Final Report

F I N A L R E P O RT 2 0 1 0 - 2 0 1 5

DO POVO AMERICANO

MOÇAMBICANOS ME AMERICANOS

JUNTOS NA LUTA CONTRA O HIV/ SIDA PEPFAR Acknowledgements

First of all we would like to thank the USAID team, for allowing us to execute this project. We have received great technical support from our respective AORs and activity managers. We would like to mention especially Sereen Thaddeus, Branca Cruz and Alyssa Leggoe. We also thank our main partner Fundação para o Desenvolvimento da Comunidade (FDC) for being an integral part of this project. We thank all partners and CBO's that have been contributing to this project. A special mention has to be made about the support we received from different government entities and from Parliament. Without the support of CNCS and MISAU, this project would not have gotten the same results. And lastly we want to thank the whole CCP team in Baltimore and at the Maputo Field office. Acknowledgements

Executive Summary 5 1. PACTO OVERALL OBJECTIVES AND APPROACH 8 2. COMMUNITY-DRIVEN HIV PREVENTION AND UPTAKE OF SERVICES 10 3. DEMAND GENERATION FOR HIV SERVICES 19 1. Integrated Mass Media and Community Campaign on Multiple Sexual Partners and Related Risk Behaviors: "Andar Fora é Maningue Arriscado" 2. Demand Generation Campaign for Medical Circumcision 3. Securing sustainability, technical capacity and commitment among media partners to continue producing high impact TV Health programming 4. mHealth Referral System

4. YOUTH IN ACTION 1. SensaSons: Lyrics Contest and Youth Music Festival 29 2. Tchilling Saudável: Sports for Life 3. 100% Kool: Youth-led Radio 4. Avante ESH: Safe School Program 5. Avante Jovens: Out-of-School Youth

5. GENDER BASED VIOLENCE INITIATIVE 1. Gender mainstreaming in PACTO interventions 33 2. Partnership with HOMEN (Homens pela Mudança-Men for Change): Conversa de Homens Tool 3. Communication Tools for support of GBV victims - "How to Support the Victims of Sexual Violence" 4. Campaign against Sexual Harassment in the Workplace 5. 16 Days of Activism against GBV Campaign

6. HEALTH COMMUNICATION 39 1. Malaria 2. Tuberculosis 3. Nutrition, Water and Sanitation 4. Family Planning (FP)

7. STRENGTHENING CAPACITY FOR SOCIAL AND BEHAVIOR CHANGE 43 COMMUNICATION 1. Leadership: a systematic approach to Social and Behavior Change Communication - based on evidence and impact of actions 2. Training of public, private and civil society institutions

8. RESEARCH, MONITORING AND EVALUATION 1. Research studies 46 2. SEMPRE 3. PACTO's qualitative impact evaluation

9. LESSONS LEARNED 50 10. PERSPECTIVE FOR THE FUTURE 5 1 ACRONYMS AND ABBREVIATIONS 5 3 INDEX

6. HEALTH COMMUNICATION 39 1. Malaria 2. Tuberculosis 3. Nutrition, Water and Sanitation 4. Family Planning (FP)

8. RESEARCH, MONITORING AND EVALUATION 1. Research studies 46 2. SEMPRE 3. PACTO's qualitative impact evaluation

9. LESSONS LEARNED 50 10. PERSPECTIVE FOR THE FUTURE 5 1 ACRONYMS AND ABBREVIATIONS 5 3 Executive Summary

The Johns Hopkins Center for Communication Programs (CCP) and FDC (Fun- dação para o Desenvolvimento da Comunidade-Community Development Foundation) implemented the USAID-funded project PACTO--Prevenção Activa e Comunicação Para Todos or Active Prevention and Communication for All--between October 2010 and December 2015 in the three provinces of Southern Mozambique (Maputo City, Maputo Province and Gaza) with the highest HIV prevalence. The project conducted social and behavior change communication (SBCC) interventions focused on HIV prevention and uptake of services and on combatting gender-based violence (GBV) and long term capacity strengthening of public, private and civil society institutions. In 2014, the PACTO project received the mandate from USAID to integrate other health priorities into the project, incorporating themes such as malaria, tuberculosis, hygiene, nutrition, water and sanitation and family planning.

Social and Behavior Change Communication: Community Dialogue Qualitative research conducted under the Health Communication Partnership Associate Award (2007 - 2010) uncovered an underlying desire for change in the way men and women related to each other, and in the way young people learned about sex and about what it means to be a man or a woman. The country was fertile ground for a Mozambican adaptation of the African Trans- formation (AT) community dialogue series aimed at changing gender norms. Tchova Tchova Histórias de Vida (TTHV-Moving Forward Life Stories) has become a genuine social movement, achieving a scale (156,906 people reached) and impact unmatched by any other AT adaptation. With technical support from the University of California, San Francisco, PACTO added the Positi- ve Prevention (PP) community tool for people living with and affected by HIV, reaching 77,943 people. Conversa de Homens (Conversation among Men), developed in partnership with the local NGO HOPEM, has reached 8,944 men. It aims to encourage male involvement in order to contribute to more balanced relations between men and women, to engage men in promoting health, to reduce the occurrence of gender-based violence against young and adult women, and to promote male circumcision, condom use and HIV testing. Avante Famílias (Go Families!), adapted from the regional Go Girls! Initi- ative set of tools, focused on improving communication skills among young people and adults to be able to address difficult issues in relation to sexuality, HIV/AIDS, sexual abuse and harassment. This tool was implemented from 2011 to 2013 in all communities covered by PACTO, reaching 14,606 parents and guardians.

PACTO F I N A L R E P O RT | 5 Executive Summary

PACTO F I N A L R E P O RT | 5 PACTO introduced the SmYes Saúde mHealth referral system to its commu- training in communication to prevent HIV to political, community and religi- nity interventions in 2014. Through the system, facilitators in the community ous leaders at national, provincial and district levels, including the Parliamen- send referrals by SMS to a focal point based at the health facility. The system tary Office for the Fight against AIDS. With support from PACTO, the Centre allows tracking of individuals, showing whether or not the referral actually of Excellence for Communication for Health was created at the Polytechnic arrived at the clinic after being referred. It also allows the focal point to com- University in Maputo. PACTO equipped it with a state-of-the-art audio and municate with the facilitator, in case the person does not arrive, permitting radio studio to record communication programs, a community radio broad- follow-up. In total, 15 health facilities have been using the system and 30,479 casting health programs, and a web center for publishing nationally relevant people have had access to health services, using the system. articles in relation to health, in particular HIV and AIDS, written by journalists trained by PACTO. In addition, PACTO gave technical assistance to the Poly- technic University to incorporate a specialization in Communication for Social and Behavior Change Communication: Mass Media Health in its Communication course. Under the guidance of PACTO consul- tants, students of the Center's radio script writing and production workshops PACTO conducted mass media campaigns on multiple sexual partnerships produced the 15 episode drama series Fatias da Vida (Slices of Life). and related risk behaviors (Andar Fora é Maningue Arriscado-Stepping out is quite risky) and voluntary medical male circumcision (VMMC). In addition, PACTO worked with the four major television stations, the national radio sta- Communication in Other Health Areas tion and eight community radio stations providing technical support on issues pertaining to public health and HIV combination prevention, as well as the PACTO supported the Communication Working Group of the National Mala- development of content, building of skills, and promotion of linkages with ria Control Program and facilitated the development, pretesting and adoption community interventions, partners and the Ministry of Health. From 2011 to of a national malaria brand (logo and slogan). Following the floods that rava- 2015, PACTO participated in the "16 Days of Activism against Gender-Based ged the coast of Zambézia in February 2015, the Nicoadala District Adminis- Violence Campaign," coordinated by the Ministry of Gender, Child and Social tration launched an integrated malaria and diarrhea prevention campaign, Action. Banners, songs, radio and television spots and posters were produ- assisted by the PACTO project, which included health fairs, mosquito net dis- ced, with the participation of ex-President Joaquim Chissano and more than tribution, road shows, radio programs and spots, door-to-door outreach, prac- 25 public figures. tical demonstrations of correct bed net use, and video sessions followed by community dialogues. PACTO developed a tuberculosis screening instrument that is administered at Social and Behavior Change Communication: Youth TTHV and PP sessions, as well as printed educational materials, radio spots PACTO partnered with renowned musician and composer Moreira Chongui- and TV, radio and television programs on tuberculosis. In the catchment areas ça to create the SensaSons lyrics contest and youth music festival. Youth were of four health facilities, where a TB referral and counter-referral system had mobilized through Facebook and by artists in the schools, involving about been established, TTHV and PP facilitators referred participants for TB diag- 4,000 students in discussions about sexuality, modern lifestyles, peer pres- nosis and treatment, as well as other services such HIV testing, return to ART, sure and the risks associated with violence, sexual abuse and HIV. The final etc. A focal point was placed in these health facilities, who receives the people stage of SensaSons was a mega music festival, where musicians performed referred from the community and personally escorts them to the health servi- the ten winning lyrics and the CD with these songs was launched. ce they need. During the IX African Games in 2011, PACTO contributed to the production of Thanks to these interventions, 4,868 people were referred to TB services and a series of 12 TV spots starring Mozambican athletes who challenged young 4,132 active searches were made to trace defaulters, which resulted in 2,458 people to reflect about their future and what it takes to achieve excellence, people returning to treatment. including making healthy choices to prevent HIV. PACTO also established 14 In coordination with the Ogumaniha project, PACTO conducted water and local healthy entertainment venues, designated "Healthy Chilling" (Tchilling sanitation activities in the district of Nicoadala, Zambezia province, with a Saudável) sites, where athletes, fans and African Games enthusiasts could focus on nutrition. As a result, 1,350 families received messages about good find entertainment and educational live theater and music. nutrition habits and environmental sanitation. Out of the second Entertainment-Education Workshop in 2011 came 100% PACTO supported the Ministry of Health in promoting demand and access to Kool, an educational radio program aimed at youth aged 15 to 19 carried on family planning services through the Tchova Tchova Historias de Vida (TTHV) eight Maputo-based radio stations. and Positive Prevention (PP) community interventions, as well as supporting Two other adaptations from the Go Girls! set of tools are Avante ESH, a safe the creation and consistent use of a national FP brand, conducting a family schools program and Avante Jovens for out-of-school youth. planning campaign in Manhiça and producing a family planning flipchart. A total of 8,894 people were reached by the TTHV and PP tools. Out of these, 1,445 women were referred to health services, of which 486 women were Capacity Strengthening specifically referred for family planning, 70 women to antenatal care and 144 women to PMTCT services. PACTO provided continued technical assistance to the communication unit (UNICOM) of the National AIDS Council (CNCS) and the Department of Health Promotion (DEPROS) of the Ministry of Health. The project provided

6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 7 PACTO introduced the SmYes Saúde mHealth referral system to its commu- training in communication to prevent HIV to political, community and religi- nity interventions in 2014. Through the system, facilitators in the community ous leaders at national, provincial and district levels, including the Parliamen- send referrals by SMS to a focal point based at the health facility. The system tary Office for the Fight against AIDS. With support from PACTO, the Centre allows tracking of individuals, showing whether or not the referral actually of Excellence for Communication for Health was created at the Polytechnic arrived at the clinic after being referred. It also allows the focal point to com- University in Maputo. PACTO equipped it with a state-of-the-art audio and municate with the facilitator, in case the person does not arrive, permitting radio studio to record communication programs, a community radio broad- follow-up. In total, 15 health facilities have been using the system and 30,479 casting health programs, and a web center for publishing nationally relevant people have had access to health services, using the system. articles in relation to health, in particular HIV and AIDS, written by journalists trained by PACTO. In addition, PACTO gave technical assistance to the Poly- technic University to incorporate a specialization in Communication for Social and Behavior Change Communication: Mass Media Health in its Communication course. Under the guidance of PACTO consul- tants, students of the Center's radio script writing and production workshops PACTO conducted mass media campaigns on multiple sexual partnerships produced the 15 episode drama series Fatias da Vida (Slices of Life). and related risk behaviors (Andar Fora é Maningue Arriscado-Stepping out is quite risky) and voluntary medical male circumcision (VMMC). In addition, PACTO worked with the four major television stations, the national radio sta- Communication in Other Health Areas tion and eight community radio stations providing technical support on issues pertaining to public health and HIV combination prevention, as well as the PACTO supported the Communication Working Group of the National Mala- development of content, building of skills, and promotion of linkages with ria Control Program and facilitated the development, pretesting and adoption community interventions, partners and the Ministry of Health. From 2011 to of a national malaria brand (logo and slogan). Following the floods that rava- 2015, PACTO participated in the "16 Days of Activism against Gender-Based ged the coast of Zambézia in February 2015, the Nicoadala District Adminis- Violence Campaign," coordinated by the Ministry of Gender, Child and Social tration launched an integrated malaria and diarrhea prevention campaign, Action. Banners, songs, radio and television spots and posters were produ- assisted by the PACTO project, which included health fairs, mosquito net dis- ced, with the participation of ex-President Joaquim Chissano and more than tribution, road shows, radio programs and spots, door-to-door outreach, prac- 25 public figures. tical demonstrations of correct bed net use, and video sessions followed by community dialogues. PACTO developed a tuberculosis screening instrument that is administered at Social and Behavior Change Communication: Youth TTHV and PP sessions, as well as printed educational materials, radio spots PACTO partnered with renowned musician and composer Moreira Chongui- and TV, radio and television programs on tuberculosis. In the catchment areas ça to create the SensaSons lyrics contest and youth music festival. Youth were of four health facilities, where a TB referral and counter-referral system had mobilized through Facebook and by artists in the schools, involving about been established, TTHV and PP facilitators referred participants for TB diag- 4,000 students in discussions about sexuality, modern lifestyles, peer pres- nosis and treatment, as well as other services such HIV testing, return to ART, sure and the risks associated with violence, sexual abuse and HIV. The final etc. A focal point was placed in these health facilities, who receives the people stage of SensaSons was a mega music festival, where musicians performed referred from the community and personally escorts them to the health servi- the ten winning lyrics and the CD with these songs was launched. ce they need. During the IX African Games in 2011, PACTO contributed to the production of Thanks to these interventions, 4,868 people were referred to TB services and a series of 12 TV spots starring Mozambican athletes who challenged young 4,132 active searches were made to trace defaulters, which resulted in 2,458 people to reflect about their future and what it takes to achieve excellence, people returning to treatment. including making healthy choices to prevent HIV. PACTO also established 14 In coordination with the Ogumaniha project, PACTO conducted water and local healthy entertainment venues, designated "Healthy Chilling" (Tchilling sanitation activities in the district of Nicoadala, Zambezia province, with a Saudável) sites, where athletes, fans and African Games enthusiasts could focus on nutrition. As a result, 1,350 families received messages about good find entertainment and educational live theater and music. nutrition habits and environmental sanitation. Out of the second Entertainment-Education Workshop in 2011 came 100% PACTO supported the Ministry of Health in promoting demand and access to Kool, an educational radio program aimed at youth aged 15 to 19 carried on family planning services through the Tchova Tchova Historias de Vida (TTHV) eight Maputo-based radio stations. and Positive Prevention (PP) community interventions, as well as supporting Two other adaptations from the Go Girls! set of tools are Avante ESH, a safe the creation and consistent use of a national FP brand, conducting a family schools program and Avante Jovens for out-of-school youth. planning campaign in Manhiça and producing a family planning flipchart. A total of 8,894 people were reached by the TTHV and PP tools. Out of these, 1,445 women were referred to health services, of which 486 women were Capacity Strengthening specifically referred for family planning, 70 women to antenatal care and 144 women to PMTCT services. PACTO provided continued technical assistance to the communication unit (UNICOM) of the National AIDS Council (CNCS) and the Department of Health Promotion (DEPROS) of the Ministry of Health. The project provided

6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 7 Institucional Partners

Fórum Mulher Rede de Comunicação Rede de Homens para a Miramar, Lda Mudança - HOPEM (Televisão/Rádio) Pacto overall objectives Açucareira de Xinavane 1. EcoSida-Associação dos Empresários Contra HIV e 22 rádios Comunitárias SIDA, Tuberculose e Malária and approach CHASS SMT/Niassa Universidade Politécnica - Médicos Sem Fronteiras Apolitécnica LAYOUT Televisão de Moçambique TEBA SOICO/STV PIRCOM PACTO -- Prevenção Activa e Comu- prevention lifestyles among people ded to introduce the strategic appro- TIM - Televisão Indepen- nicação Para Todos or Active Preven- living with HIV and AIDS (PLHA), to aches to combined HIV prevention, dente de Moçambique FHI 360 tion and Communication for All, is a condemn gender-based violence to use cross-cutting gender approa- MorePromotions JICA USAID-funded project that was (GBV) across all media and commu- ches in all tools and interventions, Mahala Filmes/Pipas Forjaz PSI implemented by John Hopkins Uni- nity interventions, and to promote and to improve coordination at natio- Universidade da California - Projecto SCIP versity's Center of Communication the utilization of the GBV service nal, provincial and district levels. São Francisco Media for Development International (MFDI) Programs (CCP) and FDC (Fundação continuum in Mozambique. Moreover, Mozambican public sec- JHPIEGO GAPI - Sociedade de para o Desenvolvimento da Comuni- tor institutions, civil society, private CHIBUTO In order to achieve these objectives, Investimentos dade) in the three provinces of Sout- media institutions and journalists CHÓKWÈ the project used a Strategic Commu- MANDLAKAZE hern Mozambique (Maputo City, were empowered to produce and nication Approach, which introduced Maputo Province and Gaza) with the implement HIV prevention pro- XAI -XAI Implementation Partners a new model of HIV prevention that highest HIV prevalence between grams. As such, a supportive envi- MANHIÇA BILENE takes the specific needs of adults, October 2010 and December 2015. ronment for HIV prevention was crea- ACIDECO AMJ Kindlimuka Pfuka Lixile young people and people living with The aim of PACTO is to promote the ted, encouraging political, traditional ADEMUC AMUCHEFA Lado Lado Posto Policial Xinavane HIV into account, built around the MATOLA MAPUTO CIDADE adoption of safer sexual behaviors and religious leaders to speak in favor ADCR Amudeia Mapungo Reencontro three main components of combina- and uptake of HIV prevention servi- of the prevention and use of HIV ser- ACOSAMUDECO Apapurg Matsoni R. P. Hlauleka tion prevention (structural, behavio- BOANE ces among the Mozambican general vices. Community-based approa- Açucareira Xinavane Tinhena ral and HIV services) and which is APC NHAKUTSE population, to increase the demand ches and mass media were also used specifically adapted to the Mozambi- AJCDC Hocosida Nova Vida Vucane for the prevention of mother-to-child to model preventive behaviors (such can context. Through the use of this Amigos do GATV Imba Ntwanano Pfukani transmission (PMTCT) services, as risk perception, partner reduction, model, the adoption of safer sexual Pfuka Uhanha Voluntary Medical Male Circumcisi- condom use, testing, adherence to behavior was encouraged and on (VMMC) and HIV testing and treatment, stigma reduction, gender demand for HIV prevention services counseling (HCT) among men and equality behaviors and open dialogue in the general population of Mozam- Government Partners women, to assure adherence to anti- with the community), thus inspiring bique was increased. At the same retroviral therapy (ART) and positive a social movement for HIV preventi- time, technical leadership was provi- ICS on. Instituto Governos Provinciais Ministério de Género, Gabinete Parlamentar de Comunicação Social e Centrais Criança e Acção Social de Prevenção e Combate ao HIV/SIDA.

Ministério da Educação Ministério da Saúde e Desenvolvimento Humano

The strategies and interventions used in the PACTO project were developed and implemented in close partnership with local and international partners and with the Government, ensuring that the success of the PACTO project will remain long after the completion of the project. The partnerships thus created by PACTO are very diverse and include among the public sector, the Ministries of Health, Gender, Child and Social Action and Educati- on and Human Development, the National AIDS Council (CNCS) and their departmental representations, the Natio- nal Parliament, specifically the Office for Prevention and Fight against AIDS and the Institute for Social Communicati- on (ICS) and their radio network of 22 community stations. Among the academic institutions, PACTO partnered with the Universidade Politécnica where the Centre of Excellence in Health Communication was created. Likewise, PACTO partnered and collaborated closely with the major national TV and Radio broadcasters TVM, STV, TIM, Miramar and Radio Moçambique; and the largest music and TV production houses-More Promotions and Mahala Filmes/Pipas Forjaz. Very important, PACTO partner with national NGOs such as HOPEM and Forum Mulher and with 29 community-based organizations. Among private sector institutions, the project carried out activities with the Association of Businessmen against HIV and AIDS (ECOSIDA), Tongaat Hulett Sugar South Africa. Xinavane Sugar Refinery, Sociedade Moçambicana de Investimento e Desenvolvimento GAPI, Teba Ltd, Compa- nies & Businesses, Mozambique (TEBA). Among the international partners, PACTO had the collaboration of the University of California, San Francisco which guided the project in the area of positive prevention among PLHA.

8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 9 Institucional Partners

Ministério da Educação Ministério da Saúde e Desenvolvimento Humano

8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 9 SESSION THEME Vasco Mboana, 54 years old, lives with his wife of 1 Gender Roles: What can men do? over 35 years, Angelina Ndavi, in Chibututuine. The 2 Traditional and Cultural Values couple has seven children aged 20 to 37 years. Vasco started consuming alcohol excessively during his teen 3 Gender Roles: What can women do? years. "The scars on my body were caused by my actions 4 Ways to overcome domestic violence (gender after drinking, and not because I am a thief. When I am based violence) drunk, I get involved in fights." 5 Dialogue about condom use Vasco and his wife accepted the invitation of facilitators 6 Stigma and blame among couples to start participating in Tchova Tchova sessions. "Tchova 7 Communication between Adults and Children, Tchova made me realize that I wasn´t living a normal Sex Education life. The video that motivated me to change was about 8 Sexual networks: Multiple concurrent sexual ways to overcome violence. I was able to mirror myself in 9 partners the behavior of the man in the video who was later able Mozambiquesince 2010, and uses ART adherence: Living longer with HAART to listen to his wife and overcome his alcohol video and writtenprofiles, available in 10 abuse."Angelina witnesses: "My husband has changed Sero-discordant Couples: Living with differences seven local languages to promote 11 since we began attending the sessions. He no longer dialogue among participants of both Working together: Forming Action Groups for beats or insults us and now helps us in household chores. sexes to encourage them to reflect on on-going promotion of healthy behaviors and I feel that he is now accepted in our community." how the unequal gender relations support of community members, especially influence HIV infection and constitu- Community-driven HIV te barriers to health care and family 2. cohesion. prevention and uptake Initially, the tool was developed with 156,906 a view of improving gender relations People reached by of services in order to prevent the emergence of Chibuto Tchova Tchova Community Interventions new infections. Throughout the project however, the TTHV sessions Many of the behaviors that contri- 1. TchovaTchova Life Stories have been adapted to respond to the bute to the spread of HIV and to situ- (TTHV)-Fostering Community growing number of infected people Chókwè Mandlacaze ations of violence are based on soci- Dialogue around HIV/AIDS Pre- and the complexity of the issue, inclu- al, cultural and gendernorms. For vention Behaviors and Referral ding disclosure of HIV status, preven- this reason, the PACTO project used to Services tion of mother-to-child transmission, a series of participatory approaches care and treatment adherence of Because harmful practices are partly and tools to engage community PLHA. Bilene Xai-Xai N driven by inequitable gender dyna- members and leaders in collective mics, TTHV emphasizes transforma- TTHV is conducted by trained facili- dialogue to encourage people to tion of gender norms and male invol- tators during 11 sessions, each of Cidade de Xai-Xai take preventive health behaviors as vement in lowering risky sexual beha- which introduces a theme through a Manhiça well as to promote uptake of servi- viors, reducing victimization/blaming video profile which illustratesnon- ces. fictional people and real stories.The of women, increasing uptake and Distrito Total The community-driven tools deve- adherence of ART and PMTCT, and sessions, on the following themes, 31% Manhiça 21,830 loped by PACTOemphasize new reducing barriers that prevent disclo- are designed to last on average of 21/ 2 Matola 31,799 ways of thinking, feeling and acting sure and access to health services. hours. Matola Ka Mavota 14,817 that contribute to attenuate inequa- Cidade TTHV proposes to engage communi- During the project, 354 community D.U. Nª5 Kamubukwane 13,078 lities and strengthen male involve- ties and leaders in collective dialo- facilitators and field supervisors, D.U. Nª3 Ka Maxakene 6,372 ment in the promotion ofHIV/AIDS D.U. Nª4 gues and problem solving, using an belonging to the local partner com- Distr. Xai Xai 15,336 healthy behaviors. The tools are innovative approach to gender, munity based organizations (CBOs), Cidade Xai Xai 18,669 based upon evidence, have been through the making of real video pro- were trained in the use of the tool.In Chibuto 12,148 pretested, and in the case of Tcho- 4,111 - 4,949 69% files of men, women and couples who total, the project reached 156,906 Manjacaze 5,235 vaTchova, evaluated . 4,950 - 7,330 tell their storyofhow they overcame people, of which 31% were men. Bilene 6,416 The strategic community driven social, cultural and gender barriers in Below is an example of a story of a 7,331 - 9,092 Chókwè 11,206 Female Male activities developed by the project order to make positive changes in family, whose life changed thanks to 9,093 - 16,839 Total 156,906 include following components: their lives. The tool has been used in TchovaTchova. 16,840 - 22,595 Participantes TTHV

1 Figueroa, M.E., Poppe, P., Carrasco, M., Pinho, M.D., Massingue, F., Tanque, M., and Kwizera, A. (in press). Effectiveness of community dialogue in changing gender and sexual norms for HIV prevention: evaluation of the Tchova Tchova program in Mozambique. Journal of Health Communication. Table 1 - People reached by Tchova Tchova Interventions

1 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 1 SESSION THEME Vasco Mboana, 54 years old, lives with his wife of 1 Gender Roles: What can men do? over 35 years, Angelina Ndavi, in Chibututuine. The 2 Traditional and Cultural Values couple has seven children aged 20 to 37 years. Vasco started consuming alcohol excessively during his teen 3 Gender Roles: What can women do? years. "The scars on my body were caused by my actions 4 Ways to overcome domestic violence (gender after drinking, and not because I am a thief. When I am based violence) drunk, I get involved in fights." 5 Dialogue about condom use Vasco and his wife accepted the invitation of facilitators 6 Stigma and blame among couples to start participating in Tchova Tchova sessions. "Tchova 7 Communication between Adults and Children, Tchova made me realize that I wasn´t living a normal Sex Education life. The video that motivated me to change was about 8 Sexual networks: Multiple concurrent sexual ways to overcome violence. I was able to mirror myself in 9 partners the behavior of the man in the video who was later able Mozambiquesince 2010, and uses ART adherence: Living longer with HAART to listen to his wife and overcome his alcohol video and writtenprofiles, available in 10 abuse."Angelina witnesses: "My husband has changed Sero-discordant Couples: Living with differences seven local languages to promote 11 since we began attending the sessions. He no longer dialogue among participants of both Working together: Forming Action Groups for beats or insults us and now helps us in household chores. sexes to encourage them to reflect on on-going promotion of healthy behaviors and I feel that he is now accepted in our community." how the unequal gender relations support of community members, especially influence HIV infection and constitu- Community-driven HIV te barriers to health care and family 2. cohesion. prevention and uptake Initially, the tool was developed with 156,906 a view of improving gender relations People reached by of services in order to prevent the emergence of Chibuto Tchova Tchova Community Interventions new infections. Throughout the project however, the TTHV sessions Many of the behaviors that contri- 1. TchovaTchova Life Stories have been adapted to respond to the bute to the spread of HIV and to situ- (TTHV)-Fostering Community growing number of infected people Chókwè Mandlacaze ations of violence are based on soci- Dialogue around HIV/AIDS Pre- and the complexity of the issue, inclu- al, cultural and gendernorms. For vention Behaviors and Referral ding disclosure of HIV status, preven- this reason, the PACTO project used to Services tion of mother-to-child transmission, a series of participatory approaches care and treatment adherence of Because harmful practices are partly and tools to engage community PLHA. Bilene Xai-Xai N driven by inequitable gender dyna- members and leaders in collective mics, TTHV emphasizes transforma- TTHV is conducted by trained facili- dialogue to encourage people to tion of gender norms and male invol- tators during 11 sessions, each of Cidade de Xai-Xai take preventive health behaviors as vement in lowering risky sexual beha- which introduces a theme through a Manhiça well as to promote uptake of servi- viors, reducing victimization/blaming video profile which illustratesnon- ces. fictional people and real stories.The of women, increasing uptake and Distrito Total The community-driven tools deve- adherence of ART and PMTCT, and sessions, on the following themes, 31% Manhiça 21,830 loped by PACTOemphasize new reducing barriers that prevent disclo- are designed to last on average of 21/ 2 Matola 31,799 ways of thinking, feeling and acting sure and access to health services. hours. Matola Ka Mavota 14,817 that contribute to attenuate inequa- Cidade TTHV proposes to engage communi- During the project, 354 community D.U. Nª5 Kamubukwane 13,078 lities and strengthen male involve- ties and leaders in collective dialo- facilitators and field supervisors, D.U. Nª3 Ka Maxakene 6,372 ment in the promotion ofHIV/AIDS D.U. Nª4 gues and problem solving, using an belonging to the local partner com- Distr. Xai Xai 15,336 healthy behaviors. The tools are innovative approach to gender, munity based organizations (CBOs), Cidade Xai Xai 18,669 based upon evidence, have been through the making of real video pro- were trained in the use of the tool.In Chibuto 12,148 pretested, and in the case of Tcho- 4,111 - 4,949 69% files of men, women and couples who total, the project reached 156,906 Manjacaze 5,235 vaTchova, evaluated . 4,950 - 7,330 tell their storyofhow they overcame people, of which 31% were men. Bilene 6,416 The strategic community driven social, cultural and gender barriers in Below is an example of a story of a 7,331 - 9,092 Chókwè 11,206 Female Male activities developed by the project order to make positive changes in family, whose life changed thanks to 9,093 - 16,839 Total 156,906 include following components: their lives. The tool has been used in TchovaTchova. 16,840 - 22,595 Participantes TTHV

1 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 1 TTHV at the Workplace The age group of TTHV participants, with the preferable age for TTHV participants initially set as 18-50 years old, was expanded, as it was observed that men above that age are also interested in attending the TTHV sessions. sively for leaders or participating in launches, some leaders regularly A specific TTHV tool for use in the workplace was deve- started attending TTHV sessions loped, in partnership with ECOSIDA (the Association of with other community members. Businessmen against AIDS). TTHV in the Workplace The specific targeting of leaders provides an abbreviated version of 5 sessions, also (including religious leaders, village conducted by trained facilitators. chiefs and neighborhood secre- 24,902 taries) not only encouraged people reached stronger overall attendance in the workplace interventions at the TTHV sessions, but Session the leaders were also equipped with tools to reduce conflicts People reached by that cause violence in the family and 1 Gender Roles: What can men do? Intervations at the Xinavane Sugar Refinery community to ensure the continuity ne of the chal- approaches of health promotion and turning lenges the pro- to specifically target them into reference people in their 2 Sexual networks: Multiple concurrent sexual partners Tchova Tchova 7,644 ject encountered men, such as adapting the whilst implementing community / neighborhood. Topics tools for specific use by leaders, for Conversation for discussions ranged from gender the TTHV activities, was use at the workplace, and by expan- 3 Ways to overcome domestic violence (GBV) among men 2,557 equality issues, HIV risk related the difficulty to engage men in the ding the age group of TTHV partici- TTHV workshops and sessions. At behavior such as multiple concur- Harassment pants. 6,663 the end of the first project year, the rent partnerships, use of alcohol and 4 ART adherence: Living longer with HAART Campaign proportion of men participating in A specific TTHV tool was develo- violence, access and rights to land Medical TTHV was 26% and 30% in Mapu- ped for training community leaders, ownership, family rights and obliga- 3,818 to Province and Maputo City res- given the importance of leaders- tions. A total of 3,624 community 5 Sero-discordant Couples: Living with differences Circumcision pectively, and as low as 13% in hip's recognition of the social bene- leaders, who attended the Tchova Gaza Province. The project addres- fit for their communities. Besides Tchova and GBV activities, were HCT 4,220 sed these challenges, using several attending special workshops exclu- trained. 0 1,000 3,000 5,000 One of the main partnerships developed under this com- 2,000 6,000 7,000 8,000 4,000 ponent, is an intervention at the Xinavane Sugar Refinery, near Manhiça, a town located at 80 km from Maputo Pro- Workplace Intervations vince. The Sugar Refinery is the main employer in that Armando Vangakui, 60 years old, a pastor at the Pentecostal Universal Church, residing in Coca Missava, area and the pillar of the local economy, causing the inter- Male Female Total vention to have a significant impact on the specific target Gaza Province, is one of the many community leaders Tchova Tchova 3951 3693 7644 who have experienced the positive changes TTHV has population. Not only were gender and HIV related issues Conversation among men 2557 0 2557 brought to his own personal life. discussed at length during the TTHV sessions, but additional interventions were developed, such as a referral and Harashment Campaign 3028 3635 6663 Armando is married to Alda Francisco Ndlhane, with counter-referral system between the refinery and three Medical Circumcision 2014 1804 3818 whom he has seven children aged 4 to 30 years. Arman- local hospitals, HIV testing campaigns, and Sexual do explains how the TTHV sessions helped the couple to HTC 2573 1647 4220 Harassment in the Workplace campaigns. Using codes, easily manage the relationship between father and this system enables the program to count the numbers of daughter. "I used to be afraid of asking for my daughter´s Similar activities were implemented at several companies in workers who participated in the Tchova Tchova Workpla- help, even to serve me a glass of water or fetch water for the cities of Maputo and Matola: S.S Construções bathing purposes. I was raised not to ask my daughter for ce sessions and who were referred to hospital services, Empreendimentos e Serviços LDA, Maputo City Municipal favors, not even to serve me a glass of water, because and is organized to protect employee confidentiality wit- Council and Empresa Moçambicana de Construção e that I was taught that this is her mother´s role as my hin the company. Promoção Imobiliária, Limitada EMOCIL. wife. Whenever my wife was away, I handled all the chores myself. My daughter and I couldn't have a conversation about anything. I have a young, 4 year old daughter, home and I can now have a proper dialogue with my and I wasn't even allowed to change her wet underwear. I daughter without feeling bad about it or afraid that my An HIV testing campaign was organized at the Refinery, with all workers interested in being tested receiving a had no right to care for the girls, only for the boys", says wife will become upset. I can also talk about sexuality testing code. The company only receives test results by code, without the workers' names. The campaign team, Arnaldo. Alda agrees by adding, "I was also raised in this matters. When the mother is not at home, my daughter made up of counselors trained by the hospital, however, gets a list with the same codes and the names of the manner and taught that only I am allowed to attend to can now cook and serve food for me, I can change my 4 my husband, not my daughter." But the TTHV sessions year old daughter ´s clothes and the tension at home is employees. On a monthly basis, the health units report the number of employees, according to sex, who arrived at changed the way the family lives. "TTHV sessions helped less heavy because of our new lifestyle." Armando conclu- the health unit following referral to the AIDS in the Workplace program at Xinavane. Workers whose test results my family and my church. Today we live in harmony at des. are positive but have not sought services are followed up by counselors from the health unit, working with counselors from the refinery.

1 2 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 3 TTHV at the Workplace The age group of TTHV participants, with the preferable age for TTHV participants initially set as 18-50 years old, was expanded, as it was observed that men above that age are also interested in attending the TTHV sessions. sively for leaders or participating in launches, some leaders regularly A specific TTHV tool for use in the workplace was deve- started attending TTHV sessions loped, in partnership with ECOSIDA (the Association of with other community members. Businessmen against AIDS). TTHV in the Workplace The specific targeting of leaders provides an abbreviated version of 5 sessions, also (including religious leaders, village conducted by trained facilitators. chiefs and neighborhood secre- 24,902 taries) not only encouraged people reached stronger overall attendance in the workplace interventions at the TTHV sessions, but Session the leaders were also equipped with tools to reduce conflicts People reached by that cause violence in the family and 1 Gender Roles: What can men do? Intervations at the Xinavane Sugar Refinery community to ensure the continuity ne of the chal- approaches of health promotion and turning lenges the pro- to specifically target them into reference people in their 2 Sexual networks: Multiple concurrent sexual partners Tchova Tchova 7,644 ject encountered men, such as adapting the whilst implementing community / neighborhood. Topics tools for specific use by leaders, for Conversation for discussions ranged from gender the TTHV activities, was use at the workplace, and by expan- 3 Ways to overcome domestic violence (GBV) among men 2,557 equality issues, HIV risk related the difficulty to engage men in the ding the age group of TTHV partici- TTHV workshops and sessions. At behavior such as multiple concur- Harassment pants. 6,663 the end of the first project year, the rent partnerships, use of alcohol and 4 ART adherence: Living longer with HAART Campaign proportion of men participating in A specific TTHV tool was develo- violence, access and rights to land Medical TTHV was 26% and 30% in Mapu- ped for training community leaders, ownership, family rights and obliga- 3,818 to Province and Maputo City res- given the importance of leaders- tions. A total of 3,624 community 5 Sero-discordant Couples: Living with differences Circumcision pectively, and as low as 13% in hip's recognition of the social bene- leaders, who attended the Tchova Gaza Province. The project addres- fit for their communities. Besides Tchova and GBV activities, were HCT 4,220 sed these challenges, using several attending special workshops exclu- trained. 0 1,000 3,000 5,000 One of the main partnerships developed under this com- 2,000 6,000 7,000 8,000 4,000 ponent, is an intervention at the Xinavane Sugar Refinery, near Manhiça, a town located at 80 km from Maputo Pro- Workplace Intervations vince. The Sugar Refinery is the main employer in that Armando Vangakui, 60 years old, a pastor at the Pentecostal Universal Church, residing in Coca Missava, area and the pillar of the local economy, causing the inter- Male Female Total vention to have a significant impact on the specific target Gaza Province, is one of the many community leaders Tchova Tchova 3951 3693 7644 who have experienced the positive changes TTHV has population. Not only were gender and HIV related issues Conversation among men 2557 0 2557 brought to his own personal life. discussed at length during the TTHV sessions, but additional interventions were developed, such as a referral and Harashment Campaign 3028 3635 6663 Armando is married to Alda Francisco Ndlhane, with counter-referral system between the refinery and three Medical Circumcision 2014 1804 3818 whom he has seven children aged 4 to 30 years. Arman- local hospitals, HIV testing campaigns, and Sexual do explains how the TTHV sessions helped the couple to HTC 2573 1647 4220 Harassment in the Workplace campaigns. Using codes, easily manage the relationship between father and this system enables the program to count the numbers of daughter. "I used to be afraid of asking for my daughter´s Similar activities were implemented at several companies in workers who participated in the Tchova Tchova Workpla- help, even to serve me a glass of water or fetch water for the cities of Maputo and Matola: S.S Construções bathing purposes. I was raised not to ask my daughter for ce sessions and who were referred to hospital services, Empreendimentos e Serviços LDA, Maputo City Municipal favors, not even to serve me a glass of water, because and is organized to protect employee confidentiality wit- Council and Empresa Moçambicana de Construção e that I was taught that this is her mother´s role as my hin the company. Promoção Imobiliária, Limitada EMOCIL. wife. Whenever my wife was away, I handled all the chores myself. My daughter and I couldn't have a conversation about anything. I have a young, 4 year old daughter, home and I can now have a proper dialogue with my and I wasn't even allowed to change her wet underwear. I daughter without feeling bad about it or afraid that my An HIV testing campaign was organized at the Refinery, with all workers interested in being tested receiving a had no right to care for the girls, only for the boys", says wife will become upset. I can also talk about sexuality testing code. The company only receives test results by code, without the workers' names. The campaign team, Arnaldo. Alda agrees by adding, "I was also raised in this matters. When the mother is not at home, my daughter made up of counselors trained by the hospital, however, gets a list with the same codes and the names of the manner and taught that only I am allowed to attend to can now cook and serve food for me, I can change my 4 my husband, not my daughter." But the TTHV sessions year old daughter ´s clothes and the tension at home is employees. On a monthly basis, the health units report the number of employees, according to sex, who arrived at changed the way the family lives. "TTHV sessions helped less heavy because of our new lifestyle." Armando conclu- the health unit following referral to the AIDS in the Workplace program at Xinavane. Workers whose test results my family and my church. Today we live in harmony at des. are positive but have not sought services are followed up by counselors from the health unit, working with counselors from the refinery.

1 2 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 3 2. Positive Prevention (PP) Above all, they create self-help com- Action Group and Go Families) and Community Tool munity networks in order to promo- referrals by participants of previous te an attitude of respect for PLWHA, groups, community leaders and The Positive Prevention Community so that they can live a "positive" qua- family members. At the end of each Tool is part of a series of efforts to lity life, free of violence. Discussions session participants receive con- improve the health and quality of life are led by a trained facilitator, with doms, as well as materials provided of people living with HIV (PLHA) in support of PP manuals and commu- by PACTO about Tuberculosis the communities. PP is implemen- nication tools. Participants in PP (TB)/HIV, Sexually Transmitted ted through community discussions sessions are identified by partnering Infections (STI's) and Prevention of in groups of 8 to 12 people in 8 the- with PLHA CBOs which provide mother-to-child transmission of matic sessions, which include know- home-based visits, Grupos de HIV (PMTCT). Each group meets ledge and skills for PLWHA to pre- Apoio à Adesão Comunitária twice a week for one month with the vent new HIV infections through GAACs, Highly Active Antiretroviral objective of promoting behavior sexual intercourse and vertical Therapy (HAART) defaulters from change in the following areas during transmission and to support each lists provided by health personnel, the eight sessions in each "round": other for adhering to treatment. other PACTO programs (e.g. TTHV,

SESSION Distrito Total 26% Kamubukwane 8,103 1 Reducing risky behaviors: Reduction in the number 5 Reduction or elimination of the consumption Distr. Xai Xai 4,598 of sexual partners; correct use of condoms in all sexual of alcohol and other drugs Chibuto 2,295 relations; sexually transmitted infections Manjacaze 2,232 Bilene 1,180 2 Disclosure of sero-status; partner testing; 6 Reduction of gender based violence; gender norms Cidade Xai Xai 4,838 sero-discordant couples Chókwè 4,571 Matola 13,355 74% Manhiça 12,839 3 Adherence to HIV services (increase uptake of ART, 7 Accessing or creating support services in the Boane family planning, PMTCT, diagnosis and treatment community (e.g. GAAC - Grupos de Apoio a 23,527 Ka Maxakene 205 of STI's); TB/HIV co-infection Adesão Comunitária) Female Male Total 77,943 4 Complying with the recommendations of PMTCT during 8 Referral of GBV cases to services so as to guide pregnancy, childbirth and breastfeeding; Option B+ the victims of violence to reference services and in health facilities minimize occurrence of these cases among HIV-positive women; Interpersonal communication skills

3. Community Support Groups: Action Groups and Self-Help Groups Demand Creation The Action Groups were created by people who participated in the TTHV and PP sessions and continue developing activities in the communities. The support groups aim to carry out complementary activities to ensure the sustainability of the PACTO actions in communities.

Based on the priorities of PEPFAR/ USAID, to strengthen the link with health services, the project identified four key areas of HIV prevention and of the use of HIV services, that are Health facilitated by the Action Groups and the Self-Help Groups: (1) support to the service providers/health facilities; (2) acti- Facility ve search of cases of defaulting patients and losses-to- follow-up; (3) references or monitoring of patients to HIV services; and (4) creating demand for HIV prevention and services at the community level.

In total, 130 Action Groups (TTHV) and Self- Help Groups Referral Active Art (PP) were created by the project, involving 1,541 participants, to Defaulter who were responsible for tracking 17,803 people to the Services Tracing health services.

1 4 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 5 2. Positive Prevention (PP) Above all, they create self-help com- Action Group and Go Families) and Community Tool munity networks in order to promo- referrals by participants of previous te an attitude of respect for PLWHA, groups, community leaders and The Positive Prevention Community so that they can live a "positive" qua- family members. At the end of each Tool is part of a series of efforts to lity life, free of violence. Discussions session participants receive con- improve the health and quality of life are led by a trained facilitator, with doms, as well as materials provided of people living with HIV (PLHA) in support of PP manuals and commu- by PACTO about Tuberculosis the communities. PP is implemen- nication tools. Participants in PP (TB)/HIV, Sexually Transmitted ted through community discussions sessions are identified by partnering Infections (STI's) and Prevention of in groups of 8 to 12 people in 8 the- with PLHA CBOs which provide mother-to-child transmission of matic sessions, which include know- home-based visits, Grupos de HIV (PMTCT). Each group meets ledge and skills for PLWHA to pre- Apoio à Adesão Comunitária twice a week for one month with the vent new HIV infections through GAACs, Highly Active Antiretroviral objective of promoting behavior sexual intercourse and vertical Therapy (HAART) defaulters from change in the following areas during transmission and to support each lists provided by health personnel, the eight sessions in each "round": other for adhering to treatment. other PACTO programs (e.g. TTHV,

1 4 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 5 Men reached by Conversa de Homens A good example of one of the Action Groups created under the impulse of PACTO is the "Salva a Vida" (Saves Life) Action Group based in the village of Chegua, administrative post of Malehice, Chibuto District, created in September 2011, when a number of participants volunteered to continue activities after having participated in all TTHV sessions. The group mobilizes people for HIV testing, follows up on PLHA and cares for orphans and vulnerable children (OVC). "It's true, this group saves lives indeed," says Dulce, 29 years old, married to Auré- lio, aged 34, with 3 children aged between 1 and 12. "When Salva! came to my home, I was just waiting to die… I was so sick, they told me to go to the hospital but I didn't have money. They collected money for transportation. My husband came with me and was also encouraged by Salva! to get tested. We both tested positive, and now, after a few months in treatment, I feel good." Aurélio emphasizes that, "Salva! made me understand that it was better to get tested before I got sick, that's why I did the test even though I wasn't feeling sick, just to 8,944 know my status so that I could prevent diseases through hospital care." men reached by “Conversa de Homens"

1% 20% 4. Conversa de Homens Kamubukwane 37% The Conversa de Homens (Conversation among Men) tool was developed in partnership with the local NGO Chibuto 21% HOPEM (Homens pela Mudança - Men for Change). It is Cidade de Xai-Xai the only tool available in the country which is specifically 21% targeting men and is adapted to the Mozambican context. It aims to encourage male involvement in the pro- Cidade da Matola motion of dialogues among men in order to contribute to more balanced relations between men and women, to Manhiça engage men in promoting health, to reduce the occurrence of gender-based violence among young and adult women, and to promote male circumcision, condom use and HIV testing. The story of Gemílio Nhamaio, a 50 year old resident of Kamubukwane district of Maputo City, illustrates the Conversa de Homens consists of the following eight the- power of the Conversa de Homens sessions, and the relationship between the various community components matic sessions: of the PACTO project.

Session Gemílio is married and lives with his wife, Maria-Lourdes. After having 1 Introduction of Conversa de Homens sessions been sick for a while, he was advised to get tested for HIV, and then came the news that would change his life, "You are HIV-positive." Gemílio found this very 2 Gender inequality and power relations hard to accept, but he learned to take care of his HIV status when he joined a PP group, linked to the CBO Hixikanwe. "Hixikanwe has helped me in many ways:

3 Gender Based Violence (GBV) moral support and things I've learned that help me in everyday life. If it were not for them, I do not know what would have become of me. I'm not working since I discovered that I am HIV-positive and the basic basket offered by the 4 Violence and sexual harassment Association and its partners helps to support my family. It's worth knowing I'm HIV positive because I am taking medication, and I know which state is worse." 5 Alcohol use and violence Gemílio has also been one of the first participants in the Conversas com Homens dialogues, helping him to become a different man, an example in the 3 How to take care of your health community as well as a good husband, father and grandfather to his family. He says, "Sometimes I'm able to help resolve conflicts in the community and at 4 Breaking the cycle of violence home I help my wife doing housework, cooking, bathing the kids and washing clothes."

5 Where to find help in the case of violence

1 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 7 Men reached by Conversa de Homens A good example of one of the Action Groups created under the impulse of PACTO is the "Salva a Vida" (Saves Life) Action Group based in the village of Chegua, administrative post of Malehice, Chibuto District, created in September 2011, when a number of participants volunteered to continue activities after having participated in all TTHV sessions. The group mobilizes people for HIV testing, follows up on PLHA and cares for orphans and vulnerable children (OVC). "It's true, this group saves lives indeed," says Dulce, 29 years old, married to Auré- lio, aged 34, with 3 children aged between 1 and 12. "When Salva! came to my home, I was just waiting to die… I was so sick, they told me to go to the hospital but I didn't have money. They collected money for transportation. My husband came with me and was also encouraged by Salva! to get tested. We both tested positive, and now, after a few months in treatment, I feel good." Aurélio emphasizes that, "Salva! made me understand that it was better to get tested before I got sick, that's why I did the test even though I wasn't feeling sick, just to 8,944 know my status so that I could prevent diseases through hospital care." men reached by “Conversa de Homens"

5 Where to find help in the case of violence

1 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 7 In Xai-Xai district, several participants who completed men have become role models in their communities, ins- the sessions of the Conversa de Homens program deve- piring and encouraging others to initiate the necessary loped an initiative, by creating a Group called "Reference changes. On the other hand, the fact that they are wor- Group Against Domestic Violence", to help women and king in coordination with the support services, enables their children who are victims of domestic violence, by full support for those who have suffered violence, while at identifying and referring them to the relevant services. the same time the perpetrators are held responsible. Community leaders, religious leaders and community members belong to the group, which works in partnership with community-based organizations as well as state 5. Avante Familia institutions (the Hospital, the Office of Assistance to PACTO created a specific tool designed to strengthen Women and Children, Health and Social Welfare), direc- family relationships and to create an HIV/AIDS protective ting victims to these services. environment for youth and adolescents. Avante Família According to the 25 members, the creation of this Group focused its approach to improve communication skills aims to involve men in the fight against violence, "we all among young people and adults to be able to address know that there are men who are against violence, in this difficult issues in relation to sexuality, HIV/AIDS, sexual context we created a group of men in order to sensitize abuse and harassment. This tool was implemented from other men to fight against all forms of violence against 2011 to 2013 in all communities covered by PACTO, rea- women". Being active and influential community mem- ching 14.606 parents and guardians of education. bers, it makes the initiative work. Firstly because these 3. Demand Generation for HIV Services

People Reached By Communication Adult/youth Intervention

lity), etc. Discussion of one's sexual Male Female Total 1. Integrated Mass Media and Com- munity mobilization and interperso- munity Campaign on Multiple nal communication to deliver its mes- partner's rights included issues such 5,396 5,311 Maputo City 1,585 3,811 5,396 Sexual Partners and Related Risk sage. as the responsibility to know and disclose their HIV status to one anot- Maputo Province 1,027 2,872 3,899 3,899 Behaviors: “Andar Fora é Manin- gue Arriscado” her; what they consider safer sex; Gaza Province 360 4,951 5,311 3,811 the need for better communication; 4,951 TV Talk Shows 2,872 consensus about lifestyle; and the Grand Total 2,972 11,634 14,606 1,585 1,027 360 In November 2012, PACTO suppor- PACTO promoted a series of discus- need for VCT. MAPUTO CITY MAPUTO PROV. GAZA PROV. ted the National AIDS Council sions on four key TV Stations (TVM, STV, Miramar and TIM) that addres- Male Female Total (CNCS) dissemination of Andar Fora é Maningue Arriscado campaign, a sed issues related to sexual net- high profile national mass media and works, the role of men as family pro- community driven intervention that tectors and health promoters, gen- focused on creating debate and der-based violence, sero-discordant Esperança Albino Chichango, a 31-year old single mother of a 12 year old daughter and resident of Nhacutse, Gaza reflection on some of the critical risk couples and the importance of kno- Province, was very keen to participate in the "Avante Família" because she was experiencing some difficulties in factors and drivers of the HIV epide- wing one's HIV status. mic in Mozambique. The campaign managing the relationship with her only daughter. "When I returned home from the session, the first conversation Discussions on the show explored continued the multiple concurrent I had with my daughter was about what I had learnt from the session. I told her that the session taught parents to the motivations to engage in multi- sexual partners (MCP) campaign educate their children without resorting to physical violence. It was difficult for me to have this conversation with ple concurrent sexual partnerships first launched by CNCS in 2010 and my daughter because the relationship I was maintaining with her was causing me a lot of pain and suffering. My (MCP) and debated societal and its theme translates loosely as "Step- individual expectations about gen- daughter preferred spending time playing with our neighbors and when they gave her chores to do, she would do ping out is quite risky", the use of them and spend meals at their home. She would return home only at night to sleep and return to our neighbors´ der roles and rights of sexual part- "out" implying outside of marriage or ners. Most of the issues identified by home early the following day, even before we awakened. She would go to school only when she wanted and had no stable partnerships. The main pur- participants were consistent with the respect for her uncles and grandmother. I didn't know what else to do so I used physical violence against her but pose of the campaign was to discuss findings from the formative research that too didn´t work." Esperança´s participation in the "Avante Família" sessions and commitment to follow all the risks of MCP, increase social conducted by PACTO before the the assigned homework changed the relationship with her daughter for the better. "I have stopped using violence disapproval of MCP, encourage men campaign and included problems against my daughter. I now resort to dialogue to educate her and call her to reason. When she does something to go for HIV testing (preferably with within primary relationships (e.g. their partners) and improve their inappropriate, I call her and have a chat with her. I started seeing the changes when my daughter begun spending lack of emotional and sexual satis- relationships with their primary part- more time at home and doing some household chores. The neighbors with whom she used to spend most of her faction), economic issues, peer pres- ners for better communication and sure (e.g. signs of prestige and sexu- time now ask about her whereabouts." safer sex. The campaign strategy al prowess), family pressure (e.g. to used mass media, social media, com- find a spouse or in cases of inferti-

People Reached By Communication Adult/youth Intervention

1 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 1 7 Dissemination of the campaign on internet and social ICS, Reecontro and Hixikanwe. These events allowed the media team to gather some impressions and valuable feedback from communities in relation to the campaign. The mes- The campaign messages continued to be disseminated sages of the campaign had overflowed media platforms through Facebook and through PACTO's website. The to become ingrained in popular discourse, in the streets Facebook page of the campaign has been a forum for and markets. From the knowledge contests, it was visible heated debates, where about 3,300 fans have shared that many participants were connected to PACTO inter- ideas, experiences and perceptions about the risks of ventions in some way, whether through radio programs, multiple sexual partnerships. An interesting trend obser- TV programs or community interventions. The best ans- ved in the last two months of the campaign was the large wers during the contests were awarded Andar Fora cam- number of personal stories and requests for help through paign t-shirts or calendars. the inbox. Stories were selected and shared anony- different situations made through local radio stations to mously on the page, allowing users to put out their views where men are challen- and advice on the stories published. The topics of the reinforce message penetration and Branding of Chapas and Tchopelas ged to make choices and reach. Four spots were broadcast by stories included HIV status disclosure, difficulties in adopt responsible and healthy beha- Radio Cidade during the breaks in the negotiating safer sex, fear of partner abandonment and Beginning in January 2013, PACTO began an innovative viors Fatias da Vida drama series, while people who felt at risk of infection due to promiscuous partnership with public transport vehicles. This involved several activities and events with the drivers of cha- “Andar Fora é Maningue Arrisca- An opportunity to reach a larger male some community radio stations were partners. Individual replies were provided to the senders audience with the spots came with broadcasting the spots during the of the messages, with advice to seek appropriate servi- pas (mini-buses) and tchopelas (3-wheel motorcycle do” TV Spots taxis) in urban areas of Maputo, Matola and Xai-Xai. A the live broadcast of the African Nati- airing of Tchova-Tchova radio maga- ces. total of 50 chapas and 100 tchopelas were circulating One of the central pieces of the cam- ons Football Cup on TVM 1 and 2. zine. The spots were not translated with the brand and slogans of the campaign in the form paign was four popular TV spots that This is particularly significant due to into local languages, since the main provided the basis for radio and print the fact that the airtime for this very of large adhesive signs on the sides of the vehicles. target was people from urban areas, “Andar Fora é Maningue Arriscado” Community Inter- materials that used dialogue and popular program was discounted as mentioned. A video report produced and broadcast by Gungu-TV 30% from commercial rates by TVM. ventions images from the spots. In addition, showed that the branding of chapas and tchopelas trig- as part of the campaign, PACTO pro- PACTO carried out interventions in urban and peri-urban gered interesting conversations about the campaign mes- moted a series of discussions on TV areas to further reinforce TV and radio messaging. Com- sages between passengers, ticket collectors and drivers. that addressed issues related to sexu- Drama and Music on TV Radio spots and magazines munity activities such as group discussions and chapa This further led to the idea of using chapas and tchopelas al networks, among others. PACTO Gungu TV launched 15 episodes of to distribute campaign leaflets and stickers to interested developed the TV spots (later also Although the MCP campaign was and tchopela (urban and peri-urba transportation) para- the Fatias da Vida TV drama series, passengers. PACTO also distributed CDs containing adapted to a radio format) after pre- mainly designed for urban areas des were held in Maputo, Xai-Xai and Chibuto. Activities adapted from the radio soap opera recordings of radio programs about Andar Fora to be testing with representative groups of (where television is preferred over in Gaza Province had the support of the community radio script of the same name, originally played in the chapas and tchopelas to inspire discussions the target audience. The spots depict radio), significant interventions were of Xai-Xai under the leadership of the Social Communi- developed by PACTO and Politécnica cation Institute (ICS) and CBO Reencontro, while in University's Health Communication Maputo activities had the support of Radio Cidade and Center of Excellence (CECS). These Descriptions of the Spots the CBO Hixikanwe. 15 episodes depict social norms, lack Title Objective Synopsis Duration of couple dialogue, peers pressure The peri-urban events in Maputo and Chibuto consis- and other factors underlying MCP ted of participatory discussion sessions and know- Spot 1 Increase social A man chooses to stay with his 60 sec behaviors and challenges the audien- ledge contests facilitated by members of PACTO, "Family” disapproval of family instead of continuing the ce to adopt safer behaviors as well as MCP affair with his mistress. to adhere to HIV services.

Spot 2 Challenge A man takes his wife out to enjoy 60 sec A music video marked the final "Friday” masculine norms Friday night; other men admire stage of the MCP campaign with that compel men to him and decide to bring their assume risky wives too. behaviors

Spot 3 Encourage men to Two men watching sports dis- 60 sec "Discordant go for VCT cuss HIV testing and discordance couples” (preferably with and conclude that a man must be partners) tested for HIV even when his wife has already been.

Spot 4 Disapprove GBV and After hearing a coworker's out- 60 sec MCP/GBV improve couple pourings about her husband (full version: communication being violent, a man realizes that 2 min) he also behaves the same way. He calls his wife, determined to change the course of their lives for the better. In 2013, PACTO was invited by the MOH to provide technical assistance to the National Program for Medi- cal Circumcision in the design of a national strategy to 3,058 increase demand for medical male circumcision services. insertions of programs provinces with highest 750 and TV spots In response to this request, PACTO developed a com- inserts of the 15 episode of the HIV prevalence in radio soap series “Fatias da Vida”, munication campaign for medical circumcision, which transmitted in 25 radio Mozambique (Gaza and included two interrelated strategic components: trai- stations. Maputo provinces). The ning in counseling and communication skills for health results from this evaluation identi- providers, and the creation of demand for medical fied various relationships among pre- circumcision services. 58% vention behaviors including Multiple of people interviewed Sexual Partners (MSP) and condom in the evaluation were exposed use; condom use at first sex and con- 5,898 to the campaign on the issues of the cam- dom ideation and use; condom use at grassroot level pilot intervention paign, which further led first sex and attitudes that discourage to an innovative initia- MSP; HIV disclosure and condom tive from some tchopela use. The campaign had a positive drivers to distribute con- effect on reducing MSP behavior 2. Demand Generation Campaign The five radio spots were produced The local campaigns took place in doms to their passengers through increasing knowledge and for Medical Circumcision in Portuguese, Macua, Sena and the communities where PACTO had during weekends and night discussion of MSP risk with sex part- Changana and were distributed to ongoing activities, particularly in the shifts. To make this happen, PACTO ners; it has also shown that those A number of studies have shown on youth and adults). This informati- more than 30 public, private and provinces of Gaza and Maputo, and organized weekly meetings with on is based on audience estimates with MSP knowledge were less likely that an African man who gets cir- community radio stations nationwi- also through the mass media (tele- tchopela drivers to prepare and train from the African Nations Football to engage in MSP behavior. The cam- cumcised can reduce his relative risk de. To continue achieving synergy vision spots and radio programs) in them on the main themes of the cam- Cup, as there were no updated audi- paign also had a positive direct of HIV infection through heterosexu- across all campaign materials, TV order to reach a wider audience. paign. The tchopela drivers also par- ence studies to provide definitive sta- impact on knowledge and discussion al relations by as much as 44 per- spots reinforced the messages and Circumcision services were offered ticipated and shared their experi- tistics. of MSP risk and an indirect effect on cent, according to the U.S. Centers ences in discussions on TVM's attitudes that discourage MSP communication objectives descri- at the health facilities and through PACTO also broadcast a total of 141 for Disease Control and Prevention Homen que é Homen and Gungu- through MSP knowledge and discus- bed above. mobile units by the Ministry of radio magazines, 508 insertions of (CDC). Only around 20 percent of TV. Tchopela drivers handed out a sion. Those with knowledge and dis- Health and by Jhpiego, a non- radio spots and 226 airings of all the young men between the ages of 20 PACTO designed and produced com- total of 8,680 condoms to their cus- cussion of MSP with sex partners governmental organization. 15 episodes of the “Fatias da Vida” munication materials directed to the were more likely to have attitudes and 30 however, and not even 8 per- tomers. drama series in nine community radio that discourage MSP. Finally, it is cent of those over 30 years old, are target groups, and for use by the In May 2014, PACTO piloted some stations, followed by debates (talk- PACTO organized six parades involv- noteworthy that 58% of the survey's circumcised in Mozambique. The healthcare services (flipcharts, bro- community level awareness cam- shows) produced locally. ing almost all 50 chapas and 100 respondents were exposed to one or Ministry of Health (MOH) thus chures and posters), each designed paigns for medical circumcision at tchopelas on major routes in Maputo In 2013, an evaluation of the campa- more communication activities in the added medical circumcision (MC) to to serve a specific purpose: the sugar refineries of Xhinavane City. The parades culminated with ign was carried out by USAID project two study provinces (Figueroa & Kin- its HIV prevention arsenal and set shows on Costa do Sol beach, broad- Research to Prevention (R2P) in two caid, 2014 ). the ambitious goal to increase the cast live by Radio Cidade. These national prevalence of male circum- Material Purpose the Material events also included contests, inter- cision to 80% in men between 10 views and journalistic reports, as well Number of spot inserts in the radio programming and 49 years of age. Flipchart to use in the Designed to support the counselors and community as distribution of campaign materi- community activists to communicate well with the public about als. The communication campaign used medical circumcision (can be used in group discussions Province Programe/ Magazine Radio Spot “Fatias da Vida” Station Episodes Insert novel a logo, slogan and a visual composi- or one-on-one meetings) Also, a total of 18 billboards were 180 15 tion that represents the Mozambi- placed in Maputo City, Maputo Prov- Radio Cidade 45 Flipchart to use in the Designed to support counselors to communicate well health facility with users about medical circumcision. Can be used in Province Radio Voz Coop 4 0 30 can flag colors, appealing to a sense ince and Gaza Province, and print group discussion or one-on-one consultations. Maputo City of local and national identity. "Faz a materials were distributed to partner Radio Maria 49 180 30 and Province Circuncisão: Torna-te Um Novo organizations in all communities Radio Komati 10 40 15 Homem" (Get circumcised; Become Brochure for youth and Designed to disseminate general information about the covered by PACTO and included Radio Xinavane 10 40 15 adults to use at the health advantages of circumcision, how it is done and all a new man) is the slogan that was facility associated care 6,000 posters, 3,000 stickers, 1,250 Radio Xai-xai 16 64 23 T-shirts, 500 calendars, and 500 adopted to integrate all campaign Radio Manjacaze 42 168 42 coasters. Gaza components and materials. The cam- Brochure for youth and With illustration adapted for those who cannot read, Province Radio Mabalane 20 0 40 paign communication objectives and adults to use at the developed to provide general information about medical community level circumcision Radio Chibuto 14 56 16 key messages represent the aspirati- Results of the "Andar Fora Campa- 141 508 226 ons, values and perceived benefits of ign “ medical circumcision among the Brochure for leaders Contains information about circumcision and the role of target audience. All campaign prin- leaders in generating demand Number of spotNumber inserts of inBroadcasts the radio programming The TV spots were broadcast 3,058 ted materials, TV and radio spots, times in a total of nine months (No- Station Nov12 Dec12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 media programs and promotional Brochure for mothers and Contains information about circumcision and care for vember 2012 to July 2013). Accor- TVM 1 & 2 69 143 129 84 - - - - 425 items consistently carry out the caregivers of minors the mothers of youth eligible for medical circumcision ding to the TVM Commercial Miramar 50 54 19 - - - - - 123 same positioning, as demonstrated Department, the estimated audience STV 44 38 38 - - - - - 120 Gungu TV - 180 465 130 125 1701 1701 1701 1,410 in the table below by the synergy was 12.5 million people (75% men Brochure for post-surgery Contains information about care to take after the aged 18-49 or approximately 9 milli- ECO-TV - 180 180 120 120 2202 1602 - 980 between radio spots and campaign care medical circumcision Total 163 595 831 334 245 390 330 170 3,058 posters.

22 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 2 3 In 2013, PACTO was invited by the MOH to provide technical assistance to the National Program for Medi- cal Circumcision in the design of a national strategy to 3,058 increase demand for medical male circumcision services. insertions of programs provinces with highest 750 and TV spots In response to this request, PACTO developed a com- inserts of the 15 episode of the HIV prevalence in radio soap series “Fatias da Vida”, munication campaign for medical circumcision, which transmitted in 25 radio Mozambique (Gaza and included two interrelated strategic components: trai- stations. Maputo provinces). The ning in counseling and communication skills for health results from this evaluation identi- providers, and the creation of demand for medical fied various relationships among pre- circumcision services. 58% vention behaviors including Multiple of people interviewed Sexual Partners (MSP) and condom in the evaluation were exposed use; condom use at first sex and con- 5,898 to the campaign on the issues of the cam- dom ideation and use; condom use at grassroot level pilot intervention paign, which further led first sex and attitudes that discourage to an innovative initia- MSP; HIV disclosure and condom tive from some tchopela use. The campaign had a positive drivers to distribute con- effect on reducing MSP behavior 2. Demand Generation Campaign The five radio spots were produced The local campaigns took place in doms to their passengers through increasing knowledge and for Medical Circumcision in Portuguese, Macua, Sena and the communities where PACTO had during weekends and night discussion of MSP risk with sex part- Changana and were distributed to ongoing activities, particularly in the shifts. To make this happen, PACTO ners; it has also shown that those A number of studies have shown on youth and adults). This informati- more than 30 public, private and provinces of Gaza and Maputo, and organized weekly meetings with on is based on audience estimates with MSP knowledge were less likely that an African man who gets cir- community radio stations nationwi- also through the mass media (tele- tchopela drivers to prepare and train from the African Nations Football to engage in MSP behavior. The cam- cumcised can reduce his relative risk de. To continue achieving synergy vision spots and radio programs) in them on the main themes of the cam- Cup, as there were no updated audi- paign also had a positive direct of HIV infection through heterosexu- across all campaign materials, TV order to reach a wider audience. paign. The tchopela drivers also par- ence studies to provide definitive sta- impact on knowledge and discussion al relations by as much as 44 per- spots reinforced the messages and Circumcision services were offered ticipated and shared their experi- tistics. of MSP risk and an indirect effect on cent, according to the U.S. Centers ences in discussions on TVM's attitudes that discourage MSP communication objectives descri- at the health facilities and through PACTO also broadcast a total of 141 for Disease Control and Prevention Homen que é Homen and Gungu- through MSP knowledge and discus- bed above. mobile units by the Ministry of radio magazines, 508 insertions of (CDC). Only around 20 percent of TV. Tchopela drivers handed out a sion. Those with knowledge and dis- Health and by Jhpiego, a non- radio spots and 226 airings of all the young men between the ages of 20 PACTO designed and produced com- total of 8,680 condoms to their cus- cussion of MSP with sex partners governmental organization. 15 episodes of the “Fatias da Vida” munication materials directed to the were more likely to have attitudes and 30 however, and not even 8 per- tomers. drama series in nine community radio that discourage MSP. Finally, it is cent of those over 30 years old, are target groups, and for use by the In May 2014, PACTO piloted some stations, followed by debates (talk- PACTO organized six parades involv- noteworthy that 58% of the survey's circumcised in Mozambique. The healthcare services (flipcharts, bro- community level awareness cam- shows) produced locally. ing almost all 50 chapas and 100 respondents were exposed to one or Ministry of Health (MOH) thus chures and posters), each designed paigns for medical circumcision at tchopelas on major routes in Maputo In 2013, an evaluation of the campa- more communication activities in the added medical circumcision (MC) to to serve a specific purpose: the sugar refineries of Xhinavane City. The parades culminated with ign was carried out by USAID project two study provinces (Figueroa & Kin- its HIV prevention arsenal and set shows on Costa do Sol beach, broad- Research to Prevention (R2P) in two caid, 2014 ). the ambitious goal to increase the cast live by Radio Cidade. These national prevalence of male circum- Material Purpose the Material events also included contests, inter- cision to 80% in men between 10 views and journalistic reports, as well Number of spot inserts in the radio programming and 49 years of age. Flipchart to use in the Designed to support the counselors and community as distribution of campaign materi- community activists to communicate well with the public about als. The communication campaign used medical circumcision (can be used in group discussions Province Programe/ Magazine Radio Spot “Fatias da Vida” Station Episodes Insert novel a logo, slogan and a visual composi- or one-on-one meetings) Also, a total of 18 billboards were 180 15 tion that represents the Mozambi- placed in Maputo City, Maputo Prov- Radio Cidade 45 Flipchart to use in the Designed to support counselors to communicate well health facility with users about medical circumcision. Can be used in Province Radio Voz Coop 4 0 30 can flag colors, appealing to a sense ince and Gaza Province, and print group discussion or one-on-one consultations. Maputo City of local and national identity. "Faz a materials were distributed to partner Radio Maria 49 180 30 and Province Circuncisão: Torna-te Um Novo organizations in all communities Radio Komati 10 40 15 Homem" (Get circumcised; Become Brochure for youth and Designed to disseminate general information about the covered by PACTO and included Radio Xinavane 10 40 15 adults to use at the health advantages of circumcision, how it is done and all a new man) is the slogan that was facility associated care 6,000 posters, 3,000 stickers, 1,250 Radio Xai-xai 16 64 23 T-shirts, 500 calendars, and 500 adopted to integrate all campaign Radio Manjacaze 42 168 42 coasters. Gaza components and materials. The cam- Brochure for youth and With illustration adapted for those who cannot read, Province Radio Mabalane 20 0 40 paign communication objectives and adults to use at the developed to provide general information about medical community level circumcision Radio Chibuto 14 56 16 key messages represent the aspirati- Results of the "Andar Fora Campa- 141 508 226 ons, values and perceived benefits of ign “ medical circumcision among the Brochure for leaders Contains information about circumcision and the role of target audience. All campaign prin- leaders in generating demand Number of spotNumber inserts of inBroadcasts the radio programming The TV spots were broadcast 3,058 ted materials, TV and radio spots, times in a total of nine months (No- Station Nov12 Dec12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 media programs and promotional Brochure for mothers and Contains information about circumcision and care for vember 2012 to July 2013). Accor- TVM 1 & 2 69 143 129 84 - - - - 425 items consistently carry out the caregivers of minors the mothers of youth eligible for medical circumcision ding to the TVM Commercial Miramar 50 54 19 - - - - - 123 same positioning, as demonstrated Department, the estimated audience STV 44 38 38 - - - - - 120 Gungu TV - 180 465 130 125 1701 1701 1701 1,410 in the table below by the synergy was 12.5 million people (75% men Brochure for post-surgery Contains information about care to take after the aged 18-49 or approximately 9 milli- ECO-TV - 180 180 120 120 2202 1602 - 980 between radio spots and campaign care medical circumcision Total 163 595 831 334 245 390 330 170 3,058 posters.

22 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 2 3 and Ressano Garcia, both located in Mobile unit for circumcision and Developed Material/ Communication Objective Maputo province. In Xhinavane, the Message people waiting their turn project brought together 5 journa- A good example is the village of Xinavane. Located 80 km from Maputo In Xai-xai, Chongoene, Nhacutse, lists of the local radio and 15 acti- Poster 1 & Radio Spot 1: Created demand for medical circumcision by "Here you will always be well demonstrating commitment, credibility and trust in Manhiça and Xinavane, PACTO City, it is home to the Xinavane Sugar Company, the town's major vists from the sugar company for a received and well attended!” health care providers. conducted the demand generation employer and pillar of the local economy. In May 2014, the PACTO 5-day training on the use of com- and mobilization process through project brought together 15 activists from the sugar company and 5 munication tools and materials for Poster 2 & Radio Spot 2: Strengthening the role of women in influencing and its Tchova Tchova Histórias da Vida community mobilization in prepa- "Now we are a couple who encouraging the man to get circumcised. radio journalists for a 5-day training program on the use of understands each other (TTHV) community dialogue sessi- ration for a demand generation cam- better.” ons and its Positive Prevention ses- communication tools and materials for community mobilization in paign. This campaign used a two sions with PLHA support groups, as preparation for a demand generation campaign launched in July. This pronged approach, community Poster 3 & Radio Spot 3: "Now Stimulating demand for the medical circumcision both interventions provide plenty of I am a cleaner, healthier and services promoting its benefits campaign, which is still going on, uses a two pronged approach- radio and outreach to workers in the time to discuss the benefits of medi- more attractive man” community radio and outreach to workers in the factory. The Xinavane factory. cal circumcision. A network of community radios and local leaders who Community Radio station sets aside a few minutes of its daily health The Xinavane Community Radio Poster 4 & Radio Spot 4: Creating interest and acceptance of medical were graduates of PACTO's various program, "Health and Life," to educate its audience on the importance station set a few minutes of its daily "Now it's only you missing!” circumcision, turning it into a desirable practice, a "lifestyle" adopted by the critical young mass leadership training workshops was of circumcision. People who are interested in being circumcised can health program "Health and Life" also used. register for the procedure either by visiting the station in person or over aside to educate its audience on the Poster 5 & Radio Spot 5: "I Deconstructing myths, fears and wrong information importance of circumcision. People was afraid, but I made the about CMMV PACTO also trained more than 200 the phone. Then, the radio station drafts a list to follow up on those who right choice” health professionals in the city and interested in being circumcised, are interested. Between July and September 2014, 445 men and boys province of Maputo, Gaza, Manica, could register for the procedure, Poster 6: "What are you Increasing positive attitudes towards medical registered through the radio station. Tete and Zambezia in counseling either by visiting the station in per- waiting for?” circumcision and create a favorable environment for adherence to the practice and communication skills for medi- son or over the phone. The radio cal circumcision. station then drafted a list to follow up on those interested men. Betwe- tory activists traveled from sector to Department or by giving their en July and September 2014, 445 sector to talk about the importance names directly to the activists. In cally helped media partners to duced in a very interactive radio for- men and boys registered through of circumcision. the same period, 318 adults registe- 3. Securing sustainability, technical improve the following aspects in mat that combines real life testimo- the radio station. Within the Xina- red at the factory. capacity and commitment Interested employees could regis- their content: Production of video nies, Vox Pops, drama debates, pho- vane factory, PACTO's trained fac- among media partners to conti- ter through the Social Action ne-in, text messages, questions and nue producing high impact TV stories that emphasize behavior answers with a health and/or Health programming change resulting in seeking health services; Development of discussi- HIV/AIDS specialist to provide ans- PACTO established a wide range of ons oriented to mobilize people to wers to questions coming from the strong partnerships with private and seek testing services, PMTCT, ART, public through SMS or call-in. The public media broadcasters aiming at VMMC and others; Ensure attracti- topics covered by the programs supporting their role and social res- veness of the program by better com- include Multiple Concurrent Part- ponsibility to implement and advo- bining education and entertainment. ners, Prevention of Mother-to-Child cate for HIV prevention and public PACTO recognized that greater Transmission of HIV (PMTCT), Gen- health promotion programs. PACTO involvement and participation of der-Based Violence (GBV), Pediatric worked with the four major public clinical partners and MOH experts AIDS, Anti-Retroviral Treatment and private TV stations in the was critical. PACTO liaised with the (ART) adherence, and TB and HIV country, TVM, STV, Miramar and MOH to identify authorized professi- testing among couples. TIM, as well as the public radio stati- onals to participate in the discussi- Results of securing sustainability, on Radio Mozambique and 8 com- ons on a regular basis, which led to technical capacity and commit- munity radio stations. PACTO's res- better ownership and collaboration. ment among media partners ponsibility in the collaboration with This also allowed sensitive issues to media partners consisted in the pro- be addressed together with MOH Over the life of the project, PACTO vision of technical support on issues officials in the program. produced 171 episodes of different pertaining to public health and HIV programs in different TV stations. In partnership with the national radio combination prevention, the deve- These episodes were broadcast 331 network Rádio Moçambique (RM) lopment of contents, building of times in the above mentioned media and community radios (RC), PACTO skills, and promotion of linkages with stations. Most of the programs had a produced 12-to-15-minute radio community interventions, partners format based on reality, in which magazine programs dubbed "Tcho- and the Ministry of Health. short videos with extraordinary true va-Tchova - "Escutando Podemos stories are used to promote discus- Through on-the-job trainings and Mudar" (We can change by liste- sions and reflections between the collaborative work, PACTO strategi- ning). The programs have been pro- two moderators of the program, a

24 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 2 5 and Ressano Garcia, both located in Mobile unit for circumcision and Developed Material/ Communication Objective Maputo province. In Xhinavane, the Message people waiting their turn project brought together 5 journa- A good example is the village of Xinavane. Located 80 km from Maputo In Xai-xai, Chongoene, Nhacutse, lists of the local radio and 15 acti- Poster 1 & Radio Spot 1: Created demand for medical circumcision by "Here you will always be well demonstrating commitment, credibility and trust in Manhiça and Xinavane, PACTO City, it is home to the Xinavane Sugar Company, the town's major vists from the sugar company for a received and well attended!” health care providers. conducted the demand generation employer and pillar of the local economy. In May 2014, the PACTO 5-day training on the use of com- and mobilization process through project brought together 15 activists from the sugar company and 5 munication tools and materials for Poster 2 & Radio Spot 2: Strengthening the role of women in influencing and its Tchova Tchova Histórias da Vida community mobilization in prepa- "Now we are a couple who encouraging the man to get circumcised. radio journalists for a 5-day training program on the use of understands each other (TTHV) community dialogue sessi- ration for a demand generation cam- better.” ons and its Positive Prevention ses- communication tools and materials for community mobilization in paign. This campaign used a two sions with PLHA support groups, as preparation for a demand generation campaign launched in July. This pronged approach, community Poster 3 & Radio Spot 3: "Now Stimulating demand for the medical circumcision both interventions provide plenty of I am a cleaner, healthier and services promoting its benefits campaign, which is still going on, uses a two pronged approach- radio and outreach to workers in the time to discuss the benefits of medi- more attractive man” community radio and outreach to workers in the factory. The Xinavane factory. cal circumcision. A network of community radios and local leaders who Community Radio station sets aside a few minutes of its daily health The Xinavane Community Radio Poster 4 & Radio Spot 4: Creating interest and acceptance of medical were graduates of PACTO's various program, "Health and Life," to educate its audience on the importance station set a few minutes of its daily "Now it's only you missing!” circumcision, turning it into a desirable practice, a "lifestyle" adopted by the critical young mass leadership training workshops was of circumcision. People who are interested in being circumcised can health program "Health and Life" also used. register for the procedure either by visiting the station in person or over aside to educate its audience on the Poster 5 & Radio Spot 5: "I Deconstructing myths, fears and wrong information importance of circumcision. People was afraid, but I made the about CMMV PACTO also trained more than 200 the phone. Then, the radio station drafts a list to follow up on those who right choice” health professionals in the city and interested in being circumcised, are interested. Between July and September 2014, 445 men and boys province of Maputo, Gaza, Manica, could register for the procedure, Poster 6: "What are you Increasing positive attitudes towards medical registered through the radio station. Tete and Zambezia in counseling either by visiting the station in per- waiting for?” circumcision and create a favorable environment for adherence to the practice and communication skills for medi- son or over the phone. The radio cal circumcision. station then drafted a list to follow up on those interested men. Betwe- tory activists traveled from sector to Department or by giving their en July and September 2014, 445 sector to talk about the importance names directly to the activists. In cally helped media partners to duced in a very interactive radio for- men and boys registered through of circumcision. the same period, 318 adults registe- 3. Securing sustainability, technical improve the following aspects in mat that combines real life testimo- the radio station. Within the Xina- red at the factory. capacity and commitment Interested employees could regis- their content: Production of video nies, Vox Pops, drama debates, pho- vane factory, PACTO's trained fac- among media partners to conti- ter through the Social Action ne-in, text messages, questions and nue producing high impact TV stories that emphasize behavior answers with a health and/or Health programming change resulting in seeking health services; Development of discussi- HIV/AIDS specialist to provide ans- PACTO established a wide range of ons oriented to mobilize people to wers to questions coming from the strong partnerships with private and seek testing services, PMTCT, ART, public through SMS or call-in. The public media broadcasters aiming at VMMC and others; Ensure attracti- topics covered by the programs supporting their role and social res- veness of the program by better com- include Multiple Concurrent Part- ponsibility to implement and advo- bining education and entertainment. ners, Prevention of Mother-to-Child cate for HIV prevention and public PACTO recognized that greater Transmission of HIV (PMTCT), Gen- health promotion programs. PACTO involvement and participation of der-Based Violence (GBV), Pediatric worked with the four major public clinical partners and MOH experts AIDS, Anti-Retroviral Treatment and private TV stations in the was critical. PACTO liaised with the (ART) adherence, and TB and HIV country, TVM, STV, Miramar and MOH to identify authorized professi- testing among couples. TIM, as well as the public radio stati- onals to participate in the discussi- Results of securing sustainability, on Radio Mozambique and 8 com- ons on a regular basis, which led to technical capacity and commit- munity radio stations. PACTO's res- better ownership and collaboration. ment among media partners ponsibility in the collaboration with This also allowed sensitive issues to media partners consisted in the pro- be addressed together with MOH Over the life of the project, PACTO vision of technical support on issues officials in the program. produced 171 episodes of different pertaining to public health and HIV programs in different TV stations. In partnership with the national radio combination prevention, the deve- These episodes were broadcast 331 network Rádio Moçambique (RM) lopment of contents, building of times in the above mentioned media and community radios (RC), PACTO skills, and promotion of linkages with stations. Most of the programs had a produced 12-to-15-minute radio community interventions, partners format based on reality, in which magazine programs dubbed "Tcho- and the Ministry of Health. short videos with extraordinary true va-Tchova - "Escutando Podemos stories are used to promote discus- Through on-the-job trainings and Mudar" (We can change by liste- sions and reflections between the collaborative work, PACTO strategi- ning). The programs have been pro- two moderators of the program, a

24 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 2 5 panel of experts and an audience of about 20 people in studio. Radio Mozambique (National Antenna and Maputo prov- 30,479 ince stations) and 25 local radio stations from both Gaza people ascended to health and Maputo broadcast Tchova Tchova radio magazine 25% services - SMYes episodes over the five years of the project. Each radio episodes lasted around 25-minute and featured extraordi- 39% nary true stories with interviews, vox-pop and dramatic segments. A total of 64 episodes addressing different issues related to HTC, ART, PMTCT, VMMC, stigma and 6% discrimination were produced, which were then broad- sa úde cast 3608 times in both Changana and Portuguese by 15 8% the abovementioned radio stations. The radio programs Health Facilities or were produced by Radio Mozambique with PACTO's Health Services 4 11% sentinels sites technical assistance, and then distributed to the other 12% A saúd e radio stations. PACTO's responsibility was to provide content guidance and train the radio producers in focus- mais perto d e ti ing and prioritizing health issues on a relevant topic to achieve depth, quality and greater impact. 5,898 11,341 582 VMMC PACTO also broadcast 15 additional episodes of the HIV TB WASH/Nutrit HCT Politecnica radio-novela Fatias da Vida (Slices of Life) GBV 750 times on 25 community radio stations, followed by 533 Malária FB GBV & other 44 debates (talk-shows) produced locally, as follows: return to 813 PMTCT return to 5,285 ART Family Planing 4,868 Radio Program Inserts per Station per Province Tuberculosis Number of broadcast by TV station 2,249 Radio Station Radio Station Radio Station Total Malaria Gaza Province

Emissor Prov. RM 152 272 TOPIC TIM STV TVM Miramar TOTAL 120 RC Xai-Xai 102 96 198 RC Mazivila-Macia 107 107 214 RC Manjacaze HIV 22 17 21 6 66 101 301 402 4. mHealth Referral System Number of referrals by type of Services RC Mabalane 165 409 574 In addition to the community activities that were already Type of Services RC Chibuto 108 112 220 taking place, and to respond to the growing demands crea- Number of Referrals Malaria 9 4 5 2 20 RC Chicualacuala 102 104 206 ted by the TTHV and Positive Prevention community tools Voluntary Counseling and Testing 11,341 RC Chokwé 184 182 366 for the use of health services, PACTO began to implement a referral service called mHealth (SmYes Saúde). mHealth Sub-Total Gaza 1021 1431 2452 Gender Based Violence 582 TB 8 4 5 2 19 is a reference system based on the use of mobile, wireless Maputo Province information and communication technologies, to support Active Search 6,310 RM-Provincial 140 142 282 the referral system of people (whether they are partici- FP 6 3 3 1 13 RC. Moamba 62 70 132 pants of the PACTO community tools or not) to the health Return to Antiretroviral Treatment 813 RC. Namaacha 66 62 128 services.

RC. Xinavane 40 42 82 Return to PMTCT 533 WASH/Nutrition 4 3 3 1 11 Through the system, referrals made by facilitators in the RC. Inkomati 48 52 100 community are sent by SMS to the focal point based at the 4,848 Sub Total Maputo-Prov. 356 368 724 health facility, who is able to access and register this infor- Tuberculosis Maputo City GBV 15 13 10 4 42 mation through a "tablet". The focal point is the person Return to Tuberculosis Treatment 2, 458 RM Nacional 112 24 136 who receives the people referred by the system, and for- Rádio Voz Coop 141 147 288 wards them to the designated services. The system auto- Family Planning 5,285 Total Episodes 64 44 47 16 171 Radio Muthiyana 4 4 8 matically creates a referral code that is sent to the facilita- Medical Circumcision 5,270 Sub Total Maputo-City 257 175 432 tor who has made the reference. This code is also provi- Total Total 1634 1974 3608 ded to the person being referred who provides it to the 192 76 47 16 331 Malaria Broadcasts 2,249 Debates 27 17 44 focal point when he or she arrives at the health facility. The

26 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 27 panel of experts and an audience of about 20 people in studio. Radio Mozambique (National Antenna and Maputo prov- 30,479 ince stations) and 25 local radio stations from both Gaza people ascended to health and Maputo broadcast Tchova Tchova radio magazine 25% services - SMYes episodes over the five years of the project. Each radio episodes lasted around 25-minute and featured extraordi- 39% nary true stories with interviews, vox-pop and dramatic segments. A total of 64 episodes addressing different issues related to HTC, ART, PMTCT, VMMC, stigma and 6% discrimination were produced, which were then broad- saúde cast 3608 times in both Changana and Portuguese by 15 8% the abovementioned radio stations. The radio programs Health Facilities or were produced by Radio Mozambique with PACTO's Health Services 4 11% sentinels sites technical assistance, and then distributed to the other 12% radio stations. PACTO's responsibility was to provide A saúd e content guidance and train the radio producers in focusing and prioritizing health issues on a relevant topic to mais perto d e ti achieve depth, quality and greater impact. 5,898 11,341 582 VMMC PACTO also broadcast 15 additional episodes of the HIV TB WASH/Nutrit HCT Politecnica radio-novela Fatias da Vida (Slices of Life) GBV 750 times on 25 community radio stations, followed by 533 Malária FB GBV & other 44 debates (talk-shows) produced locally, as follows: return to 813 PMTCT return to 5,285 ART Family Planing 4,868 Radio Program Inserts per Station per Province Tuberculosis Number of broadcast by TV station 2,249 Radio Station Radio Station Radio Station Total Malaria Gaza Province

26 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 27 focal point then registers that the individual has arrived for project, namely Manhiça Health Centre in Maputo provin- services and facilitates his/her access to the clinical service and Patrice Lumumba Health Centre and Chokwe ces required. One of the benefits of this system is that it Health Centre, which are both in Gaza province. In each of allows tracking of individuals, whether or not the referral the sentinel sites, PACTO trained a focal point and the com- actually arrived at the clinic after being referred. It also munity activists in the use of the system. allows the focal point to communicate with the facilitator, in case the person doesn't arrive, permitting follow up. The introduction of mHealth had its pilot phase in Ndlavela In total, 15 health facilities have been using the system and Health Center in Matola, Maputo province in March 2014. 30,479 people have had access to health services, using Later, it expanded to other sentinel sites of the PACTO the system.

sion of lyrics in 10 categories, each focusing on a specific topic: Youth were mobilized through Face- 5. Alô Vida Hotline book and by artists in the schools, involving about 4,000 students in One of the achievements of PACTO project discussions about sexuality, was the introduction of Alô Vida - the health Youth in Action modern lifestyles, peer pressure hotline at the Ministry of Health.The project 4. and the risks associated with vio- successfully revitalized the hotline--originally lence, sexual abuse and HIV. More launched by FDC, ensuring the management than 500 lyrics were submitted to of the hotline by the MOH and signed Memo- the contest and the top ten lyrics randa of Understanding with MCel and Voda- One of the main objectives of the 1. SensaSons: Lyrics Contest and were transformed into songs. A CD com, two big cell phone companies in PACTO project was to create safe Youth Music Festival of these songs was compiled with Mozambique, which provided free call-in environments for young people in the the involvement of national popular This initiative was implemented in phone numbers for the hotline. The hotline family, school and community. In artists such as Simba, the Iveth, 33 schools, in partnership with the Yolanda "Kakana", Rui Michel, SG, was operated by the Ministry of Health from order to reach all segments of youth, renowned musician and composer 2012, with continued technical and financial Miguel Xabindza, Tania Manhiça in and out of schools, PACTO combi- Moreira Chonguiça. The national support from PACTO will 2014, after which among others. ned the use of entertainment educa- lyrics contest created ample oppor- the MOH took over full operation. tion, interpersonal communication tunity for young people to project A SensaSons television program was produced by TVM, which con- Between 2012 and 2015, the hotline received approaches between adults and their opinions, to express themsel- sisted of twenty eight 15?minute 11,932 calls from the Southern region of youth, community mobilization and ves and transform their own HIV episodes. The program invited the Mozambique, of which 5,708 calls from media. Through the use of this variety messages in poetry and lyrics. musicians to talk about the lyrics Maputo City, 2,212 calls from Maputo Provin- of approaches, an estimated 24,600 The competition called for submis- they chose to interpret, and partici- ce, and 4,012 calls from Gaza Province. young people participated in the social mobilization events, lyrics competi- It is interesting to highlight that the large majo- tions and visits by artists to schools, a Topic Communication message rity of calls were made by males aged 15-19 Music Festival, and have interacted Peer Pressure Enhance the risk perception between drugs and HIV years. This reflects an important "niche" for through radio programs, Facebook, hotline services among young men who End Violence and Encourage reporting of violence against women and sms and radio telephone calls. This Sexual Abuse emphasize that there is always a way out otherwise may not be reached by standard number does not include those rea- Pressure of Lifestyle Raise community awareness about inter-generational sex health and HIV services. The topics discussed ched as a passive audience (without Young people, alcohol Enhance the risk perception and the influence of alcohol on in the calls include HIV symptoms, treatment and drugs HIV infection interaction) in the media (television People can stop consuming drug and services; forms of HIV transmission and and radio). Enhance the risk perception of drug use risky behaviors; forms of HIV prevention Young people and drug abuse Over the years, five main interventi- Life Skills Association between alcohol and risky sexual behavior including condom use; HIV Testing and how Enhance the risk perception of multiple sexual partners ons, specifically targeted at youth, to live or care for a person living with HIV. Sexuality and peer pressure The pressure of friends can influence negatively on young Other topics also include STIs, sexual and were developed by PACTO: a lyrics people contest and music festival- In life we can all start again reproductive health (689) and other illnesses. Dialogue between adults Promote the need to listen to the advice of adults that In some of the calls, more than one topic is SensaSons; a Sports for Life pro- and young people promote healthy love relationships gram--Tchilling Saudável; a Youth- Promote loyalty discussed. Promote dialogue between adults and young people. led Radio--100% Kool; a Safe School Sexual networks Promote mutual fidelity between partners program--Avante ESH, and an Out- Understanding sexual networks of-School program--Avante Jovens. Enhance the risk perception of multiple sexual partners

2 8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 2 9 focal point then registers that the individual has arrived for project, namely Manhiça Health Centre in Maputo provin- services and facilitates his/her access to the clinical service and Patrice Lumumba Health Centre and Chokwe ces required. One of the benefits of this system is that it Health Centre, which are both in Gaza province. In each of allows tracking of individuals, whether or not the referral the sentinel sites, PACTO trained a focal point and the com- actually arrived at the clinic after being referred. It also munity activists in the use of the system. allows the focal point to communicate with the facilitator, in case the person doesn't arrive, permitting follow up. The introduction of mHealth had its pilot phase in Ndlavela In total, 15 health facilities have been using the system and Health Center in Matola, Maputo province in March 2014. 30,479 people have had access to health services, using Later, it expanded to other sentinel sites of the PACTO the system.

2 8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 2 9 pate in discussions about issues cove- 2. 100% Kool: Youth-led Radio Total of Students Reached by Avante red by the awarded lyrics. In 2011, PACTO organized the Second Educational Enter- Esh by Province BCI, the second largest commercial tainment Workshop. At this workshop, the participants bank in Mozambique, became a Sen- from 8 Maputo-based radio stations (Rádio Cidade, saSons sponsor and awarded contest SFM, Índico, Top Rádio, Rádio Capital, Rádio Maria, Rádio winners with over 20 Mozambican Muthiyana and Rádio Voz Coop) developed a common literature books each during a cere- vision of partnership and technical collaboration for the mony held in September 2012. The production of an innovative concept of educational youth event legitimizes the engagement of radio, which they branded 100% Kool. The primary audi- the private sector into social respon- ence for sibility and entertainment education causes in Mozambique. 100% Kool is young people, aged 15-19, in urban and peri-urban Maputo and the objective is to reinforce life Maputo City Maputo Prov. Gaza Prov. The final stage of SensaSons was a mega music skills and empower youth through entertainment educa- festival, where musicians performed the ten winning lyrics and the CD with these songs was tion, healthy social interaction and inspirational stories of launched. The festival was held at Josina Machel young people who are the designers and leaders of their own lives. Resources used were live shows, radio drama Total of Students Reached by Sex and interactive programs with telephone calls and songs. - Avante Esh

1. Avante ESH: Safe School Program Avante ESH or “Escolas Sem HIV” (Schools without HIV) 43% is an intervention implemented by PACTO to create a 57% safe and supportive environment for students, by training teachers and school staff in order to recognize and strengthen their roles as protectors of students and as agents of change in schools. School staff were equipped Tv Show Sensasons on TVM Winner of lyrics contest being awarded Artists during music rehearsals with the necessary skills (i) to create a safe learning envi- Boys Girls ronment for all students; (ii) to promote gender equity teaching practices and (iii) to address the dangerous school practices and barriers that put girls and boys at At the start of the project, PACTO conducted a rapid Tchilling Saudável: Sports for Life live theater and music. No alcohol sale was allowed to risk of contracting HIV. assessment using a checklist on infrastructure, human under-age consumers, and venues were equipped with Besides the staff training, HIV Prevention Life skills train- resources, programs, communication materials, and the free condoms and educational materials. A total of ing was given for students in the classroom within the existence of services such as counseling corners in each In September 2011, the XI Africa Games were held in 25,000 kits were distributed, containing HIV prevention framework of the school curriculum, and youth-led activ- of the 18 upper primary and secondary schools initially Maputo. This brought sports enthusiasts from across materials including condoms, flyers, shirts, rollups, labels ities were implemented. selected. In 2012, Avante ESH evaluated the activities Africa to Maputo City. In this festive Games atmosphere, and radio programs. many young women and men were away from home, conducted in the 31 participating schools and drew making them highly vulnerable to the risks of excessive Total of students Reached byAvante Esh lessons learned in order to strengthen the program. consumption of alcohol, drugs, gender violence, inter- Boys Girls Total Priorities identified included increased ownership by the participating schools, and strengthening of teachers' generational sex and unprotected sex. Along with Pros- Maputo City 1,679 2,096 3,775 skills in delivering life-skills curricula among students. port and other partners in the Technical Working Group Maputo Province 1,411 1,908 3,319 Sports for Life was also identified as one of the key on Communication of the National AIDS Council, Gaza Province 2,050 2,799 4,859 PACTO endeavored to make the Africa Games a safe and components, emphasizing the importance of a healthy memorable experience for Mozambicans and visitors, lifestyle where sports can act as an engine to motivate Grand total 5,150 6,803 11,953 especially young people. youth to take care of their health, and to look out for the health of others. Sports and competition teach youth to PACTO contributed to the production of a series of 12 TV win and lose with dignity, and also teaches young spots starring Mozambican athletes who challenged Total of Teachers Reached byAvante Esh people that winning is not always the most important young people to reflect about their future and what it Male Female Total aspect of life, but that facing adversity, being optimistic, takes to achieve excellence, including making healthy Maputo City 26 29 55 and trying again is an essential part of life. Sports thus choices to prevent HIV. PACTO also established 14 local Maputo Province 38 42 80 healthy entertainment venues, designated "Healthy offered the ideal tool for educating youth on vital issues Gaza Province 37 31 68 Tchilling" sites, where athletes, fans and African Games such as: understanding gender equality, preventing STIs enthusiasts could find entertainment and educational and HIV/AIDS, protecting themselves against Grand total 101 101 203 exploitation and abuse, protecting the environment,

3 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 1 pate in discussions about issues cove- 2. 100% Kool: Youth-led Radio Total of Students Reached by Avante red by the awarded lyrics. In 2011, PACTO organized the Second Educational Enter- Esh by Province BCI, the second largest commercial tainment Workshop. At this workshop, the participants bank in Mozambique, became a Sen- from 8 Maputo-based radio stations (Rádio Cidade, saSons sponsor and awarded contest SFM, Índico, Top Rádio, Rádio Capital, Rádio Maria, Rádio winners with over 20 Mozambican Muthiyana and Rádio Voz Coop) developed a common literature books each during a cere- vision of partnership and technical collaboration for the mony held in September 2012. The production of an innovative concept of educational youth event legitimizes the engagement of radio, which they branded 100% Kool. The primary audi- the private sector into social respon- ence for sibility and entertainment education causes in Mozambique. 100% Kool is young people, aged 15-19, in urban and peri-urban Maputo and the objective is to reinforce life Maputo City Maputo Prov. Gaza Prov. The final stage of SensaSons was a mega music skills and empower youth through entertainment educa- festival, where musicians performed the ten winning lyrics and the CD with these songs was tion, healthy social interaction and inspirational stories of launched. The festival was held at Josina Machel young people who are the designers and leaders of their own lives. Resources used were live shows, radio drama Total of Students Reached by Sex and interactive programs with telephone calls and songs. - Avante Esh

3 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 1 preventing teenage pregnancies and reducing the use of Total of Students Reached byAvante Yout drugs and alcohol. Consequently, physical education Boys Girl Total teachers were trained to implement Sports for Life. Maputo City 3,433 3,143 6,576 Maputo Province 935 912 1,847 4. Avante Jovens: Out-of-School Youth Gaza Province 1,018 1,261 2,279 Young people who do not profit from a formal school Grand total 5,386 5,316 10,702 education, especially girls, are a particularly vulnerable group when it comes to HIV infection. Therefore, a specific intervention called "Avante Jovens" was designed to support young people who do not attend school education, to strengthen the capacity of existing Total of Boys and Girls Reached support networks of young people and to involve young by Avante Youth people in participatory processes. The program further aims to promote dialogue and to equip young people with the necessary skills to reduce their risk of HIV 21% infection through condom use, regular testing and the practice of abstinence. The activities were carried out in coordination with the health and gender-based violence 62% 17% Gender Based services. 5. Activities include youth-to-youth lectures, local football Violence Initiative tournaments, theater and the popular "chapa-da- malta", a combination of "road show" with mobile HIV services, including testing and counseling for HIV Maputo City Maputo Prov. Gaza Prov. In Mozambique, the cultural and approaches) and to develop a pilot reproductive health. social gender norms, in particular screening on gender violence (3,357 the various forms of domestic vio- people were screened), thereby pro- lence, contribute to the spread of viding communities with skills to HIV/AIDS, limiting women's access identify the manifestations of violen- to prevention and care. ce, break its cycle, support victims and seek support services. As a The actions implemented by the result, the GBVI interventions GBVI PACTO Project under the Gender enabled to perform 582 references Based Violence Initiative (GBVI) aim to gender based violence support CONVERSA to discourage all forms of gender services from 2013 to 2015. violence and to promote the engage- DE HOMENS ment of men in promoting women's and families' health and well-being. 2. Parceria com Rede Hopem (Ho- The GBVI was implemented in Gaza mens pela Mudança) Province in the districts of Xai-Xai promotion of girls' and women's and Chibuto; and in Maputo Provin- Conversa de Homens Tool health and social well-being. The ce, in the districts of Matola and The Conversa de Homens tool pro- tool was developed in partnership Manhiça. The initiative also had its Sport 4 Life Championship organized by implementing partners of the event CBO Nchundzo motes community dialogue among with HOPEM and has amply been actions in the Xhinavane Sugar Refi- men aiming at creating more balan- discussed in section II. Community nery, in partnership with ECOSIDA. ced relationships between men and driven HIV prevention and uptake of women, and involving men in the services'.

1. Gender mainstreaming in PACTO interventions Sequence Topic All community and mass media Theme 1 The story of women emancipation in Mozambique interventions developed by PACTO having a central gender approach. Theme 2 Sexual Abuse The GBVI interventions however Theme 3 Legislation against Gender Based Violence (GBV) allowed to further reflect on gender Theme 4 Available GBV services violence in all tools (TTHV, PP, Youth

3 2 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 3 preventing teenage pregnancies and reducing the use of Total of Students Reached byAvante Yout drugs and alcohol. Consequently, physical education Boys Girl Total teachers were trained to implement Sports for Life. Maputo City 3,433 3,143 6,576 Maputo Province 935 912 1,847 4. Avante Jovens: Out-of-School Youth Gaza Province 1,018 1,261 2,279 Young people who do not profit from a formal school Grand total 5,386 5,316 10,702 education, especially girls, are a particularly vulnerable group when it comes to HIV infection. Therefore, a specific intervention called "Avante Jovens" was designed to support young people who do not attend school education, to strengthen the capacity of existing Total of Boys and Girls Reached support networks of young people and to involve young by Avante Youth people in participatory processes. The program further aims to promote dialogue and to equip young people with the necessary skills to reduce their risk of HIV 21% infection through condom use, regular testing and the practice of abstinence. The activities were carried out in coordination with the health and gender-based violence 62% 17% Gender Based services. 5. Activities include youth-to-youth lectures, local football Violence Initiative tournaments, theater and the popular "chapa-da- malta", a combination of "road show" with mobile HIV services, including testing and counseling for HIV Maputo City Maputo Prov. Gaza Prov. In Mozambique, the cultural and approaches) and to develop a pilot reproductive health. social gender norms, in particular screening on gender violence (3,357 the various forms of domestic vio- people were screened), thereby pro- lence, contribute to the spread of viding communities with skills to HIV/AIDS, limiting women's access identify the manifestations of violen- to prevention and care. ce, break its cycle, support victims and seek support services. As a The actions implemented by the result, the GBVI interventions GBVI PACTO Project under the Gender enabled to perform 582 references Based Violence Initiative (GBVI) aim to gender based violence support CONVERSA to discourage all forms of gender services from 2013 to 2015. violence and to promote the engage- DE HOMENS ment of men in promoting women's and families' health and well-being. 2. Parceria com Rede Hopem (Ho- The GBVI was implemented in Gaza mens pela Mudança) Province in the districts of Xai-Xai promotion of girls' and women's and Chibuto; and in Maputo Provin- Conversa de Homens Tool health and social well-being. The ce, in the districts of Matola and The Conversa de Homens tool pro- tool was developed in partnership Manhiça. The initiative also had its Sport 4 Life Championship organized by implementing partners of the event CBO Nchundzo motes community dialogue among with HOPEM and has amply been actions in the Xhinavane Sugar Refi- men aiming at creating more balan- discussed in section II. Community nery, in partnership with ECOSIDA. ced relationships between men and driven HIV prevention and uptake of women, and involving men in the services'.

3 2 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 3 3. Communication Tools for support of GBV victims - have more knowledge about what violence is, who the port post-GBV services .We will use them in training "How to Support the Victims of Sexual Violence." main victims are, how to proceed in case violence takes activities and in promoting access to the services", says place, and the health care that the hospital provides ove- Ana Baptista, Jhpiego's GBV Initiative coordinator. Within the GBV initiative, a kit of tools was produced in rall. In addition, the importance of preventing violence order to improve understanding of Post-exposure so that it doesn't take place, and the involvement of all of Prophylaxis (PEP) and other support services for women us in combating violence. It can be seen in this material and girls who were victims of violence. The kit consists that each of us plays a key role in the prevention and miti- of six booklets "How to support victims of sexual violen- gation of violence, as well as in the treatment of the 4. Campaign against Sexual Harassment in the Work- ce" and aims to improve the demand for GBV services occurrence of violence. "Raquel Cossa, Focal Point for place and to raise awareness among victims and communities Gender DNAM, MISAU. to take preventive measures to ensure that sexual vio- In 2013, PACTO developed a program in the Xinavane lence does not happen in their communities. The bro- The brochures were distributed through a variety of ins- Sugar Refinery in partnership with ECOSIDA that inte- chures have been validated by the Ministries of Health titutions, such as Organizations fighting for Women's grated the implementation of the Tchova Tchova tools in (MoH) and Gender, Children and Social Welfare Rights, Women and Child Care Offices, MGECAS and the workplace, Conversa de Homens, and campaigns on (MGCAS), and 500 kits were produced and distributed MISAU, the National AIDS Council, Provincial and Dis- Medical Circumcision and Harassment in the Workpla- in health services and police, NGOs and associations trict Health Directorates, Provincial Education Directo- ce. fighting against violence. These partners also received rates, Donor Institutions, Community Based Organizati- Cases of sexual harassment were frequent in the sugar the kit in electronic format for subsequent reproduction. ons, and several community radio stations. Some orga- refinery, a company that employs 10,000 workers on nizations that participated at some point in the process From the start, the MoH and MGCAS recognized the average. The campaign was carried out by 15 members and have already received brochures also give positive importance of the brochures to strengthen public health of the factory's theater group who were trained to intro- feedback: "These brochures are relevant because they policies and the protection of women's rights, as Elisa duce theatrical sketches into each sector of the refinery. contain useful information to improve the quality of ser- Mutisse, Head of the Department and Focal Point for An incredible 6,663 people participated in the Campa- vices and follow-up of post-GBV cases, as well as hel- Gender in MGCAS, says "The brochures are very rele- ping to increase the use of services. The brochures will vant, as they provide a contributing mechanism in the be the basis for community leader trainings and to sup- dissemination of the Integrated Services Mechanism, because despite being focused on the health protocol, it is a step in the mechanism. The brochure will be used in The "Homem que é Homem" TV talk-show is a male dis- the process of dissemination of the sector protocols and cussion forum on the national TV channel TVM. Each specifically of the health one, through these, the infor- episode lasts one hour and includes "vox pop", testimoni- mation in the multi-sectoral integrated service mecha- es and panel discussions, giving the audience an in?- nism can be reinforced. These brochures will also be depth discussion on different topics. The partnership useful during the process of presentation of the instru- took place from 2012 to 2016, during which time were ments linked to violence in general and gender based produced 54 programs. During the 16 Days of Activism violence in particular." against Gender Violence Campaign; the following talk The two ministries believe that the brochures will be shows were co-produced in collaboration with the Civil useful in the communities "...because from the moment Society and Network HOPEM. they will have been in contact with the material, they will

3 4 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 5 3. Communication Tools for support of GBV victims - have more knowledge about what violence is, who the port post-GBV services .We will use them in training "How to Support the Victims of Sexual Violence." main victims are, how to proceed in case violence takes activities and in promoting access to the services", says place, and the health care that the hospital provides ove- Ana Baptista, Jhpiego's GBV Initiative coordinator. Within the GBV initiative, a kit of tools was produced in rall. In addition, the importance of preventing violence order to improve understanding of Post-exposure so that it doesn't take place, and the involvement of all of Prophylaxis (PEP) and other support services for women us in combating violence. It can be seen in this material and girls who were victims of violence. The kit consists that each of us plays a key role in the prevention and miti- of six booklets "How to support victims of sexual violen- gation of violence, as well as in the treatment of the 4. Campaign against Sexual Harassment in the Work- ce" and aims to improve the demand for GBV services occurrence of violence. "Raquel Cossa, Focal Point for place and to raise awareness among victims and communities Gender DNAM, MISAU. to take preventive measures to ensure that sexual vio- In 2013, PACTO developed a program in the Xinavane lence does not happen in their communities. The bro- The brochures were distributed through a variety of ins- Sugar Refinery in partnership with ECOSIDA that inte- chures have been validated by the Ministries of Health titutions, such as Organizations fighting for Women's grated the implementation of the Tchova Tchova tools in (MoH) and Gender, Children and Social Welfare Rights, Women and Child Care Offices, MGECAS and the workplace, Conversa de Homens, and campaigns on (MGCAS), and 500 kits were produced and distributed MISAU, the National AIDS Council, Provincial and Dis- Medical Circumcision and Harassment in the Workpla- in health services and police, NGOs and associations trict Health Directorates, Provincial Education Directo- ce. fighting against violence. These partners also received rates, Donor Institutions, Community Based Organizati- Cases of sexual harassment were frequent in the sugar the kit in electronic format for subsequent reproduction. ons, and several community radio stations. Some orga- refinery, a company that employs 10,000 workers on nizations that participated at some point in the process From the start, the MoH and MGCAS recognized the average. The campaign was carried out by 15 members and have already received brochures also give positive importance of the brochures to strengthen public health of the factory's theater group who were trained to intro- feedback: "These brochures are relevant because they policies and the protection of women's rights, as Elisa duce theatrical sketches into each sector of the refinery. contain useful information to improve the quality of ser- Mutisse, Head of the Department and Focal Point for An incredible 6,663 people participated in the Campa- vices and follow-up of post-GBV cases, as well as hel- Gender in MGCAS, says "The brochures are very rele- ping to increase the use of services. The brochures will vant, as they provide a contributing mechanism in the be the basis for community leader trainings and to sup- dissemination of the Integrated Services Mechanism, because despite being focused on the health protocol, it is a step in the mechanism. The brochure will be used in The "Homem que é Homem" TV talk-show is a male dis- the process of dissemination of the sector protocols and cussion forum on the national TV channel TVM. Each specifically of the health one, through these, the infor- episode lasts one hour and includes "vox pop", testimoni- mation in the multi-sectoral integrated service mecha- es and panel discussions, giving the audience an in?- nism can be reinforced. These brochures will also be depth discussion on different topics. The partnership useful during the process of presentation of the instru- took place from 2012 to 2016, during which time were ments linked to violence in general and gender based produced 54 programs. During the 16 Days of Activism violence in particular." against Gender Violence Campaign; the following talk The two ministries believe that the brochures will be shows were co-produced in collaboration with the Civil useful in the communities "...because from the moment Society and Network HOPEM. they will have been in contact with the material, they will

3 4 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 5 168,980 people reached on GBVI 500 booklets to support rape survivors - post exposure prophylaxis PEP 3,357 people screened on GBV

Members of the Theater Group at the Xinavane Sugar Participants in the Sexual Harassment in the Workplace Refinery during the Sexual Harassment in the Workplace Campaign 14 August 2013 582 Campaign references to GBV support services 25 facilitators trained on ign, which constituted 57% of all workers. Theater, along 5. 16 Days of Activism against GBV Campaign “Conversa de Homens” tools with dance and music were used as the main conduit for From 2011 to 2015, PACTO participated in the "16 Days 15 the campaign. Campaign" from November 25 to December 10, coordi- workers trained on harassment Members of the Theater Group at the Xinavane Sugar nated by the Ministry of Gender, Child and Social Action. in Xinavane Sugar Refinary 68 de Xinavane Refinery during the Sexual Harassment in the Workplace The motto of the media campaign is "Violence against communities leaders, Campaign Participants in the Sexual Harassment in the Women has no excuse". Banners, songs, radio and televi- justice and health providers Workplace Campaign 14 August 2013 sion spots and posters were produced, with the participa- trained to support rape survivors in Maputo, tion of ex-President Joaquim Chissano 6.663 During the training, many group members realized they Manhiça and Gaza had already known of many harassment cases, but did not https://www.youtube.com/results?search_query=Os+t workers benefited from Harassment and HCT Campaigns know how to address them, as group member José Bap- empos+s%C3%A3o+outros+A+Viol%C3%AAncia+co at Xinavane Sugar Refinary tista, a 25 year old Inspector explains "The harassment ntra+a+Mulher+n%C3%A3o+tem+desculpa+ and campaign training was the first time I had been educated more than 25 public figures, such as policy makers, on this topic in my life, and I realized many things could be artists, entrepreneurs, and community leaders and considered harassment. A person can unintentionally do Mozambican citizens. it, as many people are not clear on the boundaries of harassment." Or as Rosa, a 38 year old Office Assistant, who was harassed repeatedly in the past and thought The following table summarizes all people reached by the about quitting her job, witnessed: "I suffered a lot, but GBV initiative from year 2-4 of project implementation never talked with anyone. The campaign was very helpful. 8.944 I want to encourage other people not to accept harass- men reached by Conversa Number of Participation of GBV Initiatives de Homens Tool ment. Now I know no one can make me do what I do not want to do." Rosa also specifically valued the involvement Men Women Total from leadership, "Bosses always want to take advantage Conversa de 8,944 - 8,944 of the workers. Now, if this happens I remind my boss of Homens what he saw in the plays." The Harassment in the Work- Sexual place Campaign not only reached more than half of the Harassment 3,028 3,635 6,663 Xinavane Sugar Factory employees, but also gave a boost Campaign to the Campaign on HIV/AIDS Testing that was happe- Tchova Tchova 13,957 55,983 69,940 ning concurrently. "In the areas where we did not have Positive high participation from employees to get tested, we leve- 11,822 37,118 65,194 Prevention raged the new awareness provided by the Harassment Campaign. We made the link that exchange of sexual TTHV in the 11,095 7,144 18,239 favors is a risky behavior which could result in HIV infecti- Workplace on," reported Antonio Ferreira, Manager of the AIDS Pro- Total 48,846 103,880 168,980 gram in the Workplace.

3 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 37 168,980 people reached on GBVI 500 booklets to support rape survivors - post exposure prophylaxis PEP 3,357 people screened on GBV

3 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 37 The pre-test showed that malaria target groups have a Support PNCM leadership and coordination through strong preference for contents that encompass and con- the Communication Working Group vey shared core values such as family harmony, collecti- Over the year of the project, PACTO was invited to provi- ve health, collaborative action and a strong sense of nati- de technical assistance to strengthen the coordination onal cohesion. As a result of the pre-test, three propo- capacity of the PNCM, through the Communication Wor- sals were selected for further validation. king Group. PACTO supported the NMCP communication officer by ensuring that weekly meetings were held and detailed minutes produced and shared with relevant Malaria Communication Workshop partners. A total of 28 meetings were held in 2015, with consistent partner participation. PACTO has played a From November 20 to 21, 2014, PACTO organized a key role in bringing the representatives of DEPROS into Workshop in Namaacha to review the state of malaria the group and pushing the DEPROS agenda to prioritize SBCC in Mozambique, along with validating and provi- the operationalization of the malaria communication ding further inputs into the national branding process. strategy. On December 18, 2014 a meeting was held at For the first time in recent history, the workshop brought Pensão Martins, aimed at identifying priorities and plan- PNCM, DEPROS, the Public Relations Office, the World ning the activities in which DEPROS could play a key role Health Organization (WHO), the Global Fund (World in 2015, in the field of malaria and other sectors of the Vision, FDC, Malaria Consortium), and other key imple- MoH Public Health Department. A final plan was deve- menting partners together, to discuss strategic commu- loped by the technical group of facilitators and consul- nication and malaria communication priorities. In the tants who conducted the meeting. Health Communication current MOH hierarchy, the Public Relations Office has 6. the last word regarding the approval of health content for mass-media, so to have the heads of each these depart- Coordinated Malaria Community Mobilization Cam- ments at the table was a great opportunity. paign in Nicoadala A total of 35 participants attended the workshop and Following the floods that ravaged the coast of Zambézia actively participated in the lively discussions. It became in February 2015, the Nicoadala District Administration clear that the idea and the importance of a national posi- In 2014, the PACTO project received the mandate from launched an integrated malaria and diarrhea prevention tioning and branding strategy was not completely USAID to integrate other health priorities into the pro- campaign, assisted by the PACTO project. The campa- ORA understood by all the departments (especially DEPROS, ject, incorporating themes such as malaria, tuberculosis, A F ! ign started on March 16, 2015 with a public march hea- RI which is under new leadership and facing restructuring). hygiene, nutrition, water and sanitation and family plan- A ded by the Nicoadala District Administrator. Health fairs, L After deeper discussions (theory, evidence and local and ning. PACTO worked in close collaboration with the A mosquito net distribution, and sanitation activities follo- regional examples), a consensus was reached for a logo Department of Public Health Promotion (DEPROS) of wed throughout April and June, in six different locations: M and slogan, adopted by PNCM, DEPROS and implemen- the MOH, providing them support strengthening the Licuar, Nantuto, Nantete, Neriri, Mariarua and Nicoadala ting partners. approach to public health issues in the media, and in Central Township. Road-shows, radio programs and developing tools and support materials at community and health services level.

1. Malaria FAMÍLIA FORTE Development and Pre-test of National Malaria Brand E PROTEGIDA! In 2015, PACTO provided technical support to the communication component of the National Malaria Control Program (PNCM), as mandated by the President's Mala- and part of the creative proposals) recovered from diffe- ria Initiative (PMI)/USAID. As part of these efforts, rent sources. PACTO reactivated the idea of launching a national brand, picking up where another PMI BCC project had The brand proposals consisted of logos combined with a left off, harmonizing activities and reaching a consensus variety of slogans developed by local media agents. The on an overarching national malaria SBCC campaign to proposals were jointly pre-tested by PACTO and the tie activities together across different partners. PNCM in Gaza. The pre-test was conducted through focal group discussions and interviews with key- After tireless efforts, consultation and negotiations, vari- informants involving a wide spectrum of audiences, ous brand proposals were developed based on PACTO's including pregnant women, adults, young adults and desk review and inspired by the documents from the health professionals. original process (the concept notes, the creative brief PACTO's team and local partners during the campaign launching

3 8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 9 The pre-test showed that malaria target groups have a Support PNCM leadership and coordination through strong preference for contents that encompass and con- the Communication Working Group vey shared core values such as family harmony, collecti- Over the year of the project, PACTO was invited to provi- ve health, collaborative action and a strong sense of nati- de technical assistance to strengthen the coordination onal cohesion. As a result of the pre-test, three propo- capacity of the PNCM, through the Communication Wor- sals were selected for further validation. king Group. PACTO supported the NMCP communication officer by ensuring that weekly meetings were held and detailed minutes produced and shared with relevant Malaria Communication Workshop partners. A total of 28 meetings were held in 2015, with consistent partner participation. PACTO has played a From November 20 to 21, 2014, PACTO organized a key role in bringing the representatives of DEPROS into Workshop in Namaacha to review the state of malaria the group and pushing the DEPROS agenda to prioritize SBCC in Mozambique, along with validating and provi- the operationalization of the malaria communication ding further inputs into the national branding process. strategy. On December 18, 2014 a meeting was held at For the first time in recent history, the workshop brought Pensão Martins, aimed at identifying priorities and plan- PNCM, DEPROS, the Public Relations Office, the World ning the activities in which DEPROS could play a key role Health Organization (WHO), the Global Fund (World in 2015, in the field of malaria and other sectors of the Vision, FDC, Malaria Consortium), and other key imple- MoH Public Health Department. A final plan was deve- menting partners together, to discuss strategic commu- loped by the technical group of facilitators and consul- nication and malaria communication priorities. In the tants who conducted the meeting. Health Communication current MOH hierarchy, the Public Relations Office has 6. the last word regarding the approval of health content for mass-media, so to have the heads of each these depart- Coordinated Malaria Community Mobilization Cam- ments at the table was a great opportunity. paign in Nicoadala A total of 35 participants attended the workshop and Following the floods that ravaged the coast of Zambézia actively participated in the lively discussions. It became in February 2015, the Nicoadala District Administration clear that the idea and the importance of a national posi- In 2014, the PACTO project received the mandate from launched an integrated malaria and diarrhea prevention tioning and branding strategy was not completely USAID to integrate other health priorities into the pro- campaign, assisted by the PACTO project. The campa- ORA understood by all the departments (especially DEPROS, ject, incorporating themes such as malaria, tuberculosis, A F ! ign started on March 16, 2015 with a public march hea- RI which is under new leadership and facing restructuring). hygiene, nutrition, water and sanitation and family plan- A ded by the Nicoadala District Administrator. Health fairs, L After deeper discussions (theory, evidence and local and ning. PACTO worked in close collaboration with the A mosquito net distribution, and sanitation activities follo- regional examples), a consensus was reached for a logo Department of Public Health Promotion (DEPROS) of wed throughout April and June, in six different locations: M and slogan, adopted by PNCM, DEPROS and implemen- the MOH, providing them support strengthening the Licuar, Nantuto, Nantete, Neriri, Mariarua and Nicoadala ting partners. approach to public health issues in the media, and in Central Township. Road-shows, radio programs and developing tools and support materials at community and health services level.

3 8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 3 9 PACTO developed a Tuberculosis screening instrument at community level. This question- naire was adapted from clinical tuberculosis 1,280 13,000 screening, and has been applied to 7,149 parti- participants in the malaria campaign at insertions of TV and radio Licuári, Munhoha, Nicoadala-sede, Neri, programs and spots Nantuto, Nhamfunba e Maria-Rua cipants of TTHV and PP tools and some other community participants. 7,149 communities’ screenings 200 done mosquito nets offered to pregnant 2,458 women and children at Returned to the treatment 4,132 risk during floods traced defaulters and drop-outs 4,868 referrals to health 52,444 services people reached with educational sessions 2. Tuberculosis second brochure, "The patient charter on TB care", is targeting the TB patients themselves. It is an adaptation of In order to increase the demand for diagnostic and treat- the patient charter (rights and duties of the TB patient) in ment services for tuberculosis and to contribute to the simplified format and with images. This material aims to early identification of patients who are infected with TB at spots, door-to-door outreach, prac- inform the patients on the rights they have regarding the announcing the campaign inaugura- community level, Tuberculosis is discussed in the com- tical demonstrations of correct bed provision of services that they should receive, as well as tion. On the inauguration day, the munity dialogues within the context of the two PACTO net use, and video sessions followed their responsibilities with regard to their treatment and three songs could also be heard community tools Tchova-Tchova Life Stories (TTHV) and by community dialogues which con- how to prevent passing the infection to others. during the march, during the fair, in Video Sessions: PACTO developed Positive Prevention (PP). veyed essential information about the marketplace and in the streets. two videos for the campaign, based A TB reference and counter-reference system was estab- the benefits of using insecticide trea- PACTO produced and disseminated the following com- on real stories collected in Nerire lished in four health facilities, namely Ndlavela, Manhiça, ted nets (ITNs) and intermittent Church sermons and door-to-door munication materials on tuberculosis: printed educational and Natuto, two small villages in Patrice Lumumba and Chokwe Health Centers, whereto presumptive treatment (IPT)-all visits with Malaria related messages materials, radio spots and TV, radio and television pro- Nicoadala district. In both videos, the participants of the community interventions were with a decidedly local flavor. were also disseminated through grams, which were aired mainly by Radio Mozambique, men, women and couples told the referred, when in need of certain services such as an HIV activists and church leaders. In total, community radio stations and the television channels stories of how they decided to adopt test, return to TARV, etc. A focal point was placed in these 4,058 visits and door-to-doors TVM, STV and TIM. intermittent preventive treatment health facilities, who receives the people referred from the Entertainment education through encounters happened in the com- (IPT) and use bed nets consistently. Two informative brochures were produced. The first one community and forwards them personally to the health local Music: Seven Nicoadalan munities, reaching approximately Each 10 minute video profile is was entitled "Learn more about TB", and targets the gene- service needed. A TV set was installed in each waiting musicians who had never played 20,290 people through PIRCOM shown in a 60-minute interactive ral population with the aim of disseminating basic infor- room, where various health programs were shown, fol- together before, joined to form the (Interfaith Program against Malaria) community session, followed by a mation on TB, such as on what TB is, how is it contracted, lowed by group discussions, guided by the focal point. "Blue Diamonds" band, creating activists trained by PACTO. Malaria dialogue led by two trained facilita- how to prevent it, the importance of going to the health Thanks to these interventions, 4,868 people were three new songs for the campaign. messages were also conveyed by tors. Groups of 15 to 25 youngsters facility for diagnosis, the importance of adhering to treat- referred to TB services and 4,132 active searches were With support from the PACTO pro- religious leaders through prayers and adults participate in lively dis- ment and the role of the family and the community in sup- made to trace defaulters, which resulted in 2,458 people ject team, they converted a typical during church sermons. A total of 27,586 people were reached cussions sparked by the profiles. porting the reintegration of the patient with TB. The who have returned to treatment. mud and thatch roofed hut into a Two cue-cards serve as discussion studio where they composed and through the church sermons in different churches and mosques of the guides and provide a step-by-step mastered the songs in Portuguese process for exploring malaria pre- and the local Chuabo language. The Nicoadala district. vention, diagnosis and treatment Horácio Dengo, aged 43 years, resident in Matola to reach the end. He had another relapse. When he was songs combine the traditional issues. The stories presented in the Local Theater Group: A local thea- City, is an example of a person who was successfully submitted to the TB treatment for the third time at the rhythm nhambaro with pandza, also videos mirror viewers' reality, high- ter group presented a drama in Chua- brought back to TB treatment, after attending Positive Matola II Heath Center, Horácio was invited to attend a very popular beat in Nicoadala. lighting the benefits and challenges bo served as a hook to attract people Prevention sessions. Horácio started developing TB in Positive Prevention sessions led by the facilitator Ercília. Local Radio Programming: Zambé- that men, women and their families to come and get involved in the fairs South Africa, but only accepted to take the HIV test "In the group, I learned to be strong and to face the dise- zia FM, the local radio station with go through by adopting (or not) and sanitation activities, especially after coming back to Mozambique and a lot of insisten- ase with more responsibility, avoid losing nights, use the largest audience, began publicly these two key malaria prevention in rural areas. Both the "Blue Dia- ce from his relatives. The result came out as positive, condoms to avoid infecting my partners, even though I broadcasting the songs a few days methods: IPT and bed nets. During monds" musicians and the actors associated with TB. He started treatment for both disea- shared with her my status". Now, Horário knows about before the launch of the campaign. this quarter 26 video sessions were volunteered their time, free of char- ses, but abandoned it when feeling better. After a while, the importance of following the treatment for TB and At the same time, a mobile studio conducted in the communities and ge, receiving only a minimal allo- he got sick again and went through a new TB treatment, ARVT, and he is now moving forward taking the treat- unit provided by ICS (National churches and a total of 1,343 people wance for meals when working in this time using injection, but once again he was unable ment. Media Institute) drove around, stre- were reached, of which 549 men, distant locations. et by street, playing the songs and 794 women.

4 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 41 PACTO developed a Tuberculosis screening instrument at community level. This question- naire was adapted from clinical tuberculosis 1,280 13,000 screening, and has been applied to 7,149 parti- participants in the malaria campaign at insertions of TV and radio Licuári, Munhoha, Nicoadala-sede, Neri, programs and spots Nantuto, Nhamfunba e Maria-Rua cipants of TTHV and PP tools and some other community participants. 7,149 communities’ screenings 200 done mosquito nets offered to pregnant 2,458 women and children at Returned to the treatment 4,132 risk during floods traced defaulters and drop-outs 4,868 referrals to health 52,444 services people reached with educational sessions 2. Tuberculosis second brochure, "The patient charter on TB care", is targeting the TB patients themselves. It is an adaptation of In order to increase the demand for diagnostic and treat- the patient charter (rights and duties of the TB patient) in ment services for tuberculosis and to contribute to the simplified format and with images. This material aims to early identification of patients who are infected with TB at spots, door-to-door outreach, prac- inform the patients on the rights they have regarding the announcing the campaign inaugura- community level, Tuberculosis is discussed in the com- tical demonstrations of correct bed provision of services that they should receive, as well as tion. On the inauguration day, the munity dialogues within the context of the two PACTO net use, and video sessions followed their responsibilities with regard to their treatment and three songs could also be heard community tools Tchova-Tchova Life Stories (TTHV) and by community dialogues which con- how to prevent passing the infection to others. during the march, during the fair, in Video Sessions: PACTO developed Positive Prevention (PP). veyed essential information about the marketplace and in the streets. two videos for the campaign, based A TB reference and counter-reference system was estab- the benefits of using insecticide trea- PACTO produced and disseminated the following com- on real stories collected in Nerire lished in four health facilities, namely Ndlavela, Manhiça, ted nets (ITNs) and intermittent Church sermons and door-to-door munication materials on tuberculosis: printed educational and Natuto, two small villages in Patrice Lumumba and Chokwe Health Centers, whereto presumptive treatment (IPT)-all visits with Malaria related messages materials, radio spots and TV, radio and television pro- Nicoadala district. In both videos, the participants of the community interventions were with a decidedly local flavor. were also disseminated through grams, which were aired mainly by Radio Mozambique, men, women and couples told the referred, when in need of certain services such as an HIV activists and church leaders. In total, community radio stations and the television channels stories of how they decided to adopt test, return to TARV, etc. A focal point was placed in these 4,058 visits and door-to-doors TVM, STV and TIM. intermittent preventive treatment health facilities, who receives the people referred from the Entertainment education through encounters happened in the com- (IPT) and use bed nets consistently. Two informative brochures were produced. The first one community and forwards them personally to the health local Music: Seven Nicoadalan munities, reaching approximately Each 10 minute video profile is was entitled "Learn more about TB", and targets the gene- service needed. A TV set was installed in each waiting musicians who had never played 20,290 people through PIRCOM shown in a 60-minute interactive ral population with the aim of disseminating basic infor- room, where various health programs were shown, fol- together before, joined to form the (Interfaith Program against Malaria) community session, followed by a mation on TB, such as on what TB is, how is it contracted, lowed by group discussions, guided by the focal point. "Blue Diamonds" band, creating activists trained by PACTO. Malaria dialogue led by two trained facilita- how to prevent it, the importance of going to the health Thanks to these interventions, 4,868 people were three new songs for the campaign. messages were also conveyed by tors. Groups of 15 to 25 youngsters facility for diagnosis, the importance of adhering to treat- referred to TB services and 4,132 active searches were With support from the PACTO pro- religious leaders through prayers and adults participate in lively dis- ment and the role of the family and the community in sup- made to trace defaulters, which resulted in 2,458 people ject team, they converted a typical during church sermons. A total of 27,586 people were reached cussions sparked by the profiles. porting the reintegration of the patient with TB. The who have returned to treatment. mud and thatch roofed hut into a Two cue-cards serve as discussion studio where they composed and through the church sermons in different churches and mosques of the guides and provide a step-by-step mastered the songs in Portuguese process for exploring malaria pre- and the local Chuabo language. The Nicoadala district. vention, diagnosis and treatment Horácio Dengo, aged 43 years, resident in Matola to reach the end. He had another relapse. When he was songs combine the traditional issues. The stories presented in the Local Theater Group: A local thea- City, is an example of a person who was successfully submitted to the TB treatment for the third time at the rhythm nhambaro with pandza, also videos mirror viewers' reality, high- ter group presented a drama in Chua- brought back to TB treatment, after attending Positive Matola II Heath Center, Horácio was invited to attend a very popular beat in Nicoadala. lighting the benefits and challenges bo served as a hook to attract people Prevention sessions. Horácio started developing TB in Positive Prevention sessions led by the facilitator Ercília. Local Radio Programming: Zambé- that men, women and their families to come and get involved in the fairs South Africa, but only accepted to take the HIV test "In the group, I learned to be strong and to face the dise- zia FM, the local radio station with go through by adopting (or not) and sanitation activities, especially after coming back to Mozambique and a lot of insisten- ase with more responsibility, avoid losing nights, use the largest audience, began publicly these two key malaria prevention in rural areas. Both the "Blue Dia- ce from his relatives. The result came out as positive, condoms to avoid infecting my partners, even though I broadcasting the songs a few days methods: IPT and bed nets. During monds" musicians and the actors associated with TB. He started treatment for both disea- shared with her my status". Now, Horário knows about before the launch of the campaign. this quarter 26 video sessions were volunteered their time, free of char- ses, but abandoned it when feeling better. After a while, the importance of following the treatment for TB and At the same time, a mobile studio conducted in the communities and ge, receiving only a minimal allo- he got sick again and went through a new TB treatment, ARVT, and he is now moving forward taking the treat- unit provided by ICS (National churches and a total of 1,343 people wance for meals when working in this time using injection, but once again he was unable ment. Media Institute) drove around, stre- were reached, of which 549 men, distant locations. et by street, playing the songs and 794 women.

4 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 41 3. Nutrition, Water and Sanitation In coordination with the Ogumaniha project, PACTO conducted water and sanitation activities in the district of Nicoadala, Zambezia province, with a focus on nutrition, to promote individual and collective sanitation and hygiene as disease prevention priority, and promoted the consumption of local and nutritious foods in a variety of ways, in order to prevent malnutrition in children, adolescents and pregnant women. Thirty volunteers of the Community Leader Councils were trained in basic knowledge of interpersonal communication through the use of flipcharts. At the end of the training, all activists received two flipcharts, one on community nutrition and the other on environmental health promotion. Using these flipcharts, the volunteers then held community dialogue and door-to-door sessions to promote sanitation, hygiene and nutrition. Through this sanitation 30 volunteers of the Community Leader Councils trained to promote sanitati- campaign, 1,350 families received messages about good on, hygiene and nutrition 1,350 families reached on good nutrition habits and nutrition habits and environment sanitation. environment sanitation. 7. Strengthening Capacity VI.for SocialHealth and Behavior Communication Change Communication 4. Family Planning (FP)

PACTO supported the Ministry of Health in promoting demand and access to family planning 1. Leadership: a systematic appro- several ways: a manual on good com- In particular, training in communica- services through the Tchova Tchova Historias de ach to Social and Behavior Chan- munication was developed, PACTO tion to combat HIV and AIDS was Vida (TTHV) and Positive Prevention (PP) ge Communication - based on also supported the CNCS in the deve- conducted of political, community community interventions. evidence and impact of actions lopment of its 3rd and 4th National and religious leaders at national, pro- In addition to supporting the consistent Strategic HIV/AIDS Plan (PEN3 and vincial and district level, including the During the five years of the PACTO dissemination of family planning services through PEN4), and over the years, UNICOM Parliamentary Office for the Fight project, a great number of interventi- the creation of a slogan and brand that identifies the has become a strong working group against AIDS, with which a Memo- Planeamento ons were developed with the aim of program, as well as organizing a communication in the communication area with randum of Understanding (MoU) improving the quality of health com- campaign, the PACTO project developed a family high-quality results in the country. was signed. The MoU formed the munication activities in the country. planning flipchart that serves as a tool to support the Familiar basis through PACTO became the leading partner community facilitators of the local partner which tech- of several government institutions organizations that implement the TTHV and PP 2. Training of public, private and and departments to ensure that cer- tools. boys and girls that lasted four weeks. The civil society institutions tournament had participation of 14 primary and tain steps in the development of com- PACTO also contributed by developing Besides providing continuous high secondary schools. In total, 500 adolescents aged 9- munication activities, such as rese- communication materials (training manual, T-shirts, quality technical assistance to seve- 16 years were involved, with support of 28 arch, analysis, theory, design, pretes- caps and badges) that were used to launch the FP ral government institutions, and with technicians. During the campaign, 1,283 adolescents ting, implementation, evaluation and campaign in Manhiça, which took place in July and the aim to achieving sustainability of and youth were reached (679 girls and 604 boys), adaptation, are followed. August 2015. Focusing on the prevention of teen the project interventions, over the 122 over 18 and 1,161 aged 10 to 17 years. PACTO provided continued technical pregnancies and unplanned pregnancies, the years PACTO has conducted nume- assistance to the following govern- campaign was organized with the involvement of the As a result of the FP activities, a total of 8,894 people rous trainings in the country, tar- mental working groups operating in National Family Planning Program and partners, and were reached by the TTHV and PP tools. Out of geting a variety of specific groups the communication for health area: the district health and education departments of these, 1,445 women were referred to health services, at different levels. the communication unit (UNICOM) Manhiça. In order to involve adolescents and young of which 486 women were specifically referred for of the National AIDS Council (CNCS) people in the campaign, PACTO organized an family planning, 70 women to antenatal care and and the Department of Health Pro- athletics competition and football tournament for 144 women to PMTCT services. motion (DEPROS) of the Ministry of Health. PACTO assisted CNCS in

4 2 | PACTO F I N A L R E P O RT 3. Nutrition, Water and Sanitation In coordination with the Ogumaniha project, PACTO conducted water and sanitation activities in the district of Nicoadala, Zambezia province, with a focus on nutrition, to promote individual and collective sanitation and hygiene as disease prevention priority, and promoted the consumption of local and nutritious foods in a variety of ways, in order to prevent malnutrition in children, adolescents and pregnant women. Thirty volunteers of the Community Leader Councils were trained in basic knowledge of interpersonal communication through the use of flipcharts. At the end of the training, all activists received two flipcharts, one on community nutrition and the other on environmental health promotion. Using these flipcharts, the volunteers then held community dialogue and door-to-door sessions to promote sanitation, hygiene and nutrition. Through this sanitation 30 volunteers of the Community Leader Councils trained to promote sanitati- campaign, 1,350 families received messages about good on, hygiene and nutrition 1,350 families reached on good nutrition habits and nutrition habits and environment sanitation. environment sanitation. 7. Strengthening Capacity VI.for SocialHealth and Behavior Communication Change Communication 4. Family Planning (FP)

4 2 | PACTO F I N A L R E P O RT In addition, PACTO gave technical Maputo Maputo assistance to the Polytechnic Univer- Gaza Total # of # of Province City # of trained trained sity to incorporate a specialization in trained Journalists Journalists Communication for Health in their Journalists Radio Radio Radio Communication course. The curricu- Moçambique 3 Moçambique 2 Moçambique 4 9 lum was adapted accordingly and TVM 3 RM-Rádio Cidade 2 TVM 1 6 lecturers were trained. In 2014, the RC Xai Xai 3 Rádio Maria 2 SFM 1 6 first 14 students graduated in Com- munications for Health; these stu- RC Chibuto 2 RC Inhaca 2 Jornal Noticias 2 6 dents will help improve the quality of RC Manjacaze 2 RC Namaacha 2 Jornal Savana 2 6

communication for health in the RC Mabalane 2 RC Moamba 2 Jornal Zambeze 1 5 country. Besides these students, 89 Magazine RC Chicualacuala 2 R Voz islam 3 1 6 journalists were trained in Communi- Independente cation for Health, and 20 trainees RC Chokwe 2 RC Voz Coop 2 Jornal Verdade 1 5 Diário de from undergraduate and Master Moçambique 1 RC Manhiça 2 D. Moçambique 1 4 degree courses of public and private DPS 1 RC Xinavane 5 DSC 1 7 universities, including UEM, UP and NPCS 1 MISA 1 NPCSC 1 3 nical capacity building exercises for Douglas Griffiths in February 2013. ISCTEM, performed an internship at the members of the Parliamentary This Center has become a reference the Center. The growing number of DPJD 1 Radio Muthiana 2 DPJDC 1 4 Office were implemented. After for journalists and communication students interested in SBCC and ICS 1 ICS 1 Radio Capital 2 4 Health Journalism helps raise the bar some members visited PACTO's acti- students in the country. It has been Jornal Notícias 1 DPS 1 2 vities, the Office presented a report equipped with a state-of-the-art tech- for health communication programs RC Mazivila 2 NPCS 1 3 to Parliament, in which it recommen- nology audio and radio studio to and leaves an important legacy for ded the expansion of all PACTO tools record communication programs, a the future. DPEC 1 DPID 4 2 community radio broadcasting FDC 1 4 nationwide. Lastly, through the existing partners- health programs, a web center for PACTO also designed and developed hips with television stations TVM, R. Politecnica 7 7 publishing national relevant articles what it called the Administrators Kit STV, Miramar, TIM, and Radio Total 28 42 19 89 in relation to health, in particular HIV (Version II), a set of cards with speci- Mozambique, PACTO has provided and AIDS, written by journalists trai- fic guidelines, with the objectives to continuous training and technical ned by PACTO (http://centrode exce- help the leaders contribute to the assistance to these stations, as well lencia-apolitecnica.ac.mz ). fight against HIV and AIDS in their as community radio stations, in order workplaces. The Centre of Excellence also offers to assist them in the development of Miguel Ernesto Langa, a journalist at the Commu- colleague on the production of programs and I'm going to Leadership courses in Communicati- health related programs using Com- nity Multimedia Center of Manjacaze, is 25 years old show him how it is done." His friend Aurélio comments, "I Under the impulse of PACTO, a Cen- on for Health. More than 90 people, munication for Health. and lives with his partner Fátima. Radio was his childho- started working for the radio at almost the same time as tre of Excellence for Communication including students from the Poly- od dream and he always wanted to be a producer or jour- Miguel. I remember that he went to the training, I think it for Health was created at the Poly- technic University, civil servants and nalist. In 2010, after a lot of lobbying, he started working was in Bilene, and came back with a lot of new knowledge technic University in Maputo, which non-governmental organizations at Community Radio in Manjacaze as an assistant and which changed the way we make radio. We were all inex- was inaugurated by President Arman- graduated from the course between spent six months understanding radio and learning about perienced. I learned many things and we continue to work do Guebuza and U.S. Ambassador the years 2012-2014. the equipment. After that he was invited to make his first together. The production is practically in his hands. Even program. listeners, when asked what their favorite programs are, respond "Mi Nkaringane", "Um Cantor", "Saúde e Vida", In 2011 PACTO invited a number of journalists for trai- which are all produced by Miguel.” Rufaro Chitsamba is one of the Communications for Health students, ning in the production of health-related educational pro- who is finishing up his coursework for this specialization. He states that in grams. As the youngest and least experienced of the his opinion, these new courses are so useful that they should be required, not group, he had to work harder to do well. "I didn't know optional. Rufaro goes on to say, "These courses are very much in keeping how to produce a program and had no knowledge of the with the objectives of the Communication Sciences Program, teaching effici- technical aspects. Everything I know is thanks to PACTO ent communication by using the latest strategies, methodologies and thin- and even now I continue to receive support from king." At the same time, Rufaro notes that his new understanding of SBCC PACTO." A few years after her started there was a con- has been essential to his training in health journalism. Without it, his pers- test for the production of programs organized by PACTO, pectives on public health would not be as informed. With his enthusiasm and he won third place. Miguel shares the knowledge he and understanding of what he has learned, Rufaro clearly belongs to the acquired with his colleagues, "I always try to pass on next generation of professionals leading Mozambique to an AIDS-free gene- anything I learn to my colleagues, I am working with a ration.

4 4 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 4 5 In addition, PACTO gave technical Maputo Maputo assistance to the Polytechnic Univer- Gaza Total # of # of Province City # of trained trained sity to incorporate a specialization in trained Journalists Journalists Communication for Health in their Journalists Radio Radio Radio Communication course. The curricu- Moçambique 3 Moçambique 2 Moçambique 4 9 lum was adapted accordingly and TVM 3 RM-Rádio Cidade 2 TVM 1 6 lecturers were trained. In 2014, the RC Xai Xai 3 Rádio Maria 2 SFM 1 6 first 14 students graduated in Com- munications for Health; these stu- RC Chibuto 2 RC Inhaca 2 Jornal Noticias 2 6 dents will help improve the quality of RC Manjacaze 2 RC Namaacha 2 Jornal Savana 2 6 communication for health in the RC Mabalane 2 RC Moamba 2 Jornal Zambeze 1 5 country. Besides these students, 89 Magazine RC Chicualacuala 2 R Voz islam 3 1 6 journalists were trained in Communi- Independente cation for Health, and 20 trainees RC Chokwe 2 RC Voz Coop 2 Jornal Verdade 1 5 Diário de from undergraduate and Master Moçambique 1 RC Manhiça 2 D. Moçambique 1 4 degree courses of public and private DPS 1 RC Xinavane 5 DSC 1 7 universities, including UEM, UP and NPCS 1 MISA 1 NPCSC 1 3 nical capacity building exercises for Douglas Griffiths in February 2013. ISCTEM, performed an internship at the members of the Parliamentary This Center has become a reference the Center. The growing number of DPJD 1 Radio Muthiana 2 DPJDC 1 4 Office were implemented. After for journalists and communication students interested in SBCC and ICS 1 ICS 1 Radio Capital 2 4 Health Journalism helps raise the bar some members visited PACTO's acti- students in the country. It has been Jornal Notícias 1 DPS 1 2 vities, the Office presented a report equipped with a state-of-the-art tech- for health communication programs RC Mazivila 2 NPCS 1 3 to Parliament, in which it recommen- nology audio and radio studio to and leaves an important legacy for ded the expansion of all PACTO tools record communication programs, a the future. DPEC 1 DPID 4 2 community radio broadcasting FDC 1 4 nationwide. Lastly, through the existing partners- health programs, a web center for PACTO also designed and developed hips with television stations TVM, R. Politecnica 7 7 publishing national relevant articles what it called the Administrators Kit STV, Miramar, TIM, and Radio Total 28 42 19 89 in relation to health, in particular HIV (Version II), a set of cards with speci- Mozambique, PACTO has provided and AIDS, written by journalists trai- fic guidelines, with the objectives to continuous training and technical ned by PACTO (http://centrode exce- help the leaders contribute to the assistance to these stations, as well lencia-apolitecnica.ac.mz ). fight against HIV and AIDS in their as community radio stations, in order workplaces. The Centre of Excellence also offers to assist them in the development of Miguel Ernesto Langa, a journalist at the Commu- colleague on the production of programs and I'm going to Leadership courses in Communicati- health related programs using Com- nity Multimedia Center of Manjacaze, is 25 years old show him how it is done." His friend Aurélio comments, "I Under the impulse of PACTO, a Cen- on for Health. More than 90 people, munication for Health. and lives with his partner Fátima. Radio was his childho- started working for the radio at almost the same time as tre of Excellence for Communication including students from the Poly- od dream and he always wanted to be a producer or jour- Miguel. I remember that he went to the training, I think it for Health was created at the Poly- technic University, civil servants and nalist. In 2010, after a lot of lobbying, he started working was in Bilene, and came back with a lot of new knowledge technic University in Maputo, which non-governmental organizations at Community Radio in Manjacaze as an assistant and which changed the way we make radio. We were all inex- was inaugurated by President Arman- graduated from the course between spent six months understanding radio and learning about perienced. I learned many things and we continue to work do Guebuza and U.S. Ambassador the years 2012-2014. the equipment. After that he was invited to make his first together. The production is practically in his hands. Even program. listeners, when asked what their favorite programs are, respond "Mi Nkaringane", "Um Cantor", "Saúde e Vida", In 2011 PACTO invited a number of journalists for trai- which are all produced by Miguel.” Rufaro Chitsamba is one of the Communications for Health students, ning in the production of health-related educational pro- who is finishing up his coursework for this specialization. He states that in grams. As the youngest and least experienced of the his opinion, these new courses are so useful that they should be required, not group, he had to work harder to do well. "I didn't know optional. Rufaro goes on to say, "These courses are very much in keeping how to produce a program and had no knowledge of the with the objectives of the Communication Sciences Program, teaching effici- technical aspects. Everything I know is thanks to PACTO ent communication by using the latest strategies, methodologies and thin- and even now I continue to receive support from king." At the same time, Rufaro notes that his new understanding of SBCC PACTO." A few years after her started there was a con- has been essential to his training in health journalism. Without it, his pers- test for the production of programs organized by PACTO, pectives on public health would not be as informed. With his enthusiasm and he won third place. Miguel shares the knowledge he and understanding of what he has learned, Rufaro clearly belongs to the acquired with his colleagues, "I always try to pass on next generation of professionals leading Mozambique to an AIDS-free gene- anything I learn to my colleagues, I am working with a ration.

4 4 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 4 5

Year 1 Activity: This map displays in which postos and Year 2 Activity: The scale remains the same as to what extent activities occurred during the first year. before, so the same shade of gray corresponds with The shades of gray reflect increasing numbers of the same number of participants as in the last and participants. next two slides.

8. Research Studies

set of TV and Radio programs, while September Pathway to acceptance of HIV / AIDS Formative research to better unders- the Rapid Assessment of the situati- 2012 and Community Activism. tand and strengthen PACTO's work with PLHA on of People Living with HIV and March Formative Research on Male Circumci- Formative research to inform communi- AIDS guided the development of the 2013 sion in Mozambique cation interventions to create demand Positive Prevention Strategy. for male circumcision and to identify attitudes and behaviors post- Some studies have fueled the design circumcision that need to be addressed to prevent HIV infection. of national mass media campaigns. In 2012, JHUCCP conducted a quali- March Evaluating the Impact of a Communica- Evaluation of the Andar Fora Campa- 2014 tion Campaign on Multiple Sexual Part- ign on Multiple Sexual Partnerships, tative study on multiple sexual rela- nerships in Mozambique condom use and HIV testing. tionships, which provided important Qualitative study to evaluate the inputs for the second phase of the November Effectiveness of community dialogue 2015 in changing gender and sexual norms effects of the community mobilization activities to prevent HIV and utilize national campaign "Andar Fora é for HIV prevention health services in Mozambique Maningue Arriscado".

4 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 47

8. Research Studies

One of the remarkable SBCC activi- Description ties of JHU in Mozambique, is the Date Title of Research design and execution of studies, April New Gender Dynamics for HIV Preventi- Qualitative study on behavior, atti- research and evaluation of program 2009 on: Windows of Opportunities in Mozam- tudes and practices bique implementation. Under the PACTO Year 3 Activity: By Year 3 all postos involved had some Year 4 Activity: During Year 4, participant numbers July Tchova Tchova Model: Community Dialo- Evaluation of the changes produced by project, more than ten studies have 2010 gue on Gender and HIV/AIDS Prevention the Tchova Tchova program in the activity. For example, with each project year, more increased, though not as sharply as in previous been conducted, some with the behavior of people living in the intervention communities in Mozambique. and more participants were involved in activities in years. objective of designing communica- December Tchova Tchova Impact Evaluation Assessment of the effect of the TTHV Chongoene. tion strategies, others to guide the 2010 program on HIV related outcomes production of messages that pro- addressed by the program mote behavior change. July Rapid Analysis of the situation of PLHA Rapid analysis of PLHA and services 2012 and the Support Services in the Com- that support community to inform the The formative research on New Gen- munities Positive Prevention Strategy at community level in the Provinces of Maputo der Dynamics in Mozambique for and Gaza and Maputo city. example, guided the design of the September Life of couples in Mozambique: Chan- Formative research for the Andar Fora community tool "Tchova Tchova - 2012 ges and Risks - qualitative study on Campaign Life Stories" and the production of a multiple sexual relationships set of TV and Radio programs, while September Pathway to acceptance of HIV / AIDS Formative research to better unders- the Rapid Assessment of the situati- 2012 and Community Activism. tand and strengthen PACTO's work with PLHA on of People Living with HIV and March Formative Research on Male Circumci- Formative research to inform communi- AIDS guided the development of the 2013 sion in Mozambique cation interventions to create demand Positive Prevention Strategy. for male circumcision and to identify attitudes and behaviors post- Some studies have fueled the design circumcision that need to be addressed to prevent HIV infection. of national mass media campaigns. In 2012, JHUCCP conducted a quali- March Evaluating the Impact of a Communica- Evaluation of the Andar Fora Campa- 2014 tion Campaign on Multiple Sexual Part- ign on Multiple Sexual Partnerships, tative study on multiple sexual rela- nerships in Mozambique condom use and HIV testing. tionships, which provided important Qualitative study to evaluate the inputs for the second phase of the November Effectiveness of community dialogue 2015 in changing gender and sexual norms effects of the community mobilization activities to prevent HIV and utilize national campaign "Andar Fora é for HIV prevention health services in Mozambique Maningue Arriscado".

4 6 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 47 2. SEMPRE to Tchova Tchova Histórias de Vida (TTHV), Positive b) From the service perspective, there are structural Individual and family knowledge and attitudes Prevention (PP), Parent-Child Communication, and Acti- problems (lack of qualified human resources in suffi- towards ART adherence: Non-adherence to antiretro- In order to satisfy all PACTO's monitoring needs, a web- on Groups in HIV/AIDS prevention and use of services in cient numbers to provide adequate service to PLHA) viral therapy (interruptions and / or abandonment) supported platform was developed, called SEMPRE-- the project communities. and organizational problems of care and manage- seems to be more related to the patient's difficulty dea- Sistema Electrónico de Monitoria de Prevenção or ment of service records due to the high demand for ling with the side effects of the medication due to lack of Electronic Prevention Monitoring System, but the word The study was conducted in three sites, one located in different types of care and the inadequate number of sufficient food, or not knowing how to take advantage of 'sempre' also means "always" in Portuguese. the Province of Gaza (Xai-Xai) and two in the Province of service providers, and, for the same reason, insuffici- the food produced by the family, than to lack of informa- Maputo (Ndlavela and Manhiça). The participants Information collected from the community sessions of ent resources to actively search for ART defaulters. tion, or to individuals and families not recognizing the included adult men and women who were PACTO's key for example the Tchova Tchova, Positive Prevention and advantages of ART for maintaining health. Secondarily, populations, community based facilitators, service pro- The testimonials from the support groups tell of patient Avante Familia project components was entered into the the sporadic lack of medication in the health unit appe- viders and CBO representatives. Study used in-depth referrals that are going well. Providers, for their part, database (14,000 forms by June 2014). Merging those ars to be another reason for stopping the medication. individual interviews and focus groups discussions with emphasize the importance of the CBOs to ensure a cons- data with geographical coordinates allowed for the The fear of worsening the infection due to discontinuati- approximately 200 participants. tant flow of referrals, and of the Focal Points to handle production of maps, such as the ones presented below, on of use is a sign that the patient is aware of the impor- the increased demand and the CBO activists who help demonstrating growth in terms of number of tance of adherence. track down defaulters. The CBOs themselves stress the participants reached during four years of the project. Main Results advances in their organization and their cooperation Improved cooperation between clinics and community with the health units. On the whole, cooperation among organizations to support HIV prevention, care, and tre- A qualitative study to evaluate PACTO's effect on com- The main barriers with respect to the seeking of health the groups appears to be an area of weakness (the diffe- atment: munity mobilization and service utilization in Mozambi- services for HIV, can be divided into two categories; rent groups do a little of everything, not considering the que was conducted in April 2014. This study investiga- The providers state that their relationship with the com- a) From the population perspective, difficulty in acces- different qualities of each group and the fact that they do ted evidence for the increased use of HIV services, the munity has improved since they started partnering with sing services (especially, distance and lack of trans- not have the resources to expand their work areas). community-level effects that reduce stigma and create a the CBOs. Some obstacle preventing the health units portation, difficulty in communicating one's HIV supportive environment, the individual and family chan- As far as the population is concerned, the barriers des- from finding defaulters have been mentioned, which is status to the family, reservations about HIV testing ges that increase HIV prevention and treatment uptake cribed above remain, but have been minimized due to why they rely on support groups in the community lin- when there are no symptoms of infection, interrup- and adherence and the increased integration between the support of the PACTO project and its partner CBOs. ked to CBOs. The tracing of the defaulters is done by the ting ART due to lack of food, fear of receiving poor clinics and community organizations to support HIV For example, concerning the difficulties in accessing members of PP, GA and GAA, generally with success, in treatment at the health center, and the custom of prevention, and treatment uptake and adherence. services (distance and travel conditions), the support coordination with the Focal Points at the health units. only seeking medical help after the traditional reme- group members do what they can, visiting house to Resistance to testing only decreases after direct inter- The study mainly explored the effect of PACTO's com- dies are not working and the sickness is getting wor- house in the community, organizing their tasks accor- personal communication. This reveals the importance munity mobilization activities, specifically those related se; ding to a territorial division of labor, agreed upon by the of the partnership between PACTO and its CBOs and group. support groups in the community. Demand for HIV testing and linkage to care: According The analysis also showed the weaknesses of the health to community members, projects like PACTO help mobi- system to cover the needs of the PLWA, and to do the lize people to access HIV counseling and testing at the defaulter tracing and continually follow up on patients health units and to access and adhere to HIV treatment. referred, tested and treated. Additionally, it is necessary However, there are still some community members who to take steps to ensure the sustainability of the referral refuse to access HIV testing due to stigma or to the idea system. that HIV infection is not a serious illness. The work of support groups in services and communiti- Individual and family knowledge and attitude towards es has a significant impact on the lives of PLHA, as men- HIV testing: Although HIV is now more accepted as tioned in various testimonies. Groups like GAAC, GA "normal," due to the dissemination of information in the and GAA have a fundamental role in supporting health media and communities, and support of local groups, services and identifying people with symptoms of HIV. the analysis still found resistance to testing, for fear of Through them, people have easier access to testing, the result and stigma. People tend to delay testing, even treatment and hospitalization if necessary. On the other when they feel sick. On the other hand people that have hand, there is need for the health units to incorporate the participated in PACTO activities are better able to support from these groups, and especially help create accept the possibility of being infected, and are willing to the conditions that will increase access to services. get tested.

4 8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 49 2. SEMPRE to Tchova Tchova Histórias de Vida (TTHV), Positive b) From the service perspective, there are structural Individual and family knowledge and attitudes Prevention (PP), Parent-Child Communication, and Acti- problems (lack of qualified human resources in suffi- towards ART adherence: Non-adherence to antiretro- In order to satisfy all PACTO's monitoring needs, a web- on Groups in HIV/AIDS prevention and use of services in cient numbers to provide adequate service to PLHA) viral therapy (interruptions and / or abandonment) supported platform was developed, called SEMPRE-- the project communities. and organizational problems of care and manage- seems to be more related to the patient's difficulty dea- Sistema Electrónico de Monitoria de Prevenção or ment of service records due to the high demand for ling with the side effects of the medication due to lack of Electronic Prevention Monitoring System, but the word The study was conducted in three sites, one located in different types of care and the inadequate number of sufficient food, or not knowing how to take advantage of 'sempre' also means "always" in Portuguese. the Province of Gaza (Xai-Xai) and two in the Province of service providers, and, for the same reason, insuffici- the food produced by the family, than to lack of informa- Maputo (Ndlavela and Manhiça). The participants Information collected from the community sessions of ent resources to actively search for ART defaulters. tion, or to individuals and families not recognizing the included adult men and women who were PACTO's key for example the Tchova Tchova, Positive Prevention and advantages of ART for maintaining health. Secondarily, populations, community based facilitators, service pro- The testimonials from the support groups tell of patient Avante Familia project components was entered into the the sporadic lack of medication in the health unit appe- viders and CBO representatives. Study used in-depth referrals that are going well. Providers, for their part, database (14,000 forms by June 2014). Merging those ars to be another reason for stopping the medication. individual interviews and focus groups discussions with emphasize the importance of the CBOs to ensure a cons- data with geographical coordinates allowed for the The fear of worsening the infection due to discontinuati- approximately 200 participants. tant flow of referrals, and of the Focal Points to handle production of maps, such as the ones presented below, on of use is a sign that the patient is aware of the impor- the increased demand and the CBO activists who help demonstrating growth in terms of number of tance of adherence. track down defaulters. The CBOs themselves stress the participants reached during four years of the project. Main Results advances in their organization and their cooperation Improved cooperation between clinics and community with the health units. On the whole, cooperation among organizations to support HIV prevention, care, and tre- A qualitative study to evaluate PACTO's effect on com- The main barriers with respect to the seeking of health the groups appears to be an area of weakness (the diffe- atment: munity mobilization and service utilization in Mozambi- services for HIV, can be divided into two categories; rent groups do a little of everything, not considering the que was conducted in April 2014. This study investiga- The providers state that their relationship with the com- a) From the population perspective, difficulty in acces- different qualities of each group and the fact that they do ted evidence for the increased use of HIV services, the munity has improved since they started partnering with sing services (especially, distance and lack of trans- not have the resources to expand their work areas). community-level effects that reduce stigma and create a the CBOs. Some obstacle preventing the health units portation, difficulty in communicating one's HIV supportive environment, the individual and family chan- As far as the population is concerned, the barriers des- from finding defaulters have been mentioned, which is status to the family, reservations about HIV testing ges that increase HIV prevention and treatment uptake cribed above remain, but have been minimized due to why they rely on support groups in the community lin- when there are no symptoms of infection, interrup- and adherence and the increased integration between the support of the PACTO project and its partner CBOs. ked to CBOs. The tracing of the defaulters is done by the ting ART due to lack of food, fear of receiving poor clinics and community organizations to support HIV For example, concerning the difficulties in accessing members of PP, GA and GAA, generally with success, in treatment at the health center, and the custom of prevention, and treatment uptake and adherence. services (distance and travel conditions), the support coordination with the Focal Points at the health units. only seeking medical help after the traditional reme- group members do what they can, visiting house to Resistance to testing only decreases after direct inter- The study mainly explored the effect of PACTO's com- dies are not working and the sickness is getting wor- house in the community, organizing their tasks accor- personal communication. This reveals the importance munity mobilization activities, specifically those related se; ding to a territorial division of labor, agreed upon by the of the partnership between PACTO and its CBOs and group. support groups in the community. Demand for HIV testing and linkage to care: According The analysis also showed the weaknesses of the health to community members, projects like PACTO help mobi- system to cover the needs of the PLWA, and to do the lize people to access HIV counseling and testing at the defaulter tracing and continually follow up on patients health units and to access and adhere to HIV treatment. referred, tested and treated. Additionally, it is necessary However, there are still some community members who to take steps to ensure the sustainability of the referral refuse to access HIV testing due to stigma or to the idea system. that HIV infection is not a serious illness. The work of support groups in services and communiti- Individual and family knowledge and attitude towards es has a significant impact on the lives of PLHA, as men- HIV testing: Although HIV is now more accepted as tioned in various testimonies. Groups like GAAC, GA "normal," due to the dissemination of information in the and GAA have a fundamental role in supporting health media and communities, and support of local groups, services and identifying people with symptoms of HIV. the analysis still found resistance to testing, for fear of Through them, people have easier access to testing, the result and stigma. People tend to delay testing, even treatment and hospitalization if necessary. On the other when they feel sick. On the other hand people that have hand, there is need for the health units to incorporate the participated in PACTO activities are better able to support from these groups, and especially help create accept the possibility of being infected, and are willing to the conditions that will increase access to services. get tested.

4 8 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 49 Health in the communities it is important to strengthen linkage between the health system and community interventions. The health care providers also acknowledge the importance of this linkage. ?The coordination with the Ministry of health and CNCS in 9. Lessons Learned terms of their existing policies 10. Perspective for the future and programs, has improved the ownership of the project and the implementation of the activities. ?Recognition of the importance of ?The participation of community The systematic approach to SBCC new priorities. Showing that the ?The Xinavane Sugar Refinery, as community work to boost demand: members and community leaders health has been adopted by the sta- PACTO setup has a response for a concentration area of male Service providers recognize the in PACTO activities has improved keholders and the government. It most new demands in the area of workers, proved to be a quite role that CBOs and mobilizers pro- demand for and access to will be important to give some tech- Health communication. PACTO has conducive site to increase the vide in the community in informing HIV/AIDS community and health nical assistance to ensure continuity the potential to improve demand coverage of men in the Health and referring people to the servi- services. and GBV interventions (57% of to this approach. creation, retention to services and ces, but not everyone has a clear adherence to treatment. ?The role of the CBO Focal Point at male beneficiaries) at the work- PACTO established networks of understanding of the partnership the health unit is extremely impor- place, compared to the commu- OCBs, Journalist, Media Partners PACTO has built capacity at many of their Health Unit with PACTO's tant to organize the service and nity interventions, where male and TWG with relevant Ministries, different levels, this will allow that CBO partners. The providers who ensure that the referrals are served. coverage did not reach more having the possibility to develop and future SBCC Health activities can be have a better understanding of the than 30%. partnership acknowledge its effec- ?Partnership between PACTO, implement new SBCC activities for developed in a more cost efficient tiveness in expanding access to public and private sector: The ?The integration of health and Health. This investment has still the manner. An example of this is the HIV services, testing, treatment PACTO project was marked by a GBV actions in the project activi- possibility to reap many benefits in Health Communication course esta- and, defaulter tracing, as well as productive synergy among the ties, has allowed a greater level terms of resources and time. blished at A Politecnica, which offers a greater opportunity for maxi- improving the monitoring mecha- public and private sectors, civil behavior change to happen. PACTO has shown during its course society and the community. mizing the country capacity to deve- nisms set up as part of the referral ?Community screening (GBV and the flexibility to incorporate new PACTO established these part- lop quality SBCC programs. systems. PACTO participated in TB) increased the demand to health areas and within health areas nerships which allowed a greater the meeting of traditional leaders, health services organized by the MOH. In the dis- reach and sustainability with little ? trict of Manhiça, the project team financial resources. Some of the Mass-media interventions rein- was integrated into the Health Fair main partners were: Vodacom, forced the recognition and legiti- dedicated to World Tuberculosis TVM, Radio Mocambique, Com- macy of PACTO's community Day, organized by the district munity radios, A Politecnica, TDM, activities and allowed a greater health services. Also in Manhiça, Mcel, BCIel, BCI. reach. the organization AMUCHEFA rece- ?Mhealth system: allowed to syste- ?Entertainment Education appro- ived the District Administrator's matize the data collection and aches (Sesasons, 100% Kool, visit to get to know the community referrals using one system. Tchilling Saudavel, Avante work developed by this CBO, part- Jovens, Avante ESH) proved to ?In order to create demand for ner of PACTO, whose work has had be effective platforms to attract health services and also to improve a positive impact in the district. and engage youth audiences

5 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 5 1 Health in the communities it is important to strengthen linkage between the health system and community interventions. The health care providers also acknowledge the importance of this linkage. ?The coordination with the Ministry of health and CNCS in 9. Lessons Learned terms of their existing policies 10. Perspective for the future and programs, has improved the ownership of the project and the implementation of the activities. ?Recognition of the importance of ?The participation of community The systematic approach to SBCC new priorities. Showing that the ?The Xinavane Sugar Refinery, as community work to boost demand: members and community leaders health has been adopted by the sta- PACTO setup has a response for a concentration area of male Service providers recognize the in PACTO activities has improved keholders and the government. It most new demands in the area of workers, proved to be a quite role that CBOs and mobilizers pro- demand for and access to will be important to give some tech- Health communication. PACTO has conducive site to increase the vide in the community in informing HIV/AIDS community and health nical assistance to ensure continuity the potential to improve demand coverage of men in the Health and referring people to the servi- services. and GBV interventions (57% of to this approach. creation, retention to services and ces, but not everyone has a clear adherence to treatment. ?The role of the CBO Focal Point at male beneficiaries) at the work- PACTO established networks of understanding of the partnership the health unit is extremely impor- place, compared to the commu- OCBs, Journalist, Media Partners PACTO has built capacity at many of their Health Unit with PACTO's tant to organize the service and nity interventions, where male and TWG with relevant Ministries, different levels, this will allow that CBO partners. The providers who ensure that the referrals are served. coverage did not reach more having the possibility to develop and future SBCC Health activities can be have a better understanding of the than 30%. partnership acknowledge its effec- ?Partnership between PACTO, implement new SBCC activities for developed in a more cost efficient tiveness in expanding access to public and private sector: The ?The integration of health and Health. This investment has still the manner. An example of this is the HIV services, testing, treatment PACTO project was marked by a GBV actions in the project activi- possibility to reap many benefits in Health Communication course esta- and, defaulter tracing, as well as productive synergy among the ties, has allowed a greater level terms of resources and time. blished at A Politecnica, which offers a greater opportunity for maxi- improving the monitoring mecha- public and private sectors, civil behavior change to happen. PACTO has shown during its course society and the community. mizing the country capacity to deve- nisms set up as part of the referral ?Community screening (GBV and the flexibility to incorporate new PACTO established these part- lop quality SBCC programs. systems. PACTO participated in TB) increased the demand to health areas and within health areas nerships which allowed a greater the meeting of traditional leaders, health services organized by the MOH. In the dis- reach and sustainability with little ? trict of Manhiça, the project team financial resources. Some of the Mass-media interventions rein- was integrated into the Health Fair main partners were: Vodacom, forced the recognition and legiti- dedicated to World Tuberculosis TVM, Radio Mocambique, Com- macy of PACTO's community Day, organized by the district munity radios, A Politecnica, TDM, activities and allowed a greater health services. Also in Manhiça, Mcel, BCIel, BCI. reach. the organization AMUCHEFA rece- ?Mhealth system: allowed to syste- ?Entertainment Education appro- ived the District Administrator's matize the data collection and aches (Sesasons, 100% Kool, visit to get to know the community referrals using one system. Tchilling Saudavel, Avante work developed by this CBO, part- Jovens, Avante ESH) proved to ?In order to create demand for ner of PACTO, whose work has had be effective platforms to attract health services and also to improve a positive impact in the district. and engage youth audiences

5 0 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 5 1 Acronyms and Abbreviations

AG Action Group (Tchova Tchova)

AIDS Acquired Immune Deficiency Syndrome

ART Antiretroviral Therapy

ATSC Aconselhamento e Testagem na Comunidade (Community Counseling and Testing)

BCC Behavior Change Communication

CBO Community-based Organization

CCP Johns Hopkins Center for Communication Programs

CDC Centers for Disease Control and Prevention

CECS Centro de Excelência em Comunicação em Saúde (Health Communication Center of Excellence)

CLC Community Leadership Council

CNCS Conselho Nacional de Combate ao SIDA (National AIDS Council)

DEPROS Direcção de Promoção da Saúde Pública (MoH Department of Public Health Promotion)

DNAM Direcção Nacional de Assistência Médica (MOH National Health Care Directorate)

DPS Direcção Provincial de Saúde (Provincial Health Directorate)

E - E Entertainment and Education

ECOSIDA Associação de Empresários contra o SIDA (Association of Businessmen against AIDS)

ESH Escolas Sem HIV (Schools without HIV)

FDC Fundação para o Desenvolvimento da Comunidade (Community Development Foundation -local NGO)

FP Family Planning

GA Grupo de Acção (Action Group)

GAAC Grupo de Apoio à Adesão Comunitária (Community Adherence Support Group)

GAMC Gabinete de Atendimento da Mulher e Criança (Women and Children Support Services)

GBV Gender Based Violence

GFATM Global Fund to Fight AIDS, TB and Malaria

HAART Highly Active Antiretroviral Therapy

HIV Human Immunodeficiency Virus

HOPEM Homens pela Mudança (Men for Change - local NGO)

HVCT HIV Voluntary Counseling and Testing

HTC HIV Testing and Counseling

ICS Instituto de Comunicação Social (Social Communication Institute)

INSIDA Inquérito Nacional de Prevalência, Riscos Comportamentais e Informação sobre o HIV e SIDA em Moçambique (National Prevalence, Behavior Risk and HIV/AIDS Information Survey in Mozambique)

IPTp Intermittent Preventive Treatment in Pregnancy

JHU Johns Hopkins University

M&E Monitoring and Evaluation

MC Medical Circumcision

MCHIP Maternal and Child Health Integrated Program

MCP Multiple concurrent sexual partnerships

MGCAS Ministério de Gênero, Crianças e Action Social (Ministry of Gender, Children and Social Welfare

MINED Ministry of Education

MISAU Ministério da Saúde (Ministry of Health)

MMAS Ministério da Mulher e da Action Social (Ministry of Women and Social Action)

5 2 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 5 3 Acronyms and Abbreviations

AG Action Group (Tchova Tchova)

AIDS Acquired Immune Deficiency Syndrome

ART Antiretroviral Therapy

ATSC Aconselhamento e Testagem na Comunidade (Community Counseling and Testing)

BCC Behavior Change Communication

CBO Community-based Organization

CCP Johns Hopkins Center for Communication Programs

CDC Centers for Disease Control and Prevention

CECS Centro de Excelência em Comunicação em Saúde (Health Communication Center of Excellence)

CLC Community Leadership Council

CNCS Conselho Nacional de Combate ao SIDA (National AIDS Council)

DEPROS Direcção de Promoção da Saúde Pública (MoH Department of Public Health Promotion)

DNAM Direcção Nacional de Assistência Médica (MOH National Health Care Directorate)

DPS Direcção Provincial de Saúde (Provincial Health Directorate)

E - E Entertainment and Education

ECOSIDA Associação de Empresários contra o SIDA (Association of Businessmen against AIDS)

ESH Escolas Sem HIV (Schools without HIV)

FDC Fundação para o Desenvolvimento da Comunidade (Community Development Foundation -local NGO)

FP Family Planning

GA Grupo de Acção (Action Group)

GAAC Grupo de Apoio à Adesão Comunitária (Community Adherence Support Group)

GAMC Gabinete de Atendimento da Mulher e Criança (Women and Children Support Services)

GBV Gender Based Violence

GFATM Global Fund to Fight AIDS, TB and Malaria

HAART Highly Active Antiretroviral Therapy

HIV Human Immunodeficiency Virus

HOPEM Homens pela Mudança (Men for Change - local NGO)

HVCT HIV Voluntary Counseling and Testing

HTC HIV Testing and Counseling

ICS Instituto de Comunicação Social (Social Communication Institute)

INSIDA Inquérito Nacional de Prevalência, Riscos Comportamentais e Informação sobre o HIV e SIDA em Moçambique (National Prevalence, Behavior Risk and HIV/AIDS Information Survey in Mozambique)

IPTp Intermittent Preventive Treatment in Pregnancy

JHU Johns Hopkins University

M&E Monitoring and Evaluation

MC Medical Circumcision

MCHIP Maternal and Child Health Integrated Program

MCP Multiple concurrent sexual partnerships

MGCAS Ministério de Gênero, Crianças e Action Social (Ministry of Gender, Children and Social Welfare

MINED Ministry of Education

MISAU Ministério da Saúde (Ministry of Health)

MMAS Ministério da Mulher e da Action Social (Ministry of Women and Social Action)

5 2 | PACTO F I N A L R E P O RT PACTO F I N A L R E P O RT | 5 3 MOH Ministry of Health

MoU Memorandum of Understanding

MSP Multiple Sexual Partnerships

NGO Non-governmental Organization

NMCP National Malaria Control Program

NPCS Núcleo Provincial de Combate ao SIDA (Provincial AIDS Council)

OVC Orphans and Vulnerable Children

PACTO Prevenção Activa e Comunicação para Todos (Active Prevention and Communication for All)

PEN Plano Estratégico Nacional (National Strategic HIV/AIDS Plan)

PEP Post-Exposure Prophylaxis

PEPFAR President's Emergency Plan for AIDS Relief

PMI President's Malaria Initiative

PMTCT Prevention of Mother-to-Child Transmission

PIRCOM Programa Inter-Religioso Contra a Malária (Interfaith Program against Malaria)

PLHA People Living with HIV/AIDS

PNCM Programa Nacional de Control da Malária (National Malaria Control Program)

PP Prevenção Positivo (Positive Prevention)

PSI Population Services International

R2P USAID Project SEARCH: Research to Prevention

RM Rádio Moçambique

SBCC Social and Behavioral Change Communication

SEMPRE Sistema Electrónico de Monitoria de Prevenção de HIV (Electronic HIV Prevention Monitoring System)

SLSBCC Strategic Leadership and HIV/AIDS Social & Behavior Change Communication

SMS Text Messages

STI Sexually Transmitted Infections

STV Soico Televisão LDA

TB Tuberculosis

TDM Telecomunicações de Moçambique

TT Tchova Tchova

TTHV Tchova Tchova Histórias de Vida (Tchova Tchova Life Stories)

TVM Televisão de Moçambique

UATS Unidade de Aconselhamento e Testagem em Saúde (Health Counseling and Testing Unit)

UEM Universidade Eduardo Mondlane (Eduardo Mondlane University)

UNAIDS Joint United Nations Program on HIV/AIDS

UNICOM Unidade de Comunicação do CNCS (National AIDS Council Communication Unit)

UP Universidade Politécnica (Polytechnic University)

USAID United States Agency for International Development

VCT Voluntary Counseling and Testing

VMMC Voluntary Medical Male Circumcision WASH Water, Sanitation and Hygiene Rua Carlos Albers 107 | Maputo, Moçambique WHO World Health Organization Tel: +258 21 322300/322301 | Fax: +258 21 322303

MOH Ministry of Health