstrating comprehensive knowledge of HIV/AIDS. Among 15-24 year olds, 49% of men and 4% of women reported using a condom at last sex. Most (93.7%) young men and young women (83.9%) know where to get a condom. About 7% of women 15-19 years old report having had sex in the past year with a man who is at least ten years older. More women 15-24 years old have had an HIV test (56%) than young men (39%). Stigma and discrimination persist, despite more than 30 years of experience in fighting HIV/AIDS. Of those respondents 15-49 who have heard of HIV/AIDS, acceptance rates for several different statements show a range of comfort and bias when thinking about those with the disease: Statement % women agree % men agree I would care for a family member with HIV/AIDS 94.6 95.7 I would buy vegetables from a shopkeeper with HIV 79.1 83.6 Asymptomatic female teacher with HIV can teach 84.6 86

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Don’t want to keep secret that family member has HIV 28.5 37.9 Accept all four statements 18.7 27.5 3.2 Community Health Structures In 2016 SBH conducted a Community Capacity Assessment through which community members shared their perceptions about community-based volunteers (CBVs), the services they provide, and the respondents’ experiences when trying to access health services. CBVs include Neighborhood Health Committee (NHC) members, Safe Motherhood Action Group (SMAG) members, ART Adherence Counsellors, growth monitoring promoters, and home-based care volunteers. Volunteer structures such as the NHCs have a high turnover rate and need training and support. Community Health Assistants (CHAs) operate at facilities (20%) and in the community (80%); tighter coordination is needed between CHAs and the volunteer structures. Respondents confirmed that they receive health information from these cadres of volunteers and also from television, radio, newspapers, posters, churches, friends/relatives and mobile phones. Text messages were cited as the main way of using mobile phones for health promotion, but the volume of messages and language barriers can impact their effectiveness. Interviewees appreciate the CBVs and the work they do, and affirm that they are definitely a trusted source of information. The number of CBVs is insufficient, however, and they need additional support in their technical training, interpersonal communication skills, accessibility, visibility in the community, and transport. On the subject of challenges people face when trying to access services, some respondents noted that health care provider attitudes can be rude, judgmental, and unprofessional. Most of the barriers are structural or environmental in nature, e.g. long distances to facilities, lack of transport and money, and overcrowded facilities with limited operational hours. 3.3 Status of SBCC implementation structures The MOH developed a Community Behavior Change Communication Framework 2011-2015 that outlines its SBCC priorities and strategies. The MOH Health Promotion Guidelines also expired in 2015, however these are still in use although some implementing partners of the Ministry of Health have come up with their own SBCC strategies, there will be need to support MOH to harmonize and develop one national strategy. The MOH has health promotion staff at the provincial level with the exception of Eastern Province. There are only District Health Promotion Officers in Lusaka, Kitwe, and Chililabombwe. The remaining districts have health focal points who are usually Environmental Officers and in some cases are nurses. This severely constrains community-level health promotion abilities. The MOH SBCC budgets are built at district level and go through the Directorate of Health Promotion, Environment and Social Determinants at national level. The MOH has started mapping NGOs working on health promotion at the local level and is supporting the SBCC Coordinating Committees. Additional support to and expansion of the SBCC Coordinating Committees’ membership is needed. Provincial and District-level technical committees need support given membership transition, training needs, and the lack of a quality assurance system to assess how well community-based efforts are working. The Ministry of Community Development and Social Welfare (MOCDSW) includes two structures covering social welfare and community development that, under the new decentralization implementation plan, will report to district councils under local government authority. Each district has three social welfare staff (one officer and two assistants) and three community development staff. The Community Development structure also extends to the sub-center level. Some districts have three sub-centers and some have seven; there are 350 total. Currently there are 553 community development assistants (CDAs) but there is a deficit of 753 Assistants. They participate in community structures through NHCs, SMAGs and other bodies. When a community identifies a health need, the CDA will bring a health person from the nearest clinic to the community to address the issue. Often when the CDAs are working with groups on water, housing, food security, literacy and other needs, health-specific issues are also identified.

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Gaps and needs identified by the MOCDSW include: refresher training for community-based staff, (they use the same SBCC tools at the MOH but need to improve their skills), strengthening the structure of the Community Development program, improving morale, resources to fill the staff vacancies, and improving planning (there is a disconnect between the national and local level planning process). The National Food and Nutrition Commission (NFNC) leads the Scaling Up Nutrition initiative. While the NFNC has a communications unit, they are lacking in SBCC skills. The NFNC is not connected to the wider MOH technical working group (TWG) structure, and connections with other SBCC health programs are also limited. There is no quality assurance system to assess how well community programs are working. An interview with the Senior Health Promotion Officer in highlighted the resource constraints affecting community health promotion. There is a lack of transport, health education and behavior change materials, and personnel to effectively conduct community-level SBCC activities. And when activities are conducted, there is no way to measure their impact. Currently there is an effort to add SBCC metrics to bi-annual Performance Assessments in an attempt to improve programming. Some local structures such as NHCs are effective, but some need to be revitalized and retrained. Family planning and MNCH are the topics generating most interest and questions. Of all the communication channels at local level, door-to-door CBVs are the most effective. The Senior Health Promotion Officer in Choma (previously in Livingstone) confirmed many of the same challenges as her colleague in Copperbelt. In Livingstone community-level SBCC training was conducted for a small group but then it was not rolled out to other areas. Given literacy challenges, the packages of materials for communities should be simplified, and high engagement methods such as community theatre should be prioritized. CHAs are supposed to spend 80% of their time in communities, but many get diverted to health facilities due to human resource constraints. At the Kasanda Health Center in Kabwe a meeting of the Health Center Committee (HCC) took place in which a number of needs were identified. The HCC oversees the SMAGs, malaria volunteers and other CBVs covering all zones in the health center’s catchment area. The NHC noted that the community wants a needs assessment, including on health promotion, to inform budget and service priorities. Currently health promotion activities happen haphazardly and there is no documentation of impact. Much of the communication focus is on disseminating information to community members as opposed to engaging in dialogue. The SBH-led workshop and stakeholder interviews also uncovered the following key gaps related to SBCC implementation structures: • There is a lack of capacity to do SBCC work beyond the district level. At the community level, structures are not strong, information does not flow down, and structures that exist on paper are not functional. There is limited local capacity at community level to: engage with priority audience groups, deliver effective messages and materials to promote health seeking behavior, and coordinate across various government and nongovernmental stakeholders. Previous SBCC training and capacity building efforts have dissipated. • At the moment there is a major gap in donor-funded SBCC programming in Zambia. At least three local SBCC-focused NGOs have recently dramatically reduced their staff and programming. Current efforts underway are fragmented and most stakeholders are not aware of what others are doing. Furthermore, the Zambian Government relies on donor funding to conduct SBCC activities, so local ownership and sustainability are lacking. • Relevant messages and materials from the MOH do not reach communities, and often the materials that are disseminated are static (e.g. posters). The most effective means of changing behavior at community level are high-engagement methods such as interpersonal communication and drama, and capacity building is needed to use these channels well.

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• Gaps and needs at community level cannot be discussed without addressing larger health system strengthening variables such as governance, accountability, supply chain, human resources for health, financing and coordination mechanisms across national, provincial, district, community, zonal and ward levels. Community-level SBCC interventions will not be sustainable in the absence of an ecosystem that supports local ownership, stable resources, and improved capacity and coordination. In addition to these findings, and given best practices in SBCC worldwide, gaps exist in Zambia in applying tools and methodologies from human-centered design, behavioral economics, crowdsourcing, digital health, and other related disciplines to elevate the quality and effectiveness of SBCC interventions to improve health.

4. SBH SBCC Strategy

4.1 Framework and Objectives

Based on the situational analysis presented above, SBH used the following principles to frame the design of its SBCC strategy: • Ultimately, the strategy must contribute towards achieving SBH’s objective of helping the MOH reach the targets for the five indicators listed in Section 1.1 of this document; • SBH is a health system strengthening project, and not a service delivery project. Therefore, the project’s SBCC strategy must fit within its system strengthening scope and mandate; and • As a health system strengthening project, SBH has limited human and financial resources to devote to SBCC activities. Therefore, the SBCC strategy and activities must be feasible for implementation through existing SBH staff and activities (and must not require dedicated SBCC staff and/or significant budgets). Using this framework, the overall objective of this SBCC strategy is to increase utilization of high- impact health services for HIV/AIDS, family planning, MNCH, and nutrition services in SBH target communities by strengthening the MOH’s implementation of SBCC activities. The specific objectives of this strategy are: 1. To support the MOH in strengthening SBCC-related documents, frameworks, and materials 2. To support the MOH in strengthening SBCC-related structures at all levels 3. To support the MOH and other stakeholders in the effective implementation of SBCC and related activities Below we describe the activities planned to achieve each objective. 4.1.1 Objective 1: Strengthening SBCC-related documents, frameworks, and materials Identify and review documents and frameworks SBH will work with the Health Promotion TWG to identify and collect the most relevant and important SBCC-related documents, frameworks, and materials. For example, reviewing the National Health Strategic Plan health promotion component to ensure that SBCC strategies are appropriate; Facilitate the inclusion of community health structures in existing and emerging

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regulatory frameworks such as the Public Health Act and National Health Services Act, Review and update Community Behavior Change Communication Framework 2011-2015, and support MOH to develop an SBCC strategy to avoid the current fragmentation by various MOH partners. An SBH SBCC expert will review these documents and materials to ensure they are technically sound, represent the latest SBCC best practices, and respond to the most current health and SBCC needs in Zambia. SBH will present proposed updates to the TWG, and support validation workshops to review and finalize the documents and materials. The project will also support printing of the revised documents, dissemination and distribution, and orientations in SBH target districts and facilities. Coordinate message and material development The SBH-seconded Community Health Specialist will collaborate with MOH counterparts through the Health Promotion TWG and all the SBCC implementing partners to provide technical assistance to produce health promotion materials and messages in the public and private media. SBH will focus on integration of health messages. For example, messages delivered by SMAGs will cover all the key messages on safe motherhood such as focused antenatal care, safe deliveries, postnatal care, family planning services including community mobilization strategies, fistula and cancer modules. HIV- related interventions (HIV CBVs, prevention of mother-to-child transmission, counseling and testing, ART, adherence) will also be packaged. This will minimize message fragmentation and enhance the efficiency of CBV training and message dissemination. 4.1.2 Objective 2: Strengthening SBCC-related structures at all levels Support policy guidelines for structures SBH will support the MOH to develop policy guidelines for structures related to SBCC and community participation in health, such as Community Leadership Skills Manual, SBCC committees orientation package(Community Leaders Tool Kit), Community Planning Handbook and Simplified Community QI Training Manual. SBH will provide technical review and refinement of the guidelines and support their printing, dissemination, and implementation. Second staff to provide ongoing technical support to SBCC structures SBH seconds technical staff at different levels of the MOH that provide routine technical support to their MOH counterparts. As part of this ongoing support, SBH seconded staff will help strengthen SBCC and related structures through scale up of standardized capacity building for health promotion and education at district, facility and community level.

SBH has seconded a Community Health Specialist to the Directorate of Health Promotion, Environment and Social Determinants at central MOH. The seconded Community Health Specialist will provide technical assistance to revamp the Health Promotion TWG in collaboration with all stakeholders. The Community Health Specialist will advocate for enhanced capacity strengthening for community-based structures such as the NHCs and effective coordination of community based structures and CBVs. The seconded Community Health Specialist will, in collaboration with the Health Promotion TWG, facilitate the formation and revision of SBCC committees at provincial and district levels. At the provincial level, SBH has seconded the Clinical Care Specialists, the Reproductive, Maternal and Child Health Specialist and Provincial Saving Mothers Giving Life (SMGL) Coordinators in Eastern, and Southern provinces. The provincial SBH seconded staff will collaborate with the Senior Health Promotion Officer based at the Provincial Health Offices to provide technical oversight to SBCC activities at the district level including coordination of SBCC committees and partners at this level. At the district level, SBH has seconded the Health Systems Specialists and a District SMGL Coordinator to fourteen of the SBH target SMGL districts. These will closely collaborate with the District Health Promotion Focal Point Persons to provide technical oversight to the community level

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SBCC activities in the district through the health center personnel. SBH will support MOH to scale up the recruitment and retention of community based volunteers. SBH seconded staff will facilitate capacity strengthening for effective coordination of community level SBCC activities through the existing structures such as the HCCs, NHCs, SBCC Committees, and CBOs and NGOs. SBH staff will support MOH to revive the use of NHC/HCC guidelines in community health. Support the expansion of SBCC Committees Through its seconded personnel to various levels of the MOH, SBH will facilitate formation of SBCC Committees at provincial and district levels. These committees will take responsibility for strengthening SBCC coordination, from the central level Health Promotion TWG to SBCC activity implementation by various CBO, local NGOs and CBVs across districts and within communities. They also will play a monitoring role on SBCC indicators related to health seeking behaviors and track the distribution of SBCC materials. Additionally, they will strengthen multi-sectoral collaboration, community linkages and coordination in line with the decentralization policy to address Social Determinants of Health and within the Health in All Policies framework. Support CHAs to coordinate and supervise CBVs and SBCC activities SBH will work with the MOH through its seconded Community Health Specialist to provide technical assistance to the Health Promotion TWG to strengthen coordination of the various CBVs. This will create a system to support CHAs to supervise and coordinate CBVs (CHWs, NHCs, Adherence Counselors, SMAGs, CBDs etc.) to enhance the quality of SBCC messages delivered to the community and the referral system. Goals include streamlining CBV supervision and reporting structure/channels, including the referral system by the CBVs. Strengthen monitoring and evaluation of SBCC and related activities To strengthen community use of data for decision making. SBH will implement several activities to strengthen the capacity of SBCC structures to monitor and evaluate their activities, including increasing their participation in key review processes that should inform SBCC activities. The project will support quarterly HCC data review meetings and the incorporation of HCC members into facility quality improvement committees. SBH will ensure that HCCs participate in verbal autopsy of all maternal deaths in the catchment area, and support selected health facility SBCC Committee members’ participation in health facility quality improvement and maternal death surveillance and response committees. The project will also orient HCCs in target facilities to community health management information system and support health facility SBCC Committees monthly meetings to discuss selected health indicators. 4.1.3 Objective 3: Supporting effective implementation of SBCC activities Support SBCC activities through grants SBH’s main mode of direct support to the implementation of SBCC activities will be through grants provided to local CBOs and local NGOs. SBH grants will support community-based activities such as: building capacity of existing community structures such NHCs and HCCs through training, mentorship in community health planning; working with CHAs to supervise CBVs as they conduct SBCC activities in the community to ensure quality and adherence to national MOH standards, train the HCC in community QI so that they can effectively participate in the health center QI committees. Strengthen community participation in health planning SBH will strengthen community participation in planning, coordination, implementation, monitoring and evaluation at the facility and community levels. Addititinally, the project will strengthen the integration of health promotion, disease prevention, control and surveillance in all community level programs. SBH will use community participation in planning at health facility level as a strategy to

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enhance SBCC interventions. NHCs will discuss priority problems with communities and work with HCCs to incorporate SBCC activities in the health facility and district annual action plans. SBH, through seconded staff and their MOH counterparts at each level, will advocate for resource allocation to the community SBCC activities in the annual action plans. SBH will also review all existing SBCC-related planning materials such as the Simplified Guide to Community Health Planning and Helping Communities Help Themselves towards Better Health with Participatory Planning and Partnerships, to ensure they promote effective community participation in planning and support the design and dissemination of effective SBCC messages. SBH will: Enhance demand creation for gender sensitive community health services; Develop mechanisms for ensuring that 10% of DHO budget is reserved for community health activities; and Strengthen community use of data for decision making SBH supports community outreach activities as important vehicles for delivering SBCC messages. This includes supporting training of CBVs such as SMAGs, as well as the production, printing and distribution of SBCC materials. SBH also supports districts to carry out health-related events in communities, such as World AIDS Day, Safe Motherhood Week, and Child Health Week.

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Annex I: List of Stakeholders Consulted

Organization Name Title/Role

Ministry of Community Mr. Simmy Chapula Director, Planning Development and Social Welfare

Ministry of Health Ms. Rose Masilani Chief Health Promotions Officer

Zambia Community HIV Mr. Jackson Thoya Chief of Party Prevention Project (ZCHIPP) Mr. Steve Sichone SBCC Specialist

Afya Mzuri Mr. Westone Mutale Bowa Technical Director, Programs

Program for the Advancement of Dr. John Chimumbwa Chief of Party Malaria Outcomes (PAMO) project Dr. James Banda Technical Director

Mr. Evans Mwape ITN Distributor, Program Management Specialist

Mr. Maurice Pengele Technical Specialist- Monitoring and Evaluation & Operations Research

Thrive Project Ms. Beatrice kawana Senior Technical Advisor

MOH Senior Environmental Health Technician(EHT) Shibuyunji, Makululu Health Center

MOH Copperbelt Province Mr. Jonathan Mwanza Senior Provincial Health Promotion Officer

MOH Southern Province Mrs. Duffrin. Nkatya Senior Health Promotions Officer – Southern Province, Kasanda Health Center

ZHECT Ms. Chilufya Mwaba Phiri Executive Director

USAID District Coverage of Dr Michael Chanda Discover H Team, Deputy Chief Of Party Health Services Project – Harriet Zulu Social marketing – communications (DISCOVER-H)

CHAMP Rosanna N Nyerenda Executive Director Crispin Sapele Operations & Systems Director

National Food and Nutrition Ms. Robina H. Mulenga Kwofie Executive Director Commission (NFNC) Ms. Eustina Besa Communication Officer

Zambia Center for Mr. Johans Mtonga Executive Director Communication Programs (ZCCP)

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University of Maryland Dr. Gasio Deputy Chief Of Party

Travor Information Officer

Care international Ms. Josephine Nyambe

Churches Health Association of Malon Banda Deputy Director Zambia (CHAZ)

National AIDS Council (NAC) Justine Mwinga Information Public Relations Officer

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Annex II: List of Documents Consulted

Bellows, B. (2016). Scaling Up Family Planning (SUFP) Project in Zambia. PowerPoint Slides. Washington DC: Evidence Project. Boulay, M. G., Macwan’gi, M., Sinyenga, G., Mutelo, N., Namfukwe, M., & Kakompe, K. (2010). HCP End of Project Evaluation. Health Communication Partnership Zambia. Cabinet Office. (2013). The National Decentralisation Policy. Lusaka: Government of the Republic of Zambia. Cabinet Office. (2014). Decentralisation Implementation Plan (DIP) 2014 – 2017. Lusaka: Government of the Republic of Zambia. Central Statistical Office (CSO), Ministry of Health (MOH), University of Zambia, and MEASURE Evaluation. (2010). Zambia Sexual Behaviour Survey 2009. Lusaka: CSO and MEASURE Evaluation. Collins, D., & Gilmartin, C. (2016). The Cost of Scaling-up Family Planning Services: Lessons from an Innovative Project in Zambia. Research Report. Washington, DC: Population Council, The Evidence Project. Communications Support for Health (CSH) Project Final Report (2015). Enhancing the Capacity to Influence Behaviors. Chemonics International. Health Communication Capacity Collaborative. (2016). THE SBCC CAPACITY ECOSYSTEM: A Model for Social and Behavior Change Communication Capacity Strengthening. Baltimore: USAID. Government of the Republic of Zambia and United Nations Population Fund Zambia. (2005). Rapid Socio-Cultural Research as a Methodology for Informing Sexual and Reproductive Health/HIV/AIDS Programming in North-Western Province. Government of the Republic of Zambia. December 2014. Decentralisation Implementation Plan (2014- 2017). Cabinet Office, Decentralisation Secretariat. Johns Hopkins University. (2009). Health Communication Partnership Zambia Materials Catalogue. Helping Communities Help Themselves towards Better Health with Participatory Planning and Partnerships: A Facilitation Guide for District Health Officers. October 2009. USAID/Health Communication Partnership Zambia. Kumar, U. B. (2014). Trip Report. Zambia Integrated Systems Strengthening Program. MCDMCH. (2015). Ministry of Community Development, Mother and Child Health, Department of Community Development: Ministry Sector Devolution Action Plan for Community Development Functions. Lusaka: Government of the Republic of Zambia. Ministry of Community Development Mother and Child Health. 2013. Simplified Guide to Community Health Planning, Participant's Manual. Ministry of Health. (2015). Health Sector Devolution Plan. Lusaka: Government of the Republic of Zambia. Ministry of Local Government and Housing. (2013). Guidelines on The Establishment, Management and Operations of Ward Development Committees (WDCs). Lusaka: Government of the Republic of Zambia. National HIV/AIDS/STI/TB Council. (2015). National HIV/AIDS/STI/TB Council Devolution Plan: Devolution of Position of District AIDS Coordination Advisor, to be Called District HIV/AIDS Mainstreaming Planner. Lusaka: National HIV/AIDS/STI/TB Council.

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Republic of Zambia Ministry of Health. Terms of Reference for National and Provincial Health Promotion (IEC/BCC) Technical Working Groups. Republic of Zambia. National HIV/AIDS Strategic Framework 2014-2016. Ministry of Health, National HIV/AIDS/STI/TB Council. Republic of Zambia Ministry of Community Development Mother and Child Health. Adolescent Health Communication Strategy in Zambia 2013-2015. USAID/Zambia and Zambia Integrated Systems Strengthening Program. Republic of Zambia Ministry of Health. June 2014. Catalogue of Materials - Social and Behaviour Change Communication. USAID/Zambia, Zambia Integrated Systems Strengthening Program. Republic of Zambia Ministry of Health. National Malaria Communication Strategy 2011-2014. USAID/Communications Support for Health. Republic of Zambia National Food and Nutrition Commission. 2014. First 1000 Most Critical Days Programme Communication Strategy and Implementation Plan. Republic of Zambia. Revised edition 2013. The National Decentralisation Policy. Office of the President, Cabinet Office. Republic of Zambia Ministry of Health. October 2012. Guidelines for Health Promotion Programme Implementation at District Level. USAID/Zambia and Zambia Integrated Systems Strengthening Program. Republic of Zambia Ministry of Health. Community Behavior Change Communication Framework 2011- 2015. USAID/Zambia Integrated Systems Strengthening Program. Republic of Zambia Ministry of Health. March 2013. Analysis of Behavior Change Communication Materials in Selected Districts of Zambia. USAID/Zambia Integrated Systems Strengthening Program. USAID/Zambia and PEPFAR Corridors of Hope Project. (2009). Behavioral Surveillance Survey Round 4. USAID/Zambia and Zambia Integrated Systems Strengthening Program. September 2014. A Report on Engagement of Traditional Leaders in Community Health: A Synthesis of Orientation Meetings. USAID/Zambia Systems for Better Health Project. (2016). Community Capacity Assessment. Abt Associates. USAID/Zambia Systems for Better Health Project. (July 2016). Baseline Assessment Report. Abt Associates. World Health Organization. (2010). Monitoring the Building Blocks of Health Systems: a Handbook of Indicators and their Measurement Strategies. Geneva: World Health Organization. Central Statistical Office (CSO) [Zambia], and ICF International. 2014. Demographic and Health Survey 2013-2014. Rockville, Maryland, USA: Central Statistical Office, Ministry of Health, and ICF International. Zambia Integrated Systems Strengthening Program (ZISSP). 2014. Engaging Communities in Health Planning and Promotion. Program Brief. Abt Associates.

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