Egypt National TB Control Program Advocacy, Communication, and Social Mobilization (ACSM) Strategy

.ITOUTO ...... 7 1. INTRODUCTION ...... 6 EXECUTIVE SUMMARY ...... 5 ...... WHERE TOFROMHERE? 4 FOREWARD ...... 3 ABBREVIATIONS ...... AS TAEYOJCIE ...... 23 6. ACSMSTRATEGYOBJECTIVES ...... 5. AUDIENCESEGMENTATION 22 ...... 20 4. STRATEGICACSMPLANNINGCYCLE ...... 17 3. ACSMSTRATEGICFRAMEWORK...... 10 ...... 2. SITUATIONANALYSIS INDEX . omnt ae betvs...... 24 6.4 CommunityBasedObjectives ...... 24 ...... 6.3 ServiceDeliveryObjectives 23 6.2 Audience-BasedObjectives ...... 23 6.1 TBACSMStrategyObjectives ...... 5.3 In 22 5.2 SecondaryAudienceSegments ...... 22 5.1 PrimaryAudienceSegments ...... 19 3.6 ACSMStrategyManagement ...... 18 3.5 DevelopmentofACSMProgramCoreCompetencies ...... 18 3.4 StreamsofACSMActivity ...... 17 3.3 CampaignPhases ...... 17 3.2 StrategyTerminology ...... 17 3.1 ACSMStrategyGoal20092014- ...... 15 2.4 ProgramStrengths,ChallengesandOpportunities ...... 14 2.3 ACSMNeedsAssessmentFindings ...... 13 ...... 2.2 KnowledgeAttitudesandPractices 10 2.1 CountryData ...... 8 1.1 AdvocacyCommunicationandSocialMobilization ...... fl ecn rus...... 22 uencing Groups ...... 3 INDEX Advocacy, Communication, and Social Mobilization (ACSM) Strategy 7. MESSAGE DEVELOPMENT ...... 25 7.1 Potential Message Themes ...... 25 8. ILLUSTRATIVE ACTIVITIES ...... 27 8.1 Community Level Activities ...... 27 8.2 Population Health Approaches ...... 30 9. MONITORING AND EVALUATION ...... 36 9.1 Performance Indicators ...... 36 10. ACSM STRATEGY PRIORITIES ...... 40 10.1 ACSM Year One Priorities - 20092010- ...... 41 11. DOCUMENTATION & DISSEMINATION ...... 47 CONCLUSION ...... 47 INDEX

4 CCM BCC HIV HEO GFATM EMR DTM DOT DTC DPM DCT CRIS LHW KPIs KAP XDR –TB TOR TDI TARPs TA QA PPM PHC OPD MOHP MDR-TB NTP LOE AIDS ACSM AAR ABBREVIATIONS The followingkeydatasourceswereutilizedinthedevelopmentofthis strategy:MinistryofPopulationandHealth(2007)Nati Data Sources: to monitoringand evaluation ofTB/HIVactivities.Field testversion.Geneva.Strategy S., (2002)Evaluation ofAntiTuberculosisCampaign- Egypt 2002.USAIDfundedreport.World HealthOrganization,(2004)A guid Tuberculosis Control,Surveillance,Planning, Financing.NTP(2008)GFATMRound6ACSMproposaland Workplan.Verver, Sourced from:http://www.emro.who.int/stb/TBSituation-RegionalPro the TB-relatedMillenniumDevelopment GoalsWHO–StopTBPartnership.Partnership(2008) TBRegionalPro year FrameworkforAction.WHO–Stop TBPartnership(2006)TheStopTbStrategy-Buildingonandenhancing DOTStomeet Mediterranean Region.WHO–Stop TB Partnership(2006)Advocacy,CommunicationandSocialMobilization to - Anin-depthanalysisofthehealth-seeking behaviourofpatientsandhealthsystemresponseinsevencountries oftheEastern Tuberculosis ControlProgramEgypt StrategicPlan20072011-.WHO-EMRO(2006)DiagnosisandTreatment DelayinTuberculosis Technical Assistance Quality Assurance Trade Development Index Human Immunode National Tuberculosis Program Knowledge,Attitudesand Practices PrimaryHealthCentre Level of Effort Behavior Change Communication Out-patient department DistrictTuberculosisCentre DiagnosisCounselingandTesting Key Performance Indicators After Action Review Terms of Reference Public - Private Mix Directly Observed Treatment Health Education Of District Program Manager EastMediterraneanRegion DistrictTuberculosisManager CommunicationResourceInformationSystem Country Coordinating Mechanism Acquired Immunode Lady Health Worker AdvocacyCommunicationandSocialMobilization Targetaudienceratingpoints MinistryofHealthandPopulation GlobalFundAgainstAIDSTBandMalaria MultiDrugResistantTB ExtremeDrugResistantTB fi ciency Virus fi fi cer ciency Syndrome fi le-TBburden.htm WHO(2008) Report2008-Global fi ght TB-A10- onal fi le. e

5 ABBREVIATIONS Advocacy, Communication, and Social Mobilization (ACSM) Strategy

health promotion inyears programming to come. inourcountry to all TB andHIV/AIDSstakeholdersinthehopethatitwillprovide aroad-map for TB andother ofHealthandPopulationOn behalfoftheMinister inEgypt, IendorsetheNationalACSM Strategy inACSM.based organisations, andpublicprivate partnerships civilsociety auspices oftheNational TB Control including;NGOs, Program faith partners anditsmultisectoral a strategic framework for guidingACSM programs thatare facilitated by, underthe orsupported amongstallstakeholdersinthefieldofpartnerships TB control.It presents broad principlesand The Strategy isnotanendinitself, butratheraninstrumentfor expandingandpromoting 2015), andthe WHO–Stop TB Partnership ACSM 10-year Framework for to Action Fight TB (2006). The Strategy hasalsobeendeveloped inlinewiththeGlobalPlanto Stop TB Strategy (2006- been developed to address theseunfolding challenges. evolve thatare realistic, achievable andmeasurable. This NTP ACSM Strategy 20092014-has of levels. order healthgainsinthelongerterm, programs to In achieve willneedto important ACSMintensive, messagesandprograms single-minded operatingsynergistically atanumber of theapproach isthatanintegrated programming modelrequired for incorporating timely, greaterthe NationalStrategic Planto inject strat isthereforeIt apositive step to seethatNTPhasnow developed anACSM strategy inlinewith adherence, andreduce stigma associated with TB. of knowledge TB inthecommunity, behaviour andtreatment encourage earlyhealth-seeking in becoming ofincreasing importance TB control. ACSM to raiseawareness canact andincrease strategy, itisclearthatthevalueofadvocacy, communication andsocialmobilization(ACSM) is take the TB strategy linewithenhancements forward from intheoverarching 20072011-.In TB The National TB Control Program hasrecently completed itssecond NationalStrategic Planto FOREWARD Media AdvisorMedia for ofHealth&Population the Minister egic coherence to Acornerstone theseactivities. Prof. Dr. Abdelrahman Shahin Signature 7 FOREWARD Advocacy, Communication, and Social Mobilization (ACSM) Strategy

related activities. inthefuture implementationoftheEgypt NTP-ACSM partners private Strategy sector and on the World TB Day on24thMarch 2009. We lookforward towithallourpublicand working plansinreadiness Action forand District thefirstintegrated ACSM campaign belaunched to ACSM stakeholderswillbeinvited to attend theCampaign Planning Workshop develop programs needs assessment. Amr Bakr, Dr. Sherry Victor, andMs. Taghrid whoassisted coordination withproject Akl) andthe Turk - WHO ACSM Technical Advisor, aswell asACSM Team ofNTPEgypt (Dr. NadiaBadawy, Dr. (EMRO) especiallyMr. Wasiq for Khan theirassistance indeveloping thisstrategy through Tahir workshop of inAugust conducted 2008.Iwould the support alsoliketo acknowledge WHO this strategy through theprovision ofindependentadvice orattendance attheACSM planning The NTPisgrateful to thewidenumberofstakeholderswhohave contributed of to thedrafting inunisonto achieve working measurablebehaviouralprogram impact. partners approach isthatamore integrated approach to ACSM programming isrequired involving all with strategic developments intheclinicalprogram delivery. Acornerstone oftheplanning However, itisnow timeto develop amore integrated approach to theACSM program, inline with significant fundingprovided through theGlobal Fund for AIDS,Malaria TBand (GFATM). critical component in TB control andhasbeenutilisedeffectively inearlier years oftheprogram Advocacy (ACSM) Communication Mobilisation andSocial hasbeenidentified by WHOasa to eradicate TB asahealthproblem inEgypt, through more systematic approaches. Despite thesesuccesses inprogram delivery, thisisnotimeto becomplacent inmoving forward recent years andhasacurrent estimated incidence of24 TB patientsper100thousandpopulations. Egypt isrankedby WHO asalow burden TB country. hasmanagedto reduce It its TB burden in WHERE TOFROMHERE? General Director ofChestDiseases Executive Director ofNTP-Egypt Dr. EssamElmoghazy August 2008 9 WHERE TO FROM HERE? Advocacy, Communication, and Social Mobilization (ACSM) Strategy

indicators (KPIs)through behavioural determinants. resources, andamonitoring andevaluationframework to measure program keyperformance andevents, communication and socialmobilisationactivities a rangeofadvocacy massmedia through trainingandtechnical transfer thedevelopment withpublicandprivate of partners, been identified. includemoreThese intensive intargeted interventions areas, building capacity and arangeofspecificactivities ACSM channelshave populationsintheshort-term, priority be consulted andinvolved intheplanninganddevelopment process. Given theneedto address mustdrive program participation activities. TB stakeholdersandtargeted beneficiariesshould A cornerstone ofthestrategy istherecognition ownership thatcommunity involvement and basedandmediaprogramming,community andmonitoring andevaluation ofACSM. competencies for ACSM programming through theestablishmentof ‘centres ofexcellence.’ for utilization ofexistinghumanresources for ACSM, theprogram willaimto buildoncore to leverage programbuilding private publicpartnerships As activities. well asmore effective NGO, Community BasedOrganisations (CBOs), faith-basedorganisations (FBOs),aswell as willbeachievedThis by impact expandingthecurrent including network ofprogram partners evaluated through amonitoring andevaluationframework. periods. achieved,intensive If theapproach activity may show measurablebehavioural impact approach isthatamore integrated, multilevel, program willberequired withlarger scale, more programming objectives, aswell asanumberofillustrative ACSM Akeyfeature activities. ofthe challenges,stage ofthecycle. Alsoidentifiedare target populations the overarchingcountry The process provides for optimumstakeholderinvolvement, withfeedback loopsatevery Cycle incorporates program planning, dev programming, andtheutilisationofafour-stage, Stra comprised ofkeyACSMSub-Committee stakeholderswithcore competencies inACSM a holisticandsustainableACSM encompasses program. theestablishmentofa It Technical This documentproposes theOperatingprinciplesandastrategic planningframework to guide systematic, strategic approaches to theACSM program needto takeplace. roll-out and reduce stigma associated with TB. However, inorder to achieve program success, more of TB inthecommunity, behaviour andtreatment encourage earlyhealthseeking adherence, feature ofanyimportant comprehensive TB program to raiseawareness andbuildknowledge The challengesofreducing theburden of TB inEgypt are significant and complex. ACSM isan EXECUTIVE SUMMARY elopment, implementationandevaluationstages. tegic ACSM PlanningCycle. This Planning 11 EXECUTIVE SUMMARY Advocacy, Communication, and Social Mobilization (ACSM) Strategy

(MDR-TB), drugresistant extreme –TB)TB (XDR of resistant multi-drug TB/HIV co-infection, TB all riskgroups, aswell asmitigate theimpact behaviour, reduce to further TB incidence with to increase early healthseeking casedetection, ownership within communities for TB control health priorities. This requires buildinggreater TB control inanenvironment ofcompeting be doneto continue to buildmomentumfor to achieve thistarget muchmore needsto generation ofchildren free from TB. order In the chainoftransmission,inorder to have a One ofprincipal TB control strategies isto cut targets of85%. 87% beingachieved above therequired successful treatment outcomes ofmore than with goodpatienttreatment adherence and Much hasalready beenachieved inEgypt of theprogram. is yet to evolve, inlinewiththeclinicaldelivery strategic approach to ACSM program roll-out in effect Egypt inthepast,amore systematic, Although ACSM hasbeenutilisedto good WHO asacriticalcomponent in TB control. (ACSM)Mobilisation hasbeenidentified by Advocacy, Communication, andSocial developing countries. TB account for 25%ofallavoidable deathsin diseaseagent.Deathsfromsingle infectious moretuberculosis peoplethanany kills other cases of TB diseasewith1.9milliondeaths. M. in 2000,there were about8.7millionnew with Mycobacterium tuberculosis. Worldwide third oftheworld’s populationisinfected TB asapublichealthproblem. Aboutone- recognition ofthegrowing of importance declared in (WHO) TB a globalemergency 1993,the In World HealthOrganization INTRODUCTION evaluation aswell asproviding steps practical planning, development, implementationand provide amore cohesive platform for program ishopedthatthestrategy will It Mobilization. for Advocacy, Communication, andSocial Stop TB Partnership’s 10-year Framework Tuberculosis Strategic Planandthe WHO– This ACSM Strategy refers to theNational hospitals to theNTPfacilities. rates from anduniversity private practitioners address theunderlyingcauses oflow referral resources. More attention isalsoneededto given thelimitationsinhumanandfinancial strategic alliances, to create behavioral impact, through thecreation ofmorethe country and coordination ofACSM across efforts the pressing needfor greater integration Also evidentfrom recent consultations is development. and geographically, from themainstream of remained distanced socially, economically to continue for communities whichmay have Concentrated ACSM are also efforts required approaches.(IPC) ofinterpersonal communication importance ofclinicalstaff to understandthe capacity workers andfieldstaffas wellasbuilding improve of thefront-line ACSM health skills resources, muchmore needsto bedoneto commitment andtheflow ofadequate must continue to ensure high-level political in reducing TB inEgypt. Whilst advocacy efforts, willnotachieve theambitioustargets DOTS inisolationofmore intensive ACSM expansion andenhancement ofhighquality There isnow agrowing realization thatthe and otheremerging challenges. 13 INTRODUCTION Advocacy, Communication, and Social Mobilization (ACSM) Strategy to operationalise the strategy. This Strategy is selecting ACSM tools and channels, and designed to expand ACSM activities to help developing a management and monitoring address four key program challenges: system. Common features of successful social • Continuing to mobilize political marketing campaigns gleaned from the commitment and resources for TB. health communication literature indicate that the most successful programs are: • Improving case detection, referral, holding, and treatment adherence. • Strategic, Collaborative, & Participatory; • Combating stigma and discrimination • Targeted and Audience Focused; • Empowering people affected by TB • Behavior Centered; • Multi-level & Integrated – IPC supported 1.1 Advocacy Communication, by media resources; and Social Mobilization • Monitored and Evaluated with research The World Health Organisation views each informing decision making; component of Advocacy, Communication, ACSM activities include: and Social Mobilization as follows; • ACSM training, capacity building, and • Advocacy - Advocacy is a dynamic process institutional strengthening; that includes activities designed to place TB high on political and development • Community Advocacy – activities and agenda, foster political will, increase and events; sustain financial and other resources. • Developing ACSM tools and materials to • Communication - Exchange of information support community advocacy; about TB between patients/families/ • Developing distribution mechanisms to providers and communities. A two-way get programs, materials and products, participatory process of dialogue. Using where and when they are needed, and; interpersonal communication (IPC) skills • Developing methods to monitor aimed at changing behaviour, shifting community program performance and social norms & removing barriers to assure quality. behaviour change. • Social Mobilization - Mobilizing a force Growing evidence and experience from a of different groups in civil society for number of countries shows that when strategic joint action to fight stigma & eliminate ACSM approaches are applied effectively, TB as a public health threat. Not isolated and in the appropriate context, they can but collective efforts for sustainable be powerful tools for achieving protective behaviour/social change and the behaviour change. However, WHO, Stop-TB development of a more supportive partnership identifies that: attitude to patient care1. Such approaches have not been prioritized ACSM approaches have evolved to incorporate by NTPs internationally, either in terms of a comprehensive range of audience-focused strategic emphasis or in building capacity to processes in which insights from dialogue implement effective ACSM programs.” (WHO with stakeholders and research findings 2006) inform decisions about the best ways to affect behaviour change. Some of the approaches This document lays out a 5-year roadmap to include identification of problems and rectify this situation and optimize delivery populations at most risk, defining program of the TB control program services in Egypt INTRODUCTION objectives, identifying an overall strategic through ACSM approaches. approach, articulating key messages,

1 Adapted from WHO (2006) ACSM 10 Year Plan.

14 the ACSM strategy. stakeholders to explore the key elementsof andNGO with anumberofpublicsector An ACSM workshop wasalsoconducted drug sensitive anddrugresistant TB patients. workers andprogram beneficiariesincluding Discussions were withhealth conducted HealthCentre Hospital andPrimary (PHC). to TB treatment facilities includingaChest Site visitswerepartners. alsoconducted providershealth-care andprivate sector non-governmental organizations (NGOs), informants from NTP, MOHP, supporting process includedConsultations withkey assessment. The needsassessment incorporating deskresearch andaneeds the development of thisACSM strategy A situationalanalysis for wasconducted 2. SITUATIONANALYSIS main divisions: Egypt isgeographicallydividedintofour River.being theNile principal geographic feature ofthecountry total area withthe ofEgypt is1.01millionKm Libya inthewest andSudan inthesouth. The intheEast, theRedSea intheNorth, Sea international frontiers oftheMediterranean isboundedby corner the ofAfrica. It northern The ArabRepublicofEgypt islocated inthe 2.1 Country Data 1. Km2) The NileValley (approx. andDelta 33,000 Damietta and Rachid embracingthe Damietta andRachid isdividedinto two branches, the north Sea. the Mediterranean in The RiverNile south ofCairo Cairo andfrom to North fromEgypt, extending Wadi Halfato the divided into UpperEgypt andLower Valley andis to Sea theMediterranean ; which extends from the North from; whichextends theNorth 3. 2. 5. 4. in Egypt. itthehighest mountaintop thus making rises about2640meters above sealevel, granite mountains. Catherine Mount tough terrain composed ofhigh-rise oases, and El-Owainat inthe farsouth. oases, andEl-Owainat which includesFarafra, Dakhla Kharga, and BahariaOasis. The Section: Southern Great Depression, theNatroun Valley plateau andthe plain, thenorthern whichincludesthecoastal Section: borders. isdividedinto - It The Northern to theEgyptian southern in thenorth in thewest, andfrom theMediterranean Valley intheEastto theLibyan borders Km2) (approx.The Western 681,000 Desert Delta. agricultural landsofthe highly fertile The southernsection into three mainsections: istopographicallyto thewest. divided It East andtheGulfofSuezCanal Mohammed, the Gulf ofAqaba to the atRas anditsapexintheSouth North inthe its baseattheMediterranean Sinai hasatriangularshapehaving Sinai Peninsula (approx. 61,000Km2) such asgold, coal, and oil. natural resources includingvariousores level. isastore ofEgyptianThis desert that riseto about3000feet above thesea withpeaks that rangealongtheRedSea is markedwiththeEastern Mountains Sudan inthesouth. The Eastern Desert to Egypt's southern borders with North inthe ontheMediterranean Manzala Suez Canal intheEast,andfrom Lake in the West to SuezGulf, theRedSea, and Km2) (approx. 325,000 The EasternDesert ; which extends from the Nile from; whichextends theNile ; which extends from the Nile from; whichextends theNile Valley ; includes extremely ; includesextremely ; 15 INTRODUCTION Advocacy, Communication, and Social Mobilization (ACSM) Strategy 6. The Central section; comprises the area 2.1.1 Health Indicators bounded by the Mediterranean Sea to Average life expectancy of Egyptians is 71 the North. years of age. Adult literacy for males is 71%, At-Teeh plateau to the south; is a plain area and is 50% for females. The infant mortality having abundant water resources derived rate is 23 deaths per 1000 live births. from rainwater flowing from southern heights Latest figures on the TB estimated incidence to the central plateau. rate are 24 cases (all types of TB) per 100 The capital of Egypt is Cairo with an urban thousand population, with an estimated population of more than 15.5 million people. 17,200 new cases per year and 11 sputum Arabic is the formal language. English, the first positive cases per 100 thousand population, foreign language, along with French, are used or an estimated 7850 new positive cases per in business activities. Egypt ranks 16 out of year. Multi-drug resistant TB is 2.2 % of new the 20 mid-level developing countries in the cases and 38.4 % among re-treatment cases.3 Trade Development Index (TDI)2 but, with a per capita gross national income of US$1350, 2.1.2 Communications Environment it is only second to Iran in TDI, in the EMR. Egypt is one of the most pivotal nations more Egypt is divided into 29 governorates (singular popularly recognized by the media as ‘the muhafazah) and 1 self-governing city. Middle East.’ The strategic position of Egypt in Egyptian governorates are at the top tier of the this region is even more important because five-tier jurisdiction hierarchy. Governorates it is the most stable country in the region - 4 are administered by a governor (muhafez) economically, socially and culturally. As Egypt appointed by the president of Egypt. Most seemingly controls the stability in the region, governorates have a population density of the country commands a good deal of media more than one-thousand people per sq km, attention. As a result, Egypt media landscape is while the 3 largest have a population density rich and diverse, and increasingly challenged of less than two thousand per square km. by a growing generation of independent media outlets. Governorates are either fully ‘urban’ or else they are a mix of ‘urban’ and ‘rural.’ The official Electronic and Broadcast Media distinction between urban and rural is reflected There are 98 television stations in Egypt with in the lower tiers: i.e., fully urban governorates more than 8 million television sets in the have no regions (markazes), as the markaz country and over 3 million satellite users. is a conglomeration of villages. Moreover, Egyptians also own over 20 million radio sets governorates may comprise just one city, as in with 42 AM and 14 FM radio stations around the case of Cairo or Alexandria. Hence, these the country. The Egyptian Radio and Television one-city governorates are only divided into Union (ERTU) works in affiliation with the districts (i.e. urban neighbourhoods). Two new Ministry of Information to operate the eight governorates were created in 2008 - Helwan government-owned TV stations in Egypt, as and 6th October.3 well as two satellite stations, as well as 19 local and regional stations.

Egypt has also launched NileSat, the Arab world's first broadcast satellite, to carry 2 L., Reem (2008) Redrawing the Map. Al Ahram Weekly (On- Egyptian TV and radio from North Africa to line). Retrieved on: 200819-05-. the Persian Gulf.5 The launch of NileSat 101

INTRODUCTION 3 Ministry of Population and Health (2007) National Tuberculosis Control Program Egypt Strategic Plan 20072011-. satellite in April 1998, delivered more than 4 BBC News (2008) Egypt Report. Available from http://news. 100 digital TV channels as well as radio and bbc.co.uk. 5 The Central Intelligence Agency (CIA) (2002) World Factbook multimedia services to more than five million 2001. Directorate of Intelligence, http://www.cia.gov.

16 the region. increased coverage across ofmediaservices was alsolaunchedcalledDream ensuring TV satellitea second privately-owned network clothing attire and social customs. 2001 In movement, in whichhasseenrapidshifts region especiallyinterms ofthewomen’s ishelpingstimulate changeinthe NileSat turbo internet suchasdatatransmission, additional services than 150digital channelsandprovides TV systemNileSat now broadcasts to more 102,waslaunchedin2000,andthe NileSat Morocco to thePersian Gulf. Asecond satellite, Africa fromhomes across thewholeofNorth Verver,S.,(2002)EvaluationofAntiTuberculosis Campaign 9 CommitteetoProtectJournalists(2001) MiddleEastandNorth 8 Euromonitor(2007)EgyptMobile PhoneMarket.Sourcedon: 7 6 NileSat (2008)Availablefrom:http://space.skyrocket.de/ media isgovernment owned through theState of thempublishedoff-shore.Most of Egypt print mediasources in Egypt today withmost There are currently over 200independent Print Media affairs issuesonline. now ableto viewarangeofnews andcurrent for approximately 300thousandusers whoare providerswith more than50Internet service in providing access Internet to thepopulation, Egypt hasalsomaderelatively goodprogress Internet rapidly ensure themobilephoneaccess expands government deregulationfurther aheadwill low inregional terms, of buttheprospect However, penetrationrates are stillrelatively million, orapenetrationrate ofnearly28%. By March 2007thisfigure had risen to 20.3 people representing apenetrationrate of25%. rose by 34%in20056-to reach 18.2million The numberofmobilephoneusersinEgypt Mobile Phones (Egypt). ReporttabledtoGovernment, KNCV-Netherlands. org/attacks01/mideast01/Egypt.html. Africa CountryReport:Egypt.Available fromhttp://www.cpj. Egypts_ mobile_phone_market http://www.euromonitor.com/More_growth_in_store_for_ nilesat-101.htm index_frame.htm?http://www.skyrocket.de/space/doc_sdat/ incoming years. and multicastingapplications 7

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current trends injournalism. Egyptian andArabicjournalistslearnmore helps International Journalists'Network, now established, who, according to the with theAlAhramRegional Press Institute the largest Arabicnewspaper intheworld Al-Akhbar, Al-Ahramis andAl-Gumhuriya. major dailyEgyptian newspapers: Al-Ahram, owning acontrolling interest inthethree Ahram Hebdo, withtheEgyptian government al-Adab, Sa'a, Al-Ahali,al-ArabitandAl- Akher oftheseinclude:Akhbar within Egypt. Some newspapers andperiodicals are 18primary bus terminals around thecountry. posters located inshoppingmalls, trainand There are alsoawidenumberofsmall-sheet technologies.with thelatest photo-printing removable,and supersites carrying vinyl skins with many sophisticated billboard hoardings Egypt alsohasavibrantoutdoor mediamarket Outdoor Media are other TB patientsdespite thelarge network communities identifiedfrom patient interviews sourcesMain of TB information inthe and marginalized groups. population andespeciallywithvulnerable care, yet to beestablishedwiththegeneral on knowledge TB symptoms, treatment and line fieldstaffis low, with comprehensive withpopulationsegments and front-priority awareness of TB may beadequate, itshealth Although stakeholderfeedback indicates that carried intervention in2002toconducted ofan measure theimpact (operational research) surveys quantitative KAP to conducted datebaseline surveys andthelast inEgypt issporadicwithnonationalKAP KAP strategy. However, baselineinformation on TB the implementationofany effective ACSM treatment andcare are for pre-requisites toward (KAP) and practices TB prevention, determinants ofknowledge, attitudes Formative research onthebehavioural 2.2 Knowledge Attitudes and Information Practices Service ofEgypt. Service out inEgypt 8 Overall there Overall 9 . 17 INTRODUCTION Advocacy, Communication, and Social Mobilization (ACSM) Strategy of Lady Health Workers (LHWs) accounting for effort (LOE) on TB during intensive one LHW for each 10 thousand population, programming is reasonable, with the as well as Health Education Officers (HEOs) other 30% of time spent on continuous involved in TB awareness activities. The lack programming. of comprehensive data on TB KAP, through • Media programming should be a major population health approaches, will continue activity with the development of a ‘media to hinder the development of strategic, umbrella’ to support community based evidence based ACSM programs. programming. • The Campaign will be from 46- weeks It is gratifying to note that the NTP has commencing in late January, building- identified this gap in evidence on KAP and up to World TB Day (depending on moved forward with the development of advice from media planners and budget instruments and research methodology for availability). a national KAP survey. The methodology • The 24th of March (World TB Day) should incorporates a multi-stage, random sample be the end of the campaign. Partners of the population in both urban and rural should agree to launch activities at areas in a number of governorates across the commencement of the intensive the country. The survey report, which was programming period - at national and conducted during august 2008 and analyzed governorate levels - as well as conducting during September, will be available to all a number of other public relations (PR) stakeholders before the end of the year to events (earned media as opposed to paid provide essential program intelligence for media), during the campaign period. planning evidence based ACSM programs in Program Integration Recommendations - future years of activity. • We need to develop a planning ‘Organogram’ to include the NTP with a 2.3 ACSM Needs Assessment national coordinator from each program Findings sector as well as a peripheral coordinator from each program sector. The following recommendations were • A central coordinating committee as well provided by stakeholders at the ACSM Strategy as peripheral coordinating committee Planning Workshop held in August 2008. should be established from each sector Program Strategic Approach with appropriate job descriptions. Recommendations - • The campaign should be divided • It is better to have a concentrated into phases – Possibly three phases campaign of up to 46- weeks than a - pre-campaign – capacity building, continuous campaign. preparation of materials, campaign intervention – implementation, and post • This can be achieved by creating campaign – monitoring and evaluation. partnerships with each sector partner to provide feedback to a Central • The Pre campaign phase will include Committee on their actual activities for a technical committee for developing the concentrated 2 month programming materials and programs consisting of period. one person from each sector to define essential materials and the capability • It was also recommended that a plan of of each sector to define their programs, continuous programming leading-up to materials, and pre-test methods. and following an intensive programming

INTRODUCTION period as a number of agencies do Monitoring and Evaluation programming for a range of health Recommendations - issues. • A KAP survey is to be conducted after • Programming of up to 70% level of every campaign, in line with the existing

18 Program Side 2.4.2 Challenges 2.4.1 Strengths address theissuesidentified. recommendations madeinlatter chapters to withspecific challenges andopportunities, consideration thefollowing strengths, The Egypt ACSM strategy takesinto 2.4 Program Strengths, Challenges • • • • • • • • • • Some NTP public sector services are services NTPpublicsector Some Program inrelation isalow healthpriority Abroad motivated workforce offront- Strong commitment andleadershipby Systems inplace andstructures for for Asub-Committee M&Eshouldbe Amonitoring feedback mechanismon ofa Recallofmediaspotsshouldbepart Process indicators shouldbeincluded A diffracted approach Adiffracted to ACSM activities survey currently beingconducted.survey methodandlinkedto thebaseline KAP generation. demand problems withfurther heavily utilized whichcould create field force. to otherhealthprioritieswithfront-line engaged more fullyinACSM activities. volunteersand community whocould be line field workers –LHWs, HEOs, NGOs experienced by theNTP. to address thechallengescurrently program managementatNationallevel continued gainsinmeetingtargets. established to ensure bestpractice. according to needs. meetings, or viaquarterly all partners shouldbeprovidedall activities from separate survey. etc.and otheractivities This canbedonefollowing theseminars numberofseminarsetc – participants in evaluationssuchas-numberof rather thanastrategic approach reduces and Opportunities and Opportunities Beneficiary Side Beneficiary ACSM Provider Side 2.4.3 Opportunities • • • • • • • • • • • • • Identify leadorganisations withcore Littleornoinvolvement in TB ACSM Lackofawareness, andsocial knowledge to improve LackofIECmaterials delivery Collaboration in withtheprivate sector Generallackofhigh ACSM technical Limited consideration ofbehavioural Engage NTP partners andbeneficiaries EngageNTPpartners Develop strategic aparticipatory, Continuedin particularly stigma TB Relatively littlecured patientinvolvement Refugeesandinternally displaced people Patient preference for private sector other potential TB control advocates. among "Omda" leaders, /community and population. mobilisation for TB generally inthe andeducationactivities. advocacy ACSM hasnotbeenestablished. programming. andhumanresourcescapacity for determinants ofbehaviour change. perceptions orotherbiopsychosocial – awareness, knowledge, attitudesand determinants whendeveloping programs integrated program roll-out. by involving themmore fully inan program outcomes. oftheACSMimpact component onNTP planning process to increase thepotential treatment adherence. behaviour and to earlyhealthseeking delays andotherpsychosocial barriers andgendercausingtreatment ethnicity groups marginalized through poverty, in andDOTTB advocacy provision. harder andtreat. to detect (IDPs) have higherrates of TB andare factors. asaresult ofvariousunderlying services program participation andimpact. program participation of ACSM programming excellence. competencies inACSM to establish centres 19 INTRODUCTION Advocacy, Communication, and Social Mobilization (ACSM) Strategy • Establish a contracting protocol within • Refine the M&E framework - to measure government or through NGO sub- KAP performance indicators for program recipient that allows for facilitated impact. contracting and partnerships with the • Establish partnerships with HIV/AIDS private sector agencies. program for ACSM to build NTP technical • Develop innovative and creative ACSM capacity. approaches. • Add value to ACSM program through greater involvement from the private sector. INTRODUCTION

20 behavioural impact.” thereby achievingsustainableandmeasurable forto mobilize support TB control inEgypt multi-level, evidence basedACSM program “To integrated, establishaparticipatory, ACSM Strategy 2009- Goal 3.1 3. ACSMSTRATEGICFRAMEWORK over 5year term thenext oftheproject. The the changing prioritiesoftheACSM program GFATM funding rounds. This willaccount for Phased Campaigns inaccordance with TB Strategy campaign approach through be developed inlinewith thenational Furthermore, theACSM Strategy should 3.3 Campaign Phases implemented. to beobtrusive, are effectively plannedand of ACSM approaches, whichare designed multi-level, campaign, utilizingabroad range be optimized whenaconcentrated, intensive, cause. can These terms suggestthatimpact an endorengageinacrusadefor acertain continuously, vigorously, orobtrusively to gain a Campaign oneself isseenas;exerting Within oftheACSM thecontext Strategy achieve specific, long-term goals. accordingenacted to strategic principles, will procedures well-defined which, if articulates the term science originates it from military ofawar.planning andconduct Although command andthe dealing withmilitary science orthebranchofmilitary of action defined as;anelaborate andsystematic plan utilised inthefollowing chapters. Strategy is A numberofACSM terms andapproaches are 3.2 Strategy Terminology 2014 Two Campaign, andsoon. campaign (20102011-)identifiedasthe Phase Phase OneCampaign, withthesecond year the ACSM strategy willbeidentifiedasthe ACSM planfor thefirst year (20092010-)of 24th March. Strategy inthelead-upto World TB Day on programming periodfor eachPhaseofthe recommendations are for a46-week intensive to theneedsofprogram. Stakeholder ACSM campaigns implemented according ofadditionalstrategicwith thepossibility ACSM campaign perannum, willbeconducted isanticipated thatatleastoneintensiveIt To ensure scaling-upoftheprogram asa 3.5 ACSM of Development marginalized populationgroups. requirements targeting mostvulnerableand program aswell ascomply with WHO policy to address theoverarching ofthe objectives Two Streams ofACSM are proposed activities 3.4 Streams ofACSM Activity • •

Stream 2ACSM Activities detection. currently notachievingtheircase refugees andpopulationsinGovernorates population –squatters, slum dwellers, focusinginterventions onvulnerable Stream 1ACSM Activities communities. mobilisation for TB to theirconstituent andsocial ofadvocacy the delivery leaders andkeyinfluencers facilitateto males andfemales includingopinion general populationsegments of Program Core Competencies – Targeting – Targeted 21 ACSM STRATEGIC FRAMEWORK Advocacy, Communication, and Social Mobilization (ACSM) Strategy result of limited resources, networks need to ACSM programming and further building on be expanded and private public partnerships the ACSM capacity through the provision of encouraged for the ACSM component, in line consistent, specialised, technical assistance with the expansion of public - private mix (TA) with these agencies. The four Core (PPM) in the clinical component. This can Competency Areas identified for the ACSM be achieved by identifying private/public strategy are identified as follows: agencies with competencies in core areas of

CORE COMPETENCY AREAS FOR ACSM PROGRAM DEVELOPMENT

CORE COMPETENCY AREAS

Media Materials Capacity Building and Community Advocacy Monitoring Evaluation Production and Technical Assistance and Events and Research Distribution 123 4

3.6 ACSM Strategy Management In line with stakeholder recommendations A critical component to the successful it is recommended that an ACSM Technical implementation of the ACSM strategy, in line sub-Committee be established to manage with ACSM competencies, is management the program roll-out. The sub-Committee through a coordinated, multisectoral should be comprised of ACSM stakeholders response. This takes into account the multiple within NTP and NGO partner specialists in the risk factors and risk settings that contribute core competency areas. The sub-Committee to TB prevalence and the need for effective should refer to NTP management and the integration of TB ACSM activities across a wide country coordinating mechanism (CCM). range of settings A sectoral approach also The ACSM Technical sub-Committee will be provides due recognition of the increased primarily responsible for coordinating the ability to affect change by working across range of policy and implementation aspects a range of sectors and communities in a of the program. This will ensure integration partnership against TB. and capacity building opportunities for all program partners. The technical programming Partnerships should be extended to include areas required for the functional aspects of other government ministries and the private program administration are identified in the sector including advertising, market research Skills Organogram as follows. agencies, and media proprietors, as well as coalitions of patients and other program beneficiaries. Building alliances with these sectors will also facilitate the development of guidelines, policies and ACSM programs to create community environments that are more conducive to social change in the intermediate term. ACSM STRATEGIC FRAMEWORK

22 • Coalition Building. • Media Community Advocacy for Political • Advocacy andEvents. Commitment. ACSM TECHNICALSUB-COMMITTEESKILLSORGANOGRAM. ADVOCACY Capacity Building,Capacity Training & Institutional Strengthening Institutional oeCmeece o ACSM Programming Core Competencies for ACSM TechnicalSub-Committee • • Mass Media -Production Media Mass • and Distribution. Population Approaches. – Patient andGeneral. Communication (IPC) Interpersonal COMMUNICATION Monitoring andEvaluation Advocacy for Political • • Media • Media Community • Coalition Building. SOCIAL MOBILISATION Commitment. Advocacy andEvents. 23 ACSM STRATEGIC FRAMEWORK Advocacy, Communication, and Social Mobilization (ACSM) Strategy

ACSM PlanningCycle provides astaged the ACSM program evolution. The Strategic stageof with stakeholderfeedback atevery approach isrequiredcoordinated, participatory ACSM strategy atalllevels throughout Egypt, a development andimplementationofthe isrecognizedIt thatfor thesuccessful 4. STRATEGICACSMPLANNINGCYCLE FOUR-STAGE STRATEGIC ACSM CYCLE PLANNING Future Planning Program for Evaluating 4 Program ACSM Phase and Developing Identifying Problem 3 the Program Implementing Strategic ACSM PlanningCycle follows: agencies. Adiagrammatic illustrationofthe withimplementing and helpsto buildcapacity involvement from many different stakeholders Evaluation process withrepresentation and Planning, and Development, Implementation 1 Activities Materials & Messages, Concepts, & Pre-Testing Developing 2 25 STRATEGIC ACSM PLANNING CYCLE Advocacy, Communication, and Social Mobilization (ACSM) Strategy The ACSM Strategy operates continuously Stage 3 - Implementation within the annual 4-Stage Planning Cycle with • Disseminate IEC materials to stakeholders the following range of activities: support community ACSM activities through NTP Governorate offices, NGOs Stage 1 - Planning and other community networks. Conduct participatory stakeholder • Mobilize National, Governorate and consultations with donors, government, • District level operatives for intensive, civil society and the private sector. concentrated ACSM programming • Conduct formative research with target activities. groups and rapid assessments to identify Execute supporting multi-media risk settings for a comprehensive, • umbrella, media advocacy and integrated localized, situational analysis. range of community-based activities to • Utilise ACSM sub-Committee and facilitate clinical referrals and program Governorate ACSM staff for coordination of delivery. ACSM campaign planning, development, implementation and review. Stage 4 - Monitoring Evaluation and • Out-source services as required for Review Training, Capacity Building, Community • Develop Market Research Brief for and Media Advocacy, Media Production tendering of Qualitative (focus group) and and Dissemination, and Monitoring and Quantitative (pre and post intervention) Evaluation. research and integrate within Monitoring • Develop ACSM Planning Documents and Evaluation Framework. – Creative Communication and Market • Measure behavioural determinants Research Briefs for approval by ACSM through KAP- knowledge, attitudes and sub-Committee members and partner perceptions, behavioural intentions, agencies, and seek consensus on the way actual behaviours, maintenance of forward. behaviours and advocacy. • Produce inclusive, participatory National • Establish process indicators - inputs and and Governorate implementation work- outputs (internal measures of capacity, plans that include delegated agencies, skill, program penetration, and resource timing/phasing considerations, sub- distribution). Committee inputs, approval points and • Establish ACSM impact indicators adequate budgets. (audience-based measures of individual KAP and population-based measures Stage 2 - Development relating to, service demand, referral, • Conduct relevant training programs and treatment uptake and adherence). capacity building to ensure effective Conduct operational research to generate community based ACSM program • data for problem-solving and decision delivery. making; Develop singular communication • Advocate the successes of the program messages in line with Phase objectives • impact and elicit stakeholder feedback and creative concepts for activities and at Governorate and District levels, and materials. integrate comments into future planning • Conduct ACSM pre-testing and report cycles (Phases) of the strategy. results and recommendations to ACSM sub-Committee members and partner agencies. • Amend and produce final resources in accord with ACSM sub-Committee, recommendations. STRATEGIC ACSM PLANNING CYCLE

26 with thestrategic planare asfollows: segments identified for thisstrategy inline or genderdeterminants. The mainaudience psychologicalof geographic, socio-economic, groups whichmay bemarginalized asaresult should beonlower income population biopsychosocial thefocus factors ofactivity and treatment adherence. As TB islinkedto resistance behaviour to healthcare seeking which mitigate TB riskbehaviour patterns, more closelyatthosefactors by looking and concerns. This canbebestachieved audience segments withsimilarattributes tospeak directly theneedsofparticular ACSM messageswillonlybeeffective ifthey 5. AUDIENCESEGMENTATION social networks. It willbebeneficial social networks.to elicit It influencers who operate in community includes opinionleadersand keycommunity ofprogram ACSM part efforts, be animportant Another target group category, whichshould 5.3 InfluencingGroups Audience5.2 Secondary Segments Audience5.1 Primary Segments • • • • GeneralPopulation -females andmales ruralwomen. Pre-marriage Females inlower-socio- andMales TBpatients, theirfamiliesandcommunities areas. 1644- years ofageinurbanandrural and othermarginalized groups. prisoners injailsandcorrectional facilities migratory, mobileandstreet populations, dwellers, tribalpopulations, fishermen, economic categories including:slum of with ahistory TB prevalence. Key Influencers Key Influencers could include: by appropriateinitiatives supported resources. through multisectoral, coordinated, advocacy of theACSM program rollout community from theseinfluential groupssupport aspart • • • • • • • • Head Teachers, Healthandother School Health professionals includingPublic Sporting Heroes, Musicians, Sporting andother Successfully treated former TB Patients Traditional Leaders/Healers/Quacks; Religious Leaders; Omda/Village Heads; andGovernorate Public Senior Servants, colleges and universities; schools,Academic staffatsecondary Doctors; LHWs andHEOs, Pharmacists, Nursesand and Private Practitioners, Healthworkers, Role Models. and theirFamilies; level administrators;and District 27 Advocacy, Communication, and Social Mobilization (ACSM) Strategy

ACSM component. The following are objectives proposed for the 6. ACSMSTRATEGYOBJECTIVES treatment includingthefollowing: services, to audience demandfor TB screening and proposed for allACSM phases, to respond A numberofaudience are basedobjectives Objectives 6.2 Audience-Based Control 20092011-, to: program, inlinewiththeStrategic Planfor TB The overarching for objectives thethree year 6.1 TB ACSM Strategy Objectives • • • • • Change attitudesandperceptions Eliminate TB asapublichealthproblem Reachtheinterim target ofhalving TB Reachandthereafter sustaintheglobal Increase awareness –ever having adherence. of treatment, and treatment efficacy private), duration oftreatment, cost location ofDOT providers (publicand behaviour,need for earlyhealthseeking transmission andmeansofprevention, – signs andsymptoms of TB -modesof heard of TB –andcorrect knowledge and efficacy. behaviour,seeking treatment adherence perceptionsefficacy toward earlyhealth patients, personalriskperceptions, self- – stigmatizing attitudes toward TB by 2050. Goals setby 2015. Development achieving theMillennium death andprevalence by 2010toward all Governorates. success among TB cases underDOTS in andoverdetection 85%treatment targets ofachievingatleast70%case proactively needs. to program beneficiary operating onthesupplysiderespond systems andagencies delivery health service The following willensure objectives that Objectives Delivery 6.3 Service • • • • • • Ices bhvor hne and change behaviour Increase Increase behavioural Increase intentions -toward Support and scale-up andscale-up TB ACSM Support programs Increase publicand mediaadvocacy Increase ACSM ofother capacity IncreaseACSM ofclinicalservice capacity patient support. behaviour, treatment adherence and earlyhealthseeking early detection, ACSM strategy. and integrate wherever possibleinto the being implemented by otheragencies based andotheropinionleaders. as politicians, journalists, teachers, faith- programs utilizingkey influencers such target audiences. influential groups with whointeract advocates, volunteers andother advocates, LHWs, HEOs, healthproviders, andadherence.efficacy early referrals, tracing, contact treatment treatment, appropriatehealth seeking advocate expectations, forservice early and DOTS providers to meetclient treated patientsadvocating for DOTS. cases, andincidence ofsuccessfully DrugResistant) Drug Resistant,Extremely reduced incidence of MDR/XDR (Multi- of successful treatment outcomes, of healthworker incidence casedetection, attending clinicsfor screening, incidence maintenance -incidence ofat-riskpatients 29 ACSM STRATEGY OBJECTIVES Advocacy, Communication, and Social Mobilization (ACSM) Strategy 6.4 Community Based Objectives The following objectives for delivery of the ACSM strategy through community sources are proposed as follows: • Enable key influencers - community leaders, LHWs, HEOs and other health workers, teachers and faith-based leaders to confidently answer frequently asked questions on TB. • Develop user-friendly ACSM aids to support the training of community key influencers. • Create opportunities for dialogue on TB prevention, treatment and care through resource support and advocacy initiatives - between health providers and communities, between communities and community leaders, between family members, neighbours and youth. • Strengthen partnerships with NGOs, and other civil society organisations and involve communities in planning and implementation of TB prevention, treatment and care programs. • Set the program agenda, strengthen the areas of sensitisation, social communication networks, health promotion, social marketing and community mobilization. • Utilise a range of ACSM channels and places for dialogue. • Protect the interests of the multisectoral, national TB prevention, treatment and care program by reinforcing the need for collaborative efforts at a National, Governorate, District and local levels. ACSM STRATEGY OBJECTIVES

30 the relevant background information on brief iscompleted by theclientandarticulates on messageandmaterials issues. The creative collaborating withcommunication specialists strategic planningtool foris animportant process. The Creative Communication Brief development andmaterials production toto assistwiththemessage beselected agencieswillneed Private partner sector audience needs. will bedeveloped, whichare responsive to messages,pre-tested programs andmaterials (M&E) approaches, willensure highquality, These combined monitoring andevaluation followingand practices eachcampaign Phase. TB-related awareness, knowledge, attitudes, whichwillexplore surveys quantitative KAP through thepopulation-based,be supported the messagedevelopment process. This can to beinstitutionalized to adequately inform qualitative andquantitative techniques needs research via andmessagepre-testing An evidence basedprocess offormative order to achieve thedesired result. engaging way, andsustainedover timein uniformly applied, delivered pervasive, inan for eachcampaign must be single-minded, follow through Messages onthecallto action. differentlythe audience to thinkoract and to a singlekeymessagepointthatwillmotivate change. The principalchallengeisto identify onbehaviourgender determinants impacting and the cultural, spiritual, socio-economic developed audience research andreflect strategy. mustbebasedonwell- Messages will beakeyto thesuccess ofthisACSM to cut-through thecommunication clutter The process ofdeveloping effective messages 7. MESSAGEDEVELOPMENT 7.1.1 Messagestoreduce Stigma follow. to beconsidered for theACSM Campaigns possible. potential messagethemes Some to seekscreening andtreatment assoon reducing stigma andbuildingconfidence behaviour,seeking thefocus shouldbeon promote through earlycasedetection health marginalized populationsandtheneedto the focus ontargeted with interventions onsignificant impact TBprevalence. Given of TB andtreatment efficacy, can have a promote understandingof the symptoms The literature shows that TB messagesto 7.1 Potential Message Themes within the timing of the intervention. within thetimingofintervention. addressing thestagesofbehaviour change on themessagesbeingdelivered, aswell as benefits as to why theaudience shouldact brief shouldstate themainmessagesandkey importantly, thecreative communication in thecommunication environment. Most andchallenges audience, andopportunities audience, potential channelsfor reaching the ACSM strategy, aboutthe whatwe know the healthproblem, ofthe theobjectives • • Creating Positive Appeals –to stimulate Building -to improveTB BrandEquity and subsequent reduction indebilitation and subsequentreduction graphically display treatment efficacy interest, buildpersonal riskperceptions, user groups.benefits to healthservices of arangetangible andintangible in riskcommunities through thecreation andtreatmentcase detection incentives community, inorder to ensure adequate perceptions of TB generallyinthe 31 MESSAGE DEVELOPMENT Advocacy, Communication, and Social Mobilization (ACSM) Strategy thereby, reducing general community If you have a cough for more than 3 stigma and increasing community • weeks go to your local health centre. dialogue on TB. • A simple sputum test will identify if you have TB. Costly X-Rays are not required to 7.1.2 Messages to encourage early detect TB. Health Seeking Behaviour and Treatment Adherence • If you do have TB you will need to take treatment through oral medicine for a 6 • Promoting the benefits of early health month period. seeking behaviour - following cough for • The TB treatment is available free of more than 3 weeks, as well as treatment charge at all Public Health Centres efficacy – free treatment and successful whereas private sector providers you cure if help is sought early. may need to pay for the medicines. • Promoting the Improved Service Delivery • The quality of the free medicines is as Network - through public private good as or better than those provided providers and non-traditional service through the private sector. providers in difficult to reach areas. • A DOT provider within your community • Providing Complementary Messaging can assist you to make sure the medicine – linking early detection, screening and is taken every day. treatment to reduction in debilitation If you do not stick to the treatment for of patient, infection of other family and • the full period, your body can build up community members. resistance to the medicine, making it Specific TB Messages more difficult for you to be cured. • TB is a significant problem in Egypt. • Early detection, screening and treatment can prevent long term disability or death A complete cure from TB is available if • from TB, as well as prevent spreading the you seek help early. infection to other family and community members. MESSAGE DEVELOPMENT

32 as part ofthestrategy roll-out. as part are Activities Mobilisation anticipatedSocial A numberofAdvocacy Communication and 8. ILLUSTRATIVEACTIVITIES not contributed significantly the to ACSM whohave currently partners private sector from NGOtechnical specialists, aswell as the program canbeelicited withsupport building capacity direction, and settingpolicy As NTPislargely involved withcoordination the program. staff to ensure of thelong term sustainability committed to professional development of than 1%ofACSM program fundsshouldbe of thestrategy. Acommitment ofnoless overinstitutional capacity theduration trained inACSM processes inorder to build ensure are thatprogram properly partners programs to technical assistance function resources willberequired the to support strategy atanumberoflevels. Financial develop, implementandevaluate theACSM and training isrequired to properly plan, of behaviour change. Technical assistance requirements ofACSM andtheprinciples a greater understandingoftechnical toof anumberprogram achieve partners There isaneedto strengthen thecapacity Building 8.1.1 Capacity recommended. strategy, thefollowing ACSM are activities achieve theseendsinthe5year term ofthis delivery.In with efficientservice order to approaches, inconjunction dialogue-based centered oncommunity, interpersonal, The focus shouldbe ofACSM activity 8.1 Community Level Activities Building ACSM Capacity Activities to support impact. impact. program fundsto achieve greater program assist NTPintheefficientdisbursementof building andinstitutionalstrengthening will BCC andotherACSM approaches. Capacity andunderstandingofsocialmarketing, skills ACSM program implementation,andto build to support and otherpotential partners withthese buildcapacity in order to further shouldalso beengaged and research partners strategy. ACSM communication private sector • • • • • As well atNational building capacity Provision ofanACSM trainingresource Provide additionalspecialized TA theestablishmentofan Support Capacity buildinginsomecaseswill Capacity software and audio-visual equipment. andaudio-visual software human resources, computing hardware/ andequipmentincluding infrastructure need to includeestablishmentof levels. atGovernorate andDistrict partners process andNGO withpublicsector levels, building expandthe capacity XDR caseload. to managetheincreasingcapacity MDR/ to buildNTPandotherstakeholder processes. throughcapacity strategic planning buildACSM stakeholders to further NTPandotherprogram to support providers.clinical service ACSM researchsector partners, and organisations,other civilsociety private includingNTPstaff,partners NGOsand publicand private sector multisectoral ACSM comprised of Sub-Committee 33 ILLUSTRATIVE ACTIVITIES Advocacy, Communication, and Social Mobilization (ACSM) Strategy 8.1.2 Training ACSM Activities to support Training Egypt has an extensive human resource • Develop effective training manuals for network of lady health workers and HEOs ACSM training of field-staff, incorporating and community volunteers located around key TB prevention, care and support the country. However this workforce is often messages. provided with too little training in TB ACSM, in • Conduct media training workshops at relation to other health program priorities, and Governorate level (prior to and during few refresher trainings. This reduced this field intensive programming periods. staff potential involvement in TB activities. • Identify ACSM training needs within NGOs, Although training is sometimes maligned as and provide training support to ensure a process of never-ending workshops with coordinated, integrated, Governorate and few meaningful outcomes, training can be a National ACSM priorities and planning useful tool to instill understanding of ACSM approaches - problem identification, audience segmentation, behavioural processes in, what has been to date, a clinical objectives, achievable interventions and focus to the program. performance monitoring. Training activities to support the ACSM strategy • Review existing training programs and development, implementation and evaluation training capacity and conduct training process, can build institutional capacity and of trainers (ToT) to leverage program a degree of sustainability with stakeholders activities. involved in case detection and health promotion. Continuous feedback and ongoing technical 8.1.3 Peer Education support will be required to enable the process of skills development and the effective utilization Lessons learned from peer education programs of skills which focus on IPC approaches. Another have shown that the approach can reduce aspect of the training could incorporate specific stigma, increase understanding, ownership agreed upon activities with NGOs and other and involvement toward important health stakeholders involved in training to ensure problems. Peer-led communication activities integration and participation in all governorates ensure that messages disseminated are more level ACSM campaigns. credible, and more likely to be heard and acted upon by other peers. ACSM training’s desired outcomes could include the development of a range of local As well as cured patients, peer educators level activities, events and materials with could also include Omda, village heads, workplans and activities agreed upon by village doctors, school teachers, worksite NGO management, prior to the training. representatives, and role models who are in An aspect of the training should ensure an excellent position to discuss TB within their that learning is translated into realistic and constituencies. Peers could be trained and achievable interventions in-line with agreed given appropriate resource materials to equip upon deliverables, with monitoring and them with the information they need in order evaluation being an integral component of to act as effective advocates for the ACSM activities. Front-line field workers should be strategy. provided with a broader training platform The participatory process of dialogue within which includes building IPC skills, confidence targeted vulnerable and marginalized and leadership development. It is also communities, coupled with moderation by important to instill a greater understanding peer leaders can be a powerful behaviour of the importance of IPC with Medical Officers change tool. In order for these programs to be (MOs) and other clinical staff as a necessary

ILLUSTRATIVE ACTIVITIES successful, venues for peer led interventions component of their clinical service delivery. will need to be identified, and moderators

34 ACSM activities to support PeerACSM Education to support activities ACSM aids. withappropriate trained andsupported ACSM activities to support AdvocacyACSM to support activities stigma.community risk andprevention approaches andreduce raise to awarenessefforts community of TB process canalsobe akeyfeature inany members, neighbours andfriends. The leaders andcommunities, amongfamily and communities, between community population sectors, between healthproviders for dialoguewithbroad opportunities cancreate community members ofthearts identities, musiciansand leaders, sporting Using advocates suchaslocalleaders, religious approaches.as mediaadvocacy channelsaswell socialstructure community purposive approaches advocacy through value to theACSM process through more leaders. should These continue efforts add- to as thePresident’s wife andothercommunity by conducted roleand advocacy modelssuch already well utilized inEgypt through events, sensitizationprocessof thecommunity andintegral aspect Advocacy isanimportant 8.1. 4Advocacy • • • • Support NGO partners to identifyand NGO partners Support for peer andsupport Build capacity IdentifyNGOs, andothercivilsociety Establish groups TB patientsupport key elementofstrategic planning. programs, andintegrate asa advocacy opinion leaderswhenplanning ACSM leaders,use community role modelsand support. training formats, andresource materials education by including incentives within groups. street populations, andothervulnerable dwellers, squatters, IDPs, transientand programs inparticular, withslum peerto peer(PTP)training scale-up patients andlocalleadersto review and organisations with working TB andcured within riskareas. informed dialogueamongstakeholders. raising publicunderstanding andgenerating approaches. The ideaisto buildconsensus by populationhealth messages to support communication channelsfor delivering its manifestations andthemosteffective identify theroot causesofnon-compliance, effect behaviour to change, itis necessary education, orawareness-raising. order to In and notfor justinformation dissemination, tool thatstrivespowerful for behaviour change communication. Strategic communication isa range ofmediaandtheintegration ofstrategic population approaches istheutilisationofa An effective approach at expandingimpact to media reach ismore limited. low-income communities whereparticularly and scattered populationsinsomeareas, efficient. Onemajorchallengeisthelarge ensuring thattheinformation flow remains understandable andacceptable, aswell as information inamannerthatwillbecredible, NTPhowever,In itisachallengeto present the audiences andhealthworkers. messages, between andchannelingreactions of teaching, health sensitizing, carrying the development process. They are ameans components, aswell asindicators, to support As such,communication mediaare important effective reach broadto populationsegments. range ofmediacommunication channelsand whichhasagood changesinto asociety inject mediahastheundeniablepowerMass to 8.2 Population HealthApproaches • • Contract publicrelationsContract andmedia through advocacy the Support talk-back programs. panel discussions, reality andradio TV approaches –Community events, TV through publicandmediaadvocacy to provide support partners private sector findings andotherpointsofinterest. information includingrelevant research incorporating accurate program proactive, mediareleases, structured to regularly partners, disseminatesector identification andtrainingofmedia 35 ILLUSTRATIVE ACTIVITIES Advocacy, Communication, and Social Mobilization (ACSM) Strategy Well-conceived, professionally implemented, • Translate street theatre and other strategic communication campaigns are of approaches for television broadcast. particular need to the future success of the • Develop campaign (generic) brand and NTP. campaign specific positioning (slogan) to provide a cohesive, integrated range of 8.2.1 Television ACSM messages through national media and community based resourcing. Country data has shown that television ownership and coverage, especially in urban areas has been rapidly expanding with 8.2.2 Radio the impact and viewing of TV particularly Although radio has the widest reach among high. Television is already a well established the mass media in Egypt the greater impact medium in Egypt urban and peri-urban areas of television may have ‘cannibalized’ radio as well as many rural population groups. The listenership in some areas. However radio other aspect of television is its relatively novel stations still have broad reach and listenership appeal with low literacy groups and high with broad coverage by national as well impact due to graphic imagery with rural as commercial FM broadcasters across the population segments who have yet to become country. In more remote or low-income fully immersed in this medium. communities, radio provides comprehensive messaging opportunities to population There has been a large growth in the number segments that do not have regular access to of satellite TV channels and operators in Egypt television media. For these reasons radio is still which make programming difficult across an important medium with illiterate groups stations. However, a number of high rating who depend on oral based communication programs with different audience segments for their health information. indicate that effective media delivery can be achieved within reasonable budgets. More interesting health and social However, a greater level of technical support programming may renew interest in radio is required from experienced media planners once the initial novelty of Television has to identify effective reach and frequency waned. While the urban audiences are indicators measured through target audience shifting to television and other media, there is rating points (TARPS). still a need to strengthen radio reach to more inaccessible rural and internally displaced ACSM activities to support Television populations near border areas. • Develop strategic approach to creative message design and media placement ACSM activities to support Radio for television. • Develop synergistic messages for Radio • Provide public service announcements and Television through public service and paid media schedules featuring announcements and paid media key influencers and successfully treated schedules featuring key influencers patients. on radio, and provide radio talk- back opportunities on important TB issues. • Provide training to television journalists on advocacy approaches in support of TB • Establish linkages with existing popular prevention. radio soap opera productions for the provision of themes and storylines Conduct televised activities such as TV • to support TB messaging to set the panel discussions with advocates and ACSM program agendas and support other opinion leaders. community based IPC. Provide television current affairs and • Fund the translation of street theatre and news opportunities through PR and • ILLUSTRATIVE ACTIVITIES other approaches into radio treatments. earned media.

36 for NTP. generate more positive, purposive coverage or stigmatizing coverage of TB inorder to with journalists, to stem thetideofnegative arisethrough closely working Opportunities makersandtheeducated elite.being policy with themedium’s audience segments primary editorial policies are appreciated by readers, independent dailynewspaper’s more open The widenumberofgovernment and readership farexceeding often circulation. mediumfor with area, printisanimportant does thereading culture, themore remote the newspapers inruralareas rapidly, drops-off as of thepublic. Althoughaccess to daily read by opinionleadersandothermembers whichare widely newspapers inthecountry activities. There are abroad numberofArabic stories generated through mediaadvocacy informational approaches andtopical news through opportunities copy,’‘long News-print mediacanprovide ACSM 8.2.3 Newspapers Outdoor mediacanprovide ACSM campaign 8.2.4 Outdoor Media PrintACSM Media to support activities • • • • Support NGOsthrough building capacity Support Develop synergistic messagesfor paid thefocus ofNationaland Support Provide trainingto radiojournalistson vulnerable populations. TB andotherhealthstories focusing on and involvement in print journalismfor and trainingto develop greater interest leaders. coverage ofkeymessagesto opinion print, radioandmediato expand TV channels.structure behaviour withinsocial advocacy and culturalleaders, to influence TB health workers, headteachers, religious political leadersandkeyinfluencers – Governorate news-print mediaACSM to prevention treatment andcare. of approachesadvocacy insupport TB in theform ofpublications, other printbased decisions. Community-based ACSM materials confidenceto makeeffective health andskills groups in whoare fatalistic, often andlacking attitudes andperceptions ofvulnerable andchange is theneedto buildknowledge A criticalfeature ofany TB prevention efforts Development andDelivery 8.2.5 Community Materials Media OutdoorACSM to support activities placed inside ofthevehicles. ‘captive audiences’ through TB messages signage to providetransport reminders to wall branding, as well asbusesandpublic dissemination through strategically placed meansofmessage a potentially important outdoor mediashouldbefullyexplored as of anumbervulnerablepopulationgroups, isacharacteristic thatmobility Given thefact on roadside barrierwalls, andvehicle stickers. media through stand-alonesignage, painted somewhat limited experience withoutdoor slums andvulnerablecommunities. There is to billboards inhigherriskareas suchas for targetedof opportunities approaches should bestrategic. There are anumber media canbecostly to purchase soitsusage both urbanandruralareas. However, outdoor is accessible to large numbersofpeoplein andlongevity, memorability impact, and Develop anM&Eprogram to also • • • Develop high-quality billboard messages Work to identify withNGOpartners scaling upofactivities. recommendations for possiblefuture evaluate theoutdoor strategy andmake media activities. which synergise withothercampaign at thesites. to hoardings erect anagency and contract public health,socialmarketingactivities, to beusedexclusively for TB andother bus-parks, hospitalsandschool-grounds) points, truck-stops, entry sites (factory potential, free, outdoor wallbranding 37 ILLUSTRATIVE ACTIVITIES Advocacy, Communication, and Social Mobilization (ACSM) Strategy materials and merchandise can assist key network. TB stakeholders could be provided influencers in supporting behaviour change with resource order forms to monitor resource within these groups and mobilizing the call dissemination and minimize stockpiling. to action. However, community materials are ACSM activities to support Community often cited by stakeholders as being in short Materials Production and Distribution supply. This includes publications to increase knowledge on key modes of TB transmission • Technical committee to rationalise and prevention, and the need for early health the existing range of stakeholder IEC seeking behaviour, treatment adherence and resources into a core standardised set of referral options. Other community materials quality assured publication materials. will need to be produced in more user friendly • Design, pre-test, develop and distribute formats to support health service providers to the core range of ACSM materials and be more aware of the range of issues related merchandise to support community to TB prevention, treatment services, and based dialogue on TB. referral options. • Seek support from private sector distributors to disseminate materials to Although there may be a poor reading culture, reduce costs and improve delivery times, especially with lower literacy groups in rural or integrate IEC materials distribution areas, more visually based messaging such as with medical resource supply to service flip charts should be scaled-up. Publications providers. should be seen as predominantly supporting advocates and other influential groups in their • Monitor the system to identify current understanding and dissemination of important and future materials demand in all health messages to their constituents through Governorates. IPC approaches. 8.2.6 Quality Assurance A key feature of any ACSM materials Quality Assurance (QA) is a process of development program is the timely and establishing policies and guidelines to ensure efficient delivery of materials, when and that programs and products developed are where they are needed. Therefore an ACSM of the highest standard. This ACSM strategy Communication Resource Information feature can utilize QA mechanisms for System (CRIS) utilising logistics similar to that processes such as the International Standards employed for TB medical supply distribution Organization (ISO) standards for World’s should be considered to minimize the current best practice, WHO standards for ACSM ad-hoc production and dissemination of quality assurance, or develop continuous these resources. A materials distribution improvement mechanisms within the strategy database could be developed incorporating to ensure that ACSM programs, products public sector distribution in non-traditional and services are effectively delivered and outlets, through pharmacies, schools, continuously improved. QA processes could hospitals, health facilities, community centers include ACSM message and materials pre- and administrative offices in urban and rural testing, prior to materials production and networks. distribution, or quality-assured service delivery The current medical logistic program could for the range of TB prevention programs and also provide valuable distribution support activities currently being considered or scaled- through existing networks at National up. and Governorate levels. A demand driven Effective monitoring and evaluation to assure approach should be encouraged following

ILLUSTRATIVE ACTIVITIES program quality is an essential component of establishment of the IEC materials distribution any ACSM strategy, which is often overlooked

38 Assurance Quality ACSM to support activities continuous improvement instilled. development isadhered to, andaculture of ensure approach thataquality to program not beengiven enoughemphasisto date to stimulating ACSM initiatives. As suchithas in thedesire to move to newandmore • • • • Incorporate QA policy guidelinesinto IncorporateQA policy Provide posters inallNTP patientcharter satisfaction customer Incorporate ACSM Increase program towards efforts best practice. development to ensure ACSM strategy all program andmaterials activities National Strategic Plan. Collegeand Medical facilitiesinlinewith to program partners. findings andreport quantitative surveys withinformative,surveys qualitative and QA inallACSM trainingactivities. providers andincorporatehealth service by focused’moreapproaches ‘customer 39 ILLUSTRATIVE ACTIVITIES Advocacy, Communication, and Social Mobilization (ACSM) Strategy

research partners. ofprogramthrough thetechnical support development which needsto beaddressed as agapincurrent ACSM planningand ACSM hasbeenidentified interventions to accurately ofspecific measure theimpact strategy already exists. However, amethod of operationalresearch for theNational A monitoring andevaluation(M&E)program 9. MONITORINGANDEVALUATION ACSM includingthefollowing: monitoring mechanismswillberequired for anticipated thatanumberofother operational As well asnationalquantitative surveys, it is component oftheprogram canbeassessed. oftheACSMof theStrategy sotheimpact phase withthenext national level surveys continue withtheinstitutionalizingofannual should survey done onthenationalKAP More importantly, thegood work already delivery.service involvement withhealth andsatisfaction increase thelevels ofcliententry, andassess the development ofanM&Eprogram to ACSM. Research could objectives explore considered for applyingfor research for sociologists, andanthropologists could be epidemiologists, demographers, statisticians, of theNTPresearch specialistsincluding technical steering committee comprised linewiththenational In TB strategy a • • Qualitative research –for formative Quantitative research –to provide more rigorous andscientific indicators beneficiaries andkeyinformants. (IDIs)withprogram interviews in-depth with likemindedgroups, orone to one, the form of focus group discussions (FGDs) testing. ofresearchThis type could take elicitation surveys, and messagepre- following process indicators: ACSM strategy M&EFramework includingthe ofthe (KPIs) shouldalsobeincludedaspart success. ArangeofKeyPerformance Indicators comprehensive for picture long-term program behavioural determinants to provide amore these program indicators withACSM outcomes, itisnow timelyto integrate referrals,case detection, andtreatment targets toset ofperformance measure Although theNTPcurrently hasarigorous 9.1 Performance Indicators 9.1.2 OutputIndicators 9.1.1 InputIndicators • • • • • • • Number ofpublicationsresources events activities, Numberofcommunity Numberoforganisations andindividuals NationalACSM established infrastructure Development ofStrategic Plans, Establishmentofstrategic private -public Establishment ofNationaland produced anddistributed. coverage oftheseactivities. and promotions andthe conducted trained in TB ACSM. - Staff, equipmentandothersupplies. Communication Briefs. ACSM, Research Market andCreative for partnerships TB ACSM. Governorate ACSM Committees. Behaviours. Perceptions, Behavioural and Intentions Awareness, Knowledge, Attitudes and determinants includingthefollowing: behavioural the changesinprimary of ACSM program success andidentify 41 MONITORING AND EVALUATION Advocacy, Communication, and Social Mobilization (ACSM) Strategy • Number of supporting community • Increase case detection rate. resources – signage, audio-visuals, merchandise and other community It should be noted that the M&E Framework is resources produced and disseminated. a continuous process which operates at every • Number of main media resources – radio, stage of the Strategic ACSM Planning Cycle. television, news print and outdoor However, post-intervention survey data media - public service announcements should be collected following completion of produced and disseminated. each campaign phase to provide campaign • Number of media advocacy events and intelligence and set strategic direction for articles generated on Radio, TV and in future ACSM phases, themes and approaches. newspapers. Specific performance indicators and measures for the surveys could include the following: Additionally, more important impact and • Campaign Prompted and unprompted outcome indicators should also be examined recall - of community based and IPC which differ from clinical outcome and approaches, Community dialogue - social impact indicators for treatment outcomes. networks, community advocates, peers, Impact indicators for ACSM could include the etc. Community Events – community following: theatre, music and dance, workshops. Community media- outdoor signage 9.1.3 Impact Indicators – billboards, wall branding, transport signage publications materials and • Awareness - Increase in general awareness merchandise - Performance measure - of TB and TB as a priority health issue. Campaign impact evaluation. • Knowledge - Increase in knowledge of • Message Assimilation - reach and TB symptoms, TB diagnosis, referral, frequency of activities and main media treatment, case detection and cure. materials, to desired target groups - • Attitudes – toward TB Stigma, attitudes Performance measure – community toward NTP and DOTS health services, feedback and media confirmation attitudes toward treatment adherence. schedule. • Perceptions - Increase in personal risk • Message Salience - Target group perceptions toward TB. Perceptions understanding, acceptance and of free quality treatment, Increase in ownership of campaign messages, response and self-efficacy perceptions - Performance measure - Campaign – the TB messages make sense and I feel impact evaluation. confident to be able to act on them. • KAP - recall of campaign call to action and • Behaviour - Increase in behavioural key messages. Changes in knowledge, intentions toward early case detection, attitudes, risk and self-efficacy early screening, patient referral, treatment perceptions, behavioural intentions, adherence, utilization of public sector and behaviours - Performance measure services and advocacy in favour of all of -Campaign impact evaluation. the above. • Social Acceptability - Stakeholder and community acceptability of campaigns 9.1.4 Outcome Indicators - Performance measure - stakeholder feedback via consultation process and Increase in TB ACSM organizational • participatory research. capacity and sustained programming. • Decrease in TB stigma and risk behaviours. 9.2 Action Research: • Decrease in TB morbidity and mortality. Every activity or event should be evaluated in order to re-plan for the next steps basing on • Decrease in health care costs. MONITORING AND EVALUATION the experience of success/failure. A tool called

42 activity, ortask. program,gain maximumbenefitfrom every to leaders, staff, anopportunity andpartners improve onweaknesses. The AARtool affords happened, andhow to sustainstrengths and for themselves whathappened, why it with similarorshared interests to discover development professionals andcolleagues standards andenables performance discussion ofanevent, thatfocuses on Review(AAR)An After-Action isaprofessional purpose. After Review"AAR" Action willbeusedfor this It provides: problems, point the AARprovides astarting forThough all issuesor notacure-all cohesion. and promotes bonding, collegiality, andgroup This shared learningimproves team proficiency together decidehow to improve performance. can identifystrengths and andweaknesses teams describing specificobservations, focusing onthedesired outcome andby a process withtheintended outcome. By Feedback compares outputof theactual successes andfailures. keystone oftheprocess oflearningfrom events, program, oractivity. The AARisthe outthe carry as muchthosewhoactually orexperienced theyare,how skilled willsee the learningitoffers. Noone, regardless of to it—are theonesbestpoisedto identify people involved closest inanactivity—those or leaderdoesnotlearninavacuum:the successes andfailures. Agoodmanager The AARisthebasisfor learningfrom our • • • • Goodbasisfor adocumentfor detailed inevaluationreports lacking Detailsoften Feedback andinsightcriticalto improved Candid insightsinto specificstrengths and year compiling theAARsatendofeach throughdescription oftheyear activities alone. performance fromweaknesses variousperspectives Agency management. Agency items are later brought to theattention of presented. Recommendations andactionable the AARsessionitself, is aformal report set upthe “meat” ofthediscussion. Following an agenda,usingthefour guidingquestionsto dedicated scribe. The meetingshouldfollow recorded withthehelpofa onflipcharts guides thereview discussion,andnotes are preparation. Afacilitatorfacilitation andreport supplies, andtimeforlogistical support, involve more detailedplanning, coordination, Formal AARs be formal orinformal. See organizers candecidewhetherthereview will focus onimproving trainingproficiency. AAR and the exchange ofideasandobservations, All AARsfollow thesamegeneralformat, involve OF AARs TYPES for learningandteam building..opportunities preventsoften candiddiscussionandstifles climate ofacritique, focusing onwhatiswrong, and comments may notbeencouraged. The observations events Other by participants. for discussionof provides littleopportunity only gives oneviewpointandfrequently critique ormore formal evaluation.Acritique remember more thantheywould from a what happenedandwhy, theycanlearnand discover actively Because AARparticipants Informal AARs for improvements to future activities. example, theteam could quickly overall group orindividual performance. For coaching tools whilereviewing as on-the-spot Team leadersmay orproject useinformal AARs format andquestionsguidethediscussion. team itself. As withaformal AAR,thestandard be identifiedbeforehand orchosen the by the discussionleaderorfacilitator caneither responsible for theactivity, and ifnecessary, an informal AARiscarriedoutby those Frequently,out, facilitation,andreporting. preparation, planning, timeto becarried program. They require adifferent level of immediately following anevent, activity, or require more resources and are on-site usuallyconducted 43 MONITORING AND EVALUATION Advocacy, Communication, and Social Mobilization (ACSM) Strategy • Evaluate performance against a desired standard or established performance objective • Identify strengths and weaknesses • Decide how to improve performance In addition, informal AARs provide instant feedback: ideas and solutions can be immediately put to use, and the team can learn from them for future or similar application. Providing direct feedback, just in time, is a key strength of the informal AAR.

The date and time of the AAR should be identified as part of the planning schedule for the event. It is imperative that the AAR be considered as an integral part of the entire planning process. The AAR process has four steps: • Step 1. Planning the AAR • Step 2. Preparing for the AAR • Step 3. Conducting the AAR • Step 4. Following up (using the AAR results) Refer to USAID technical guidance for more details about AAR process

At the following website http://pdf.usaid.gov/pdf_docs/PNADF360.pdf MONITORING AND EVALUATION

44 ensure the optimum delivery ofthestrategy.ensure theoptimumdelivery inACSMpractice program managementwill Broadinterventions. representation andbest the strategy andthepotential effectiveness of competing forces to undermine may surface mechanisms are notinplace, anumberof effective managementand If coordinating coordination ofthestrategy rollout. aspects system to managethemany technical and largely ontheestablishmentofaneffective term 20092014-willdepend oftheproject; The success oftheACSM strategy over the 10. ACSMSTRATEGYPRIORITIES Recommendations 1 Priority Key Focal Areas to beaddressed: 10.1 ACSM Year OnePriorities - and otherriskareas. Governoratesto 20%oftheworst performing – 8020/rule80%ofACSM diverted efforts • • • • • • • • • • RecruitnewNGOsand otherprogram Consider ofincentive thepossibility based Utilize authoritative reinforcement of Using IPCapproaches and arangeof Incentives for Performance Intensified Training andSupervision Targeted Interventions Strategic Approaches Engaging newpartners Support fieldwork and staffin collection Support NTP policy atstate level.NTP policy based targets. incentives focus onpopulationandOPD collection andsuccessfulcollection casedetection. returns for front-line workers for sputum partners to expandreach ofACSMpartners efforts. 20092010- -Adopt Targeted interventions Recommendations Welfare Departments. operating withinRNTCP, HealthandSocial range ofACSM andIECpersonnelcurrently organizational development to integrate the eventually, level. sub-District This willrequire canbereplicated and structure atDistrict effectively ataStateand functions level, the an effective isinplace managementstructure the long-term success oftheprogram. Once of ACSM program managementiscriticalto system The establishmentofaparticipatory 2-ACSMPriority Program Management • • • • • • Conduct quarterly meetings orasrequired quarterly Conduct Develop possiblepromotional posters targets presentation Include onmeeting through advocacy localleaders Conduct Notify Governorate ACSM or other Establish anACSM Technical sub- collection ofsputumto meettargets.collection fieldworker suchasprizes for the and otherincentives for front-line agendas for riskareas. commitmentcommunity to TB referral. groupsand community to makea National ACSM planningworkshop. relevant staff for theirattendance the to Monitoring andEvaluation. ProductionMedia andDistribution Community Advocacy andEvents, Mass Strengthening,Building andInstitutional staff with core competencies in Capacity Committee withrepresentation from cups at sub-Centre level)cups atsub-Centre ofsputum(provision of transportation coordinate program activities. and integrated to managementstructure andto establish acohesiveplanning cycle in linewiththe4stagestrategic ACSM 45 ACSM STRATEGY PRIORITIES Advocacy, Communication, and Social Mobilization (ACSM) Strategy • Complete and endorse the ACSM segmentation, behavioural objectives, Strategy 20092014- by October 2009 development of interventions, selection and conduct the first integrated ACSM of channels for delivery and performance planning workshop by November 2008. monitoring. Provide Technical Assistance for the • Conduct ACSM training of trainers (ToT) planning process. to leverage activities. • Utilize the 4 stage strategic approach for future ACSM campaign planning in the Priority 4 - IEC Materials Production and lead-up to World TB Day 2009. Logistics The complete range of TB IEC resources is in Priority 3 - Training and Supervision need of rationalization and the development A potential shortcoming of the NTP currently of a core range of TB IEC materials is warranted. is the poor capacity and for effective patient The international Patient Charter may assist education through IPC approaches as a result in clarifying patient/provider responsibilities of health worker competing priorities and to assist in creating a customer focus culture. little sustained commitment to refresher An adequate supply of IEC materials is also training. More concentrated training needs desperately required to support front-line field to be conducted with a greater component of workers in education through IPC approaches ACSM being included within clinical training and boost the profile of the NTP around the programs at all levels. The supervisory role also country. needs to be stepped up immediately in those Governorates where performance targets have Recommendations not been met. Training to build capacity with • Rationalise a core set of IEC materials for ACSM and HEO staff must also be conducted TB control. to expand the reach and effectiveness of the • Produce Patient Charter – Distribute current program. broadly and include charter principals in training activities. Recommendations • Develop effective NTP Brand and slogan • Incorporate ACSM component within to support specific campaign themes training modules for MOs, and other and apply uniformly to all IEC materials health service providers to instill a and programs. culture of ‘client focus’ enhanced service • Establish Communication Resource delivery and effective TB inter-personal Information System (CRIS) - for effective communication. and continuous IEC materials distribution. • Support field-staff LHWs and HEOs with greater ACSM training opportunities Priority 5 - Establish Monitoring, Evaluation and incentives and provide an enhanced and Research Framework component of TB ACSM within other M&E has been identified as a gap in the ACSM health priority training. program evolution which is currently being • Conduct a media training workshop at addressed and scaled-up. National level (in the lead-up to World TB Day campaign) and involve and Recommendations Governorate media representatives in • Establish technical sub-Committee for ACSM trainings. Research and liaise with market research • Identify training needs for ACSM staff partners to develop formative, evaluative, operating within NGOs, NTP, Health and impact and outcome research methods Social Welfare departments and provide and tools. training support to ensure coordinated, • Conduct a follow-up KAP survey after integrated, Governorate and District level the Phase 1 campaign to identify TB ACSM priorities and planning approaches knowledge, attitudes, practices and beliefs ACSM STRATEGY PRIORITIES - problem identification, audience (KAP) and related performance indicators.

46 11. DOCUMENTATION&DISSEMINATION through thefollowing methods: Dissemination ofourexperiences willbe disseminated to ourstakeholders. year. This Documentwillbeprinted outand the ACSM throughout thewhole activities will give usadetaileddocumentabout Compiling Reviews theAfter –Action 'AARs" new ideasorpotential resources. similar experiences, lessonstheyhave learnt, to reciprocatealso prompt partners with “reinventing thewheel”. Sharingresults may pollination” ofexperiences andprevents between countries therefore enables “cross within thedifferent regions. Sharingideas may besimilarordifferent across countries ACSM andlessons challenges, activities and provide strategic inputfor future activities. canreview experiences The NTPandpartners By documentingandsharingACSM lessons, • • • • Media Media Conferences Disks(CDs) Compact andother Written articles reports, World Wide Web’s programme web sites, community ornationallevelcommunity meetings. andpresentations at journal articles newsletters,community newspaper or ACSM updates canbeshared through 12. CONCLUSION in Egypt in years to come. social changeneededto eradicate TB andsustainable behavioral impact out willbeableto achieve measurable integrated, multi-level program roll- anticipated thatthislarger scale, more implemented, If faithfully,partners. itis involvement canbebuiltby allprogram capacity, ownership and participation, organizational from whichto buildtechnical and strategy for Egypt willprovide amodel outlinedinthis activities TB ACSM guiding principlesandillustrative ishopedthatthekeyelements, It 47 DOCUMENTATION & DISSEMINATION Advocacy, Communication, and Social Mobilization (ACSM) Strategy