Planning Social Mobilization and Communication for Dengue Fever Prevention and Control: A Step-by-Step Guide

Will Parks and Linda Lloyd, in collaboration with the World Health Organization Mediterranean Centre for Vulnerability Reduction (WMC) and the UNICEF/UNDP/WORLD BANK/WHO Special Programme for Research and Training in Tropical Diseases (TDR)

Full Text (158 pp, PDF, 3.2 Mb, via WHO/TDR site)

Forewords | Acknowledgements
Abbreviations and acronyms
List of contributors

Introduction
- The global threat of dengue fever
- The Global Strategy
- The behavioural challenges of dengue prevention and control
- The purpose of this guide
- Social mobilization, social marketing, IEC, and COMBI
- Commitment to COMBI Planning
- Contributions of social mobilization and communication to dengue prevention and control
- Organization of this guide
- What you will not get from this guide

Fifteen steps of COMBI Planning for dengue prevention and control
Step 1. Assemble a multidisciplinary planning team
Step 2. State preliminary behavioural objectives
Step 3. Plan and conduct formative research
Step 4. Invite feedback on formative research
Step 5. Analyse, prioritize, and finalize behavioural objectives
Step 6. Segment target groups
Step 7. Develop your strategy
Step 8. Pre-test behaviours, messages, and materials
Step 9. Establish a monitoring system
Step 10. Strengthen staff skills
Step 11. Set up systems to manage and share information
Step 12. Structure your programme
Step 13. Write a Strategic Implementation Plan
Step 14. Determine your budget
Step 15. Conduct a pilot test and revise your Strategic Implementation Plan

Final words of advice

The Toolbox
Tool 1. Useful books, reports, articles, and Web sites
Tool 2. Conducting formative research
Tool 3. Social mobilization and communication strengths and weaknesses checklist
Tool 4. Analytical methods for setting behavioural objectives
Tool 5. Ten ideas for achieving the optimum budget for social mobilization and communication

36 Boxes with pictures and special items

PAHO Dengue Page
WHO Dengue Page
Tropical Disease Research:
PAHO/TDR   |   WHO/TDR

WHO Abstract   |   COMBI Strategy

The Behavioural Challenges of Dengue Prevention and Control

A major obstacle to effective implementation of selective, integrated mosquito control has been the inability of ministries of public health to mobilize and coordinate the resources needed to achieve and sustain behavioural impact among populations at risk of dengue fever and dengue hemorrhagic fever (DF/DHF). Knowledge is not enough. Regrettably, an informed and educated individual is not necessarily a behaviourally responsive individual. Many programmes continue to focus only on changing people's knowledge and on raising awareness, believing that behaviour will change; when it doesn't (and it usually doesn't), the standard response is to bombard people with even more entomological and epidemiological facts, often using sophisticated advertising techniques. But more information, fancy posters, colourful T-shirts, glossy pamphlets, and stylish TV features rarely, in themselves, lead to behavioural responses if they are not behaviourally focused. In addition, behavioural change must occur gradually. Most programmes usually manage to inform and convince but often fail to provide an effective and feasible new behaviour, or to prompt people to take the necessary steps towards adopting and maintaining the new behaviour. Achieving and sustaining behavioural results is still a major challenge.

An Enabling Environment: It may be that an individual cannot change his or her behaviour unless the setting in which he or she lives or works is also changed. The task is to discover how to make this setting an "enabling" environment, one that supports, for example, new behaviours, perhaps by providing more effective legislation, better housing construction techniques, improved services, or superior policies.

The Purpose of this Guide

A social mobilization and communication approach is called for that makes a seamless connection between knowledge and behaviour, addresses the costs and values of engaging in healthy behaviours, appreciates the gradual stages of behaviour change, and creates a supportive environment.

To date, social mobilization and communication strategies for dengue prevention and control and the research that informs these strategies, have been largely the pursuit of individual social scientists, university departments, and nongovernmental organizations (NGOs) implementing studies or field trials peripheral to national programme goals. Such strategies have tended to focus at the household and community level, with less emphasis being given to broader social changes needed in such domains as urban planning, municipal services such as water supplies, industry, and government institutions.

For the first time in relation to dengue, this guide offers a comprehensive and innovative managerial insight to planning social mobilization and communication for behavioural impact. The guide is intended for programme managers and individuals, NGOs, and other agencies with interests and/or expertise in integrating biological, chemical, environmental, and communication interventions to prevent and control DF/DHF. You may be an entomologist in charge of vector-borne disease control at national level. You may be an environmental health worker responsible for pest control, water supplies, and solid waste management within an urban authority. You may be a medical officer in charge of a district health service. This guide will help you learn about and ultimately apply the basic steps involved in developing a behaviourally focused social mobilization and communication plan that can help you achieve your public health objectives. Its style and extensive use of examples make the guide straightforward, easy to read, and enjoyable. While the topic is dengue, the planning process described can be applied to any other public health problem.

Some countries have produced or are currently producing national guidelines on community participation, behaviour change communication, and social mobilization for dengue prevention and control. It was felt that this WHO guide would contribute to the development and support of these local initiatives by demonstrating a breadth of international experiences. The guide is not a recipe book but a collection of examples and ideas, of group experiences and opinions. Its components should be challenged and adapted as occasion arises.

In this guide, we introduce COMBI (Communication for Behavioural Impact). In a structured and strategic manner, COMBI will help you to plan, implement, and monitor a variety of communication actions intended to engage individuals in considering recommended healthy behaviours and to encourage the adoption and maintenance of those behaviours. COMBI consists of three programmatic phases:

1. planning
2. implementation and monitoring
3. evaluation

This guide concentrates on COMBI Planning. Although we illustrate how various projects and strategies have been implemented around the world, the exciting task of implementation is left up to you! We shall discuss evaluation but place greater emphasis on monitoring because we view social mobilization and communication as constantly evolving. There are also plenty of resources on evaluation to which you can refer (see Tool Number 1). COMBI Planning can be divided into 15 steps (see list to right).

COMBI's Five Integrated Actions

1. Public relations/advocacy/administrative mobilization: For putting the particular healthy behaviour on the business sector and administrative/programme management agenda via the mass media—news coverage, talk shows, soap operas, celebrity spokespersons, discussion programmes; meetings/discussions with various categories of government and community leadership, service providers, administrators, business managers; official memoranda; partnership meetings.
2. Community mobilization: Including use of participatory research, group meetings, partnership sessions, school activities, traditional media, music, song and dance, road shows, community drama, leaflets, posters, pamphlets, videos, home visits.
3. Sustained appropriate advertising: In M-RIP fashion—massive, repetitive, intense, persistent—via radio, television, newspapers and other available media, engaging people in reviewing the merits of the recommended behaviour vis-à-vis "cost" of carrying it out.
4. Personal selling/interpersonal communication/counselling: Involving volunteers, schoolchildren, social development workers, other field staff, at the community level, in homes and particularly at service points, with appropriate informational literature and additional incentives, and allowing for careful listening to people's concerns and addressing them.
5. Point-of-service promotion: Emphasizing easily accessible and readily available vector control measures and fever treatment and diagnosis.

Following the 15 steps of COMBI Planning will accomplish three essential managerial tasks:

• First, establishing clear behavioural objectives.
• Second, determining the strategic roles of a variety of social mobilization and communication disciplines—for example, public relations, advocacy, administrative mobilization, community mobilization, advertising, interpersonal communication, and point-of-service promotion—in achieving and sustaining these objectives.
• And third, combining these disciplines in a comprehensive plan that provides clarity, consistency, and maximum behavioural impact to your social mobilization and communication efforts.