CHS Kenya - National Communication Strategy for Community Health Services 2012 2017 by CHSKenya

Ministry of Public Health and Sanitation

National Communication Strategy for Community Health Services Suggested citation: Ministry of Public Health and Sanitation, Republic of Kenya. National Communication Strategy for Community Health Services. Nairobi, Kenya: Government of Kenya; June 2012 @2012 Government of Kenya

ENQUIRIES AND FEEDBACK: Direct all correspondence to: Division Head, Division of Community Health Services Ministry of Public Health and Sanitation P.0. B0X 30016 GPO Nairobi 00100, Kenya i

Acronyms and Abbreviations ACSM

Advocacy Communication and Social Mobilization

AIDS

Acquired Immune Deficiency Syndrome

ANC

Ante Natal Care

BCC

Behaviour Change Communication

CBO

Community Based Organization

CHC

Community Health Committee

CHEW

Community Health Extension Worker

CHS

Community Health Strategy

CHW

Community Health Worker

CORP

Community Owned Resource Person

CSO

Civil Society Organization

Community Unit

DCH

Department of Child Health

DCHS

Division of Community Health Services

DHMT

District Health Management Team

DHP

Department of Health Promotion

DOMC

Division of Malaria Control

DON

Division of Nutrition

DRH

Division of Reproductive Health

FBO

Faith Based Organization

Frequency Modulation

Family Planning

GOK

Government of Kenya

HCP

Health Care Provider

HIV

Human Immunodeficiency Virus

ICC

Interagency Coordinating Committee

IEC

Information Education Communication

IPT

Intermittent Presumptive Treatment

IRS

Insecticide Residual Spray

JICA

Japan International Cooperation Agency

KEPH

Kenya Essential Package for Health

LLIN

Long Lasting Insecticide Net

MDGs

Millennium Development Goals

MNH

Maternal and Neonatal Health

Medical Officer

MOH

Ministry of Health v

MOMS

Ministry of Medical Services

MOPHS

Ministry of Public Health and Sanitation

NACC

National AIDS Control Council

NCD

Non Communicable Disease

NGO

Non-Governmental Organization

NHSSP

National Health Sector Strategic Plan

PHMT

Provincial Health Management Team

Reproductive Health

STI

Sexually Transmitted Infection

SWOT

Strengths, Weaknesses, Opportunities and Threats

Tuberculosis

TWG

Technical Working Group

United Nations

UNICEF

United Nations Childrenâ&#x20AC;&#x2122;s Fund

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Foreword The Ministry of Public Health and Sanitation recognises and appreciates the

development of this Communication Strategy which supports its responsibility of improving the health of the citizens by narrowing the gap between service

provision and demand for services. This is with the ultimate goal of reducing ill-health by increasing the population始s knowledge of preventable health

measures and bringing quality services closer and more accessible to the beneficiaries. The Ministryfurther recognize that community based communication focusing on behaviour change, disease prevention and access to safe water and

basic care is the hub of level one health care provision. This Communication Strategy aims at scaling up provision and uptake of Community Health Services

thus strengthening the social pillar for Kenya始s Vision 2030. It also aims at promoting preventive health care as opposed to curative interventions by promoting healthy individual lifestyles. In providing a framework for action, the

Communication Strategy connects and mobilizes people around the common cause of promotion of health and prevention of diseases at community and individual levels. It aims at bringing about synergy and collaboration between individuals,

communities,

social

networks,

and

policy

makers

through

participatory activities and dialogue in order to develop an integrated and

consolidated approach to communication in Community Health Services. The Ministry of Public Health and Sanitation is confident that this Communication Strategy will enhance service provision at the community level.All partners in the

health sector and at all levels working with communities are encouraged to use this Communication Strategy as a tool for guiding communication activities in relation to provision of Community Health Services.

Mark K. Bor, CBS Permanent Secretary, Ministry of Public Health and Sanitation

vii

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Preface The Constitution of Kenya states that every person has the right to the highest attainable standard of health, which includes the right to health care services for all. Through Vision 2030, the Government of Kenya has set out to improve the

overall livelihoods of Kenyans by providing an efficient and high quality health care

system Vision 2030 aims at shifting the bias of the National Health Bill from curative to preventive care. In order to achieve this, the Ministry of Public Health

and Sanitation is implementing the Kenya Essential Package for Health (KEPH) which recognizes the community as a critical level of health service delivery.

The Community Health Strategy approach was introduced to actualizeKEPH, with

an overall goal of enhancing community access to health care in order to improve

productivity and thus reduce poverty, hunger, child and maternal deaths, as well as improve education performance across all the development goals set out under the Vision 2030. The goal of the Community Health Strategy approach is to

improve the health status of Kenyan communities through the initiation and implementation of life-cycle focused health actions at level one. The CCommunity based communication is thus thehub of level one health care provision.

Community level activities focus on effective communication aimed at behaviour change, disease prevention, and access to basic care, safe water and sanitation.

The communication at level one is meant to facilitate behaviour change of individuals and family/householdsthrough advocacy and social mobilization. It is envisaged that the implementation of thisCommunication Strategy will contribute towards the achievement of the health sectors goals and the Kenya始s Vision 2030;

while also fulfilling the Government始s responsibility to her citizens as spelt out in

the constitution. It is my hope that this communication strategy will serve as a guide to all players

in the health sector. stages of the life cycle. In effect, this shall enhance the attainment of the country始s

Dr. John O. Odondi, OGW Head, Department of Primary Health Services viii

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Acknowledgement This National Communication Strategy for Community Health Services is a result

of concerted efforts of many individuals and stakeholders.The Ministry of

Public Health and Sanitation (MOPHS) wishes to acknowledge all those who were

involved in one way or another in the development of this Strategy. We

particularly thank

the

Advocacy Communication

and

Social

(ACSM) Technical Working Group (TWG) within the Division for guiding

the

process

developing

Mobilization

overseeing

the Communication Strategy.

and

Special thanks go to Japan International Cooperation Agency (JICA) ACSM team,

United Nations Children始s Fund (UNICEF), ACSM unit of the Division of Community Health Services (DCHS) and the Department of Health Promotion (DHP), for their

day to day technical support and guidance. We wish

acknowledge

the

contributions

all

stakeholders, both

National and Regional levels, who participated in the development of the Communication Strategy. various

organizations

The stakeholders included representatives from

including MOPHS Departments

and

Divisions,

Provincial Health Management Teams (PHMTs), District Health Management

Teams (DHMTs), doctors, clinical officers, nurses, Public Health Officers (PHOs), community members, Community Health Extension Workers (CHEWs), Community

Health Workers (CHWs), development partners, Non-Governmental Organizations (NGOs), and Community Based Organizations (CBOs). Appreciation

Communication

extended

(CBCC)

to Centre

under Essence

for

Behaviour

International

for

development of this Strategy and providing consultancy services.

Change

facilitating

and the

The development of the Communication Strategy was made possible by the financial and technical support of JICA and UNICEF.

Dr. James Mwitari Head, Division of Community Health Services

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ď&#x201A;ˇ

Increasing uptake of health services by all cohorts facilitated by transfer of knowledge and skills at household and community level.

To achieve the above stated goal, five broad strategies will be employed: a) Strategy One: Advocacy to Policy Makers, Program Planners and Media b) Strategy Two: Capacity Strengthening in Management for Health Communication c) Strategy Three: Behaviour Change Communication d) Strategy Four: Mobilization and Coordination of Communication Partners and Stakeholders e) Strategy Five: CHS Knowledge Management and Documentation

The strategy will be delivered in a phased approach where the policy makers, decision makers and program planners will be sensitised to this approach first so that the CHS communication programming can reflect the recommended rights based program design. Strengthening the ACSM structures, capacity and systems at all levels will ensure successful delivery of effective CHS communications. The ACSM coordination structures will be anchored within the existing CHS and National Health System to ensure consistency, better sector coordination and linkages from the National to the Sub-County and Community level. Monitoring

and

Evaluation

will

crucial

component

this

Communication Strategy. Assessing outcomes and impact of ACSM activities for CHS approach will be crucial in objectively establishing achievements of the Strategy and tracking performance of specific strategies employed. It will be paramount to adopt evidence based approach for of communication activities. This Communication Strategy is intended for use by the Division of Community Health Services (DCHS), Government departments and divisions, partners and stakeholders in implementing ACSM at the National, County and Sub-County and Community level. xi

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Chapter 1 Introduction 1.1. Overview of Community Health Services In order to scale up the implementation of health services, MOPHS adopted the Kenya Essential Package for Health (KEPH) which recognized the community as a critical level of health service delivery. Communities are at the heart of the Ministry of Health’s Second National Health Sector Strategic Plan (NHSSP II) (Ministry of Health, 2005). The Community Health Strategy (CHS) was initiated in 2006 to fast track the establishment of Community Units (CUs) so as to bring services closer to the community, by empowering communities with health information and essential services (Ministry of Health, March 2007). The KEPH is designed as an integrated collection of cost-effective interventions that addresses common diseases, injuries and risk factors, including diagnostics and health services, to satisfy the demand for prevention and treatment of these conditions (Ministry of Health, 2006).

1.1.1.

Goal and Objectives of Community Health Strategy

According to the Community Strategy Implementation Guidelines for Managers (2007), the goal of the CHS is to improve the health status of Kenyan communities through the initiation and implementation of life-cycle focused health actions at level one by:  Providing level one services for all cohorts and socioeconomic groups, including the “differently-abled”, taking into account their needs and priorities.  Building the capacity of the Community Health Extension Workers (CHEWs) and Community Owned Resource Persons (CORPs) to provide services at level one.

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to 2 weeks of age), early childhood (2 weeks to 5 years), late childhood (6 to 12 years), youth and adolescent (13 to 24 years), adulthood (25 to 59 years), elderly (60 years and above) (Ministry of Health, March 2007). The Kenya Health Sector Strategic Plan 2012-2017 (MoPHS, 2012) has revised the cohorts from 6 to 5. Therefore the revised specific KEPHs cohorts whom this strategy focuses on are: 1. Pregnancy and the newborn (up to 28 days): The health services specific to this age-cohort across all the Policy Objectives 2. Childhood (29 days – 59 months): The health services specific to the early childhood period 3. Children and Youth (5 – 19 years): The time of life between childhood and maturity 4. Adulthood (20 – 59 years): The economically productive period of life 5. Elderly (60 years and above): The post – economically productive period of life This Communication Strategy is designed to address the communication needs of the different cohorts as well as policy and decision makers at all levels.

2. KEPH Service Package The conditions identified and included as KEPH level one services are those in which level one services can make the most significant contribution to the improvement of health and well-being of Kenyans. The table below gives a summary of the services offered at level one under the CHS approach based on the Strategic Plan 2012 – 2017. The message themes are designed to reflect key areas of intervention as well as the critical indicators

defined

the

monitoring

and

evaluation

strategy.

The

communication matrix will build further on these message themes and define specific messages for the different cohorts. 3

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Table 1: Summary of KEPH Service Package with message theme Services

Intervention (Level 1 & 2)

Immunization



Message themes for level 1

BCG, Polio, PCB10, Pentavalent, Measles, Yellow



Full course of immunization before first birthday

fever Child Health



Deworming



Exclusive breastfeeding for first 6 months



Supplementation: Vitamin A, Zinc & other



Complimentary feeding after 6 months

micronutrients



Vitamin A supplementation every 6 months for 5



Weight monitoring



Breastfeeding and complimentary feeding



Growth monitoring every month



Acute diarrheal management with ORS and Zinc



ORS and Zinc for diarrhoeal management



Physical examination of pregnant mother



Referral to facility



Tetanus vaccination



At least 4 ANC visits



Supplementation: folic, calcium



Prompt healthcare for complications of delivery



Intermittent Presumptive Treatment for Malaria (IPT)



Accept and seek IPT during pregnancy



Antenatal profiling



Have a delivery plan



Delivery plan



Plan to deliver in a health facility

Integrated Vector



Indoor Residual Spraying of malaria



Accept your house to be sprayed with IRS

Management



LLIN distribution



Sleep under an LLIN every night



Destruction of malaria breeding sites



Recognise and seek early treatment for malaria



Chemical control of household vectors (cockroaches,



Adhere to malaria treatment

Antenatal Care

years

fleas, rodents) 

Hand washing

Water and Sanitation



Pit latrine/toilet use



Hand washing with soap at 4 critical times

Hygiene



Household water treatment



Practice proper faecal disposal



Hygiene promotion



Drink safe, clean and treated water

Health education and



Education on referral of persons with NCDs

promotion on non-



Community detection and diagnosis of NCDs



Home visits for clients with NCDs



Community rehabilitation of persons with NCDs



Occupational rehabilitation amongst children and



Refer

community

members

with

mental

conditions, substance abuse

communicable diseases Rehabilitation Occupational therapy



clients

with

NCDs

and

refer

for

rehabilitation 

youth 

Visit

Visit clients needing occupational therapy and refer for rehabilitation

Occupational rehabilitation amongst persons with mental conditions



Occupational

rehabilitation

amongst

adults

with

disabilities Health Education and promotion



Basic first aid



Learn basic first aid skills



Health education on violence and injury prevention:



Prevention of violence and injury

Road Traffic accidents, Burns/Fires, Occupational



Prevention of communicable conditions

injuries/accidents, Poisoning, Falls, Sports injuries,

Drowning, Conflict/war, Female Genital mutilation,



HIV/AIDS: Use condoms correctly and consistently

Self-inflicted injuries, Interpersonal injuries, Gender

Malaria: sleep under an LLIN every night

Based violence, Child maltreatment

Go for TB screening and testing

Health education on prevention of communicable conditions; HIV, Malaria, Tuberculosis, Neglected Tropical Diseases, Diarrheal diseases, Infestations



Health education on prevention of Non



Communicable conditions; Mental illness health, Substance abuse, Diabetes Mellitus, Cardiovascular Diseases, Cancers, Oral health,

Have

regular

medical

check-ups

for

detection of diabetes, hypertension, cancer

early

Sexual education



Sensitization of the community on safe sex practices



Consistent and correct use of condoms



Targeted education methods for high risk groups



Faithfulness to one faithful partner



Abstinence and delay in sexual debut



Harmful effects of alcohol, tobacco, substance

o Adolescents, Sex workers, Uncircumcised men, Men who have Sex with Men, Intravenous Drug Users Substance abuse



Communication on harmful effects of tobacco use, effects of alcohol use and Substance abuse, effects of

abuse, prescription drugs

prescription drugs Physical activity

Nutritional services



Health education on benefits of exercise



Health education on healthy eating



Engage in regular physical exercises for at least 30 minutes



Eat a balanced nutritious meal



Nutrition education and counselling



Eat a balanced diet



Community based growth monitoring



Pregnant mothers to eat extra portions of food



Micronutrient supplementation



Management of acute malnutrition



Exclusive breast feeding up to 6 months



Health education on appropriate infant and young



Complimentary feeding after 6 months



Child spacing and timing is beneficial for mother

child feeding 

Promotion of safe food handling

Population



Information on benefits of child spacing

management



Awareness creation on the impact of population



and child

growth



Referral for family planning method

Management of population movement particularly to



Counselling and promotion of family planning

informal settlements

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3. Rights Based Approach KEPHs level one health communication is positioned as rights-based approach as enshrined in the new constitution. This strategy considers that all individuals have a right to relevant health information and services. The individual and communities include special groups like children, people with disabilities, youth, minority and marginalised groups. The communities have a right to receive healthcare services and information and the duty bearers have an obligation to fulfil these rights. The character of communication will be that of empowerment KEPH level one health communication will be positioned as rights based approach as enshrined in the constitution.

and motivation to enable community

members,

including special, groups take action.

The KEPHs level one communications is sensitive to the different county contexts and unique communication needs. It provides direction on contextualization and adaptation of national communications to fit the local contexts which include geographical and literacy levels among others. To respond

the

rights-based

programming

important

that

communication needs of the people with disability who may need sign language or braille IEC materials be catered for. The strategy will be delivered in a phased approach where policy makers, decision makers and program planners will be the first to be sensitised on the approach so that programming can be rights-based.

1.2. Background

and

Purpose

Development

the

CHS

Communication Strategy 1.2.1. Purpose of the CHS Communication Strategy Although the CHS was chosen as a tool for implementing KEPH, gaps in understanding the approach were experienced at all levels. In addition, challenges were faced

planning, implementation, 8

monitoring and

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evaluation of ACSM activities, policy commitment as well as resource allocations for CHS including ACSM. The Communication Strategy was developed to address these challenges. The

purpose

this

Strategy,

therefore,

create

common

understanding of the CHS approach among all stakeholders and partners including the Government of Kenya (GOK). The strategy also: a) Addresses communication gaps in order to encourage effective behaviour change by all target audiences. b) Facilitates the roll out of the CHS in the entire national and subnational structures. c) Provides a clear and informed road map for the ACSM planning, implementation

and

monitoring of coherent and coordinated

programming

that will support and drive CHS and the services it offers.

The Communication Strategy will provide a clear and informed roadmap for the ACSM planning, implementation and monitoring of coherent, coordinated programming that will support and drive the CHS approach and the services it offers.

The Communication Strategy is intended for use by the DCHS, Government departments and divisions, partners and stakeholders in implementing ACSM at the National, County, Sub-County and Community levels.

1.2.2. Perspectives and Methods of Developing the CHS Communication Strategy 1. Process of CHS Communication Strategy Development The process of developing the Strategy was both consultative and participatory. Stakeholders at different levels, from the community to policy makers, were engaged in the process.

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challenges to current communication strategies (including strengths and weaknesses, existing opportunities and threats and resources). The findings of the situation analysis were presented to various stakeholders at a retreat held in June 2012.

The stakeholders at this retreat included

representatives from NGOs, District Heath Management Teams (DHMTs), Provincial Health Management Teams (PHMTs), development partners and MOPHS departments and divisions. Findings from the situation analysis were used by the stakeholders to identify key issues for the CHS Communication Strategy, audience segments, strategies and activities. 2. Alignment to Policies This Communication Strategy is designed to respond to the existing policy framework whose goal is the ‘attainment of the highest possible health standards in a manner responsive to the population needs’. The policy aims to achieve this goal through supporting provision of equitable, affordable and quality health and related services at the highest attainable standards to all Kenyans. The communication interventions are designed to focus on attaining two critical obligations of the health sector: Rights based approach to health, and ensuring health contribution to the country’s development. The policy documents that informed the development of this Communication Strategy included the Constitution of Kenya (Republic of Kenya, 2010), the Vision 2030 (Government of the Republic Kenya, 2007), the Kenya National Health Policy 2012 -2030, the Kenya Health Sector Strategic Plan 2012 to 2017 (MoPHS, December 2008) and Community Health Strategy among others. This Communication Strategy has aligned the messaging and interventions to the main articles in the Constitution of Kenya -2010 that highlight the rights based approach to health. Of particular mention are the rights to special groups in article 53 -57 who include children, people with disability, youth, minority and the marginalised; and article 174 which prescribes the aspects of devolution. In the devolved management of ACSM, this Strategy 11

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envisions a National ACSM coordinating mechanism which will be tasked with providing ACSM technical assistance, capacity strengthening for counties as well as CHS advocacy. The County ACSM coordination mechanism will be tasked with ACSM implementation and contextualization of National level communications and supporting the Sub-County level communications. The Sub-County and Community levels are the critical levels of health service delivery where health promotion and education happens at the household and community levels. 3. Visualization of the CHS National Communication Strategy Policy Framework The diagram below illustrates the relation between CHS Communication Strategy and key national policies including Constitution of Kenya, Vision 2030, NHSSP III, KEPH, Community Health Strategy, Situation Analysis and Existing communication strategies. Figure 1: Visualization of CHS Communication Policy Framework

Constitution

Vision 2030

Comprehensive National Health Policy

Communication Strategy

NHSSP II & III

Existing National Communication Strategies

KEPH

CHS

Reflection

National Communication Strategy on CHS Reflection

Results of Situation Analysis on CHS implementation

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1.3. Situation Analysis: Key Findings 1.3.1. Understanding of the CHS by Different Stakeholders 1. Understanding of the CHS by various stakeholders:

Findings from the

situation analysis indicated that the understanding and implementation of the CHS approach across board was not uniform. It was observed that those directly involved with the implementation of the CHS approach at National, Provincial and District level had a better understanding of its functions, structure, guidelines, activities and policy framework compared to health providers not directly involved with CHS.. It was also established that the understanding of the CHS approach both in the MOMS and MOPHS and partners

was

limited

dissemination system. understanding

due

inadequate

and

weak

At the regional level it was established that the

CHS

representatives of the PHMTs and DHMTs depended more on individual interest and motivation.

sensitization

Whereas some individuals

interviewed clearly understood the CHS approach and their expected roles, others could not explain its goal, implementation structure and policies although they were

It was noted that health care workers at level three, four,

and

five

had

challenge

the

functions

CHS

articulating and

activities including some of the policy issues.

aware of its existence. The understanding and support of the CHS was noted to be excellent in areas where there was direct involvement of the heads of provinces and Districts. 2. Understanding of CHS approach by health care workers: It was noted that health care workers at level three, four and five had a challenge in articulating the CHS, functions, and activities including some of the policy issues. The roles of the DCHS in implementing CHS and its functions were not clear to most these health workers.

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1.3.2. Coordination and Existing Communication Strategies 1. Coordination of partners and stakeholders in implementation of communications for CHS: The Ministries of Health departments and divisions were identified as taking a leading role in the implementation of communication activities. Different focal persons at National, Provincial and District levels were tasked with the implementation of CHS activities including communication.

Partners on the other hand provided the

Ministries of Health with technical support in the implementation of CHS. It wasă&#x20AC; howeveră&#x20AC; noted that there was limited coordination and collaboration in the various communication interventions being implemented at level one. 2. Existing Communication Strategies: Although the CHS did not have a communication strategy, different partners and stakeholders were actively implementing different components of level one service. Some departments, divisions and partners have developed communication strategies targeting different audiences and health areas for different levels. All the strategies reviewed

showed

consistency

audience

segmentation

with

the

communities as primary audiences.

1.3.3. Implementation of Communication Activities for Level One and Gaps Identified 1. Uniformity of implementation of communication activities by region: Some CHS activities including communication activities were being implemented at level one in all the five regions visited. These activities, however, varied from one region to another with more communication interventions targeting cohort 1, 2 and 3. 2. Implementation of disease prevention and control activities: While all regions reported extensive implementation of communications on HIV/AIDS, STI, TB and Malaria, none was reported for first aid and emergency preparedness, treatment of injuries and trauma. 3. Implementation of family health services: Family planning, immunization, community based referral and maternal and child care were the most 14

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Challenges in the pastoral and slum communities: In addition to

challenges in disseminating health information to pastoral and slum communities, two key issues kept emerging; these are poor faecal disposal facilities and lack of water. Specifically, construction of permanent human waste disposal structures among the pastoral and nomadic communities and space requirements in the slums were reported as big challenges. These two communities

also

faced

water

challenges

hence

hindering

the

implementation of sanitation activities. 8.

Community participation: While community health days were being

reported in all regions, participation of all the community members was a challenge. 9.

Technical and human resource capacity within MOPHS to implement

communication activities for CHS: According to the various discussions, there was consensus on the inadequate technical capacity to plan, implement, monitor and evaluate communications.

It was reported that

communication experts were not being employed within the Ministry of Public Health and Sanitation.

While the Department of Health Promotion

(DHP) has health promotion experts, they have inadequate personnel to support the various communication needs of the Ministries. The Division of Community Health Services (DCHS) was identified as lacking capacity (both expertise and staffing) to implement ACSM interventions nationally. In some cases there was reported deployment of other cadres of health workers to head communication sections with basic or no communication training. 10. Working relationship between CHS focal persons and health promotion officers: It was observed that there is disjointed working relationship between the CHS focal persons and the health promotion officers at all levels with the latter being left out in the implementation of communication interventions. This was attributed to resource constraints in some cases and inadequate briefing and information sharing in others.

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11. Partners’ technical and human resources capacities to implement ACSM activities for CHS: Partners were reported to have well-structured communication

Partners were reported to have

systems with enough qualified personnel.

well-structured communication

It was reported that some of the partners

systems with enough qualified

have been providing technical and financial

personnel.

assistance to MOMS and MOPHS to cater for communication needs. 12. Resource allocation: There is insufficient resource allocation from the Government for communication interventions and programming.

In most

cases funding support was provided by the partners in implementing communication activities both at

National,

County,

Sub-County

and

Community levels.

1.4. Recommendations Based on the Findings of the Situation Analysis 

Conduct a national branded campaign to create extensive awareness of the CHS and effective dissemination of the CHS strategy and policies within Ministries of Health, among partners and stakeholder to create common understanding of the CHS.



Prioritize

communication

interventions

for

level

one

resource

allocation to ensure full and effective implementation. 

Establish a coordination mechanism at all levels to support coherence in implementation of all communication activities to address the inadequate synchronization within Ministries of Health departments, and partners on CHS implementation including communications.



Develop a comprehensive multi-faceted communication framework to guide all CHS communication activities at all levels: There exists no effective coordination framework for communication activities.

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

Support CHWs through provision of standardized and simplified messages which are contextualized to their regions: In most regions CHWs depend on communication interventions from various partners with no direct package from GOK.



Capacity strengthening in communication for the National, County and Sub-county communication teams and CHWs: Prioritization of capacity strengthening in communications planning, implementation, monitoring and evaluation is crucial to the success of communications for CHS.



Create an integrated CHS system which incorporates all health workers, within the ministries to ensure ownership by all.



There is need to have regular knowledge, attitude and practices assessments among the community to establish the actual situation before and after communication interventions: Currently there is inadequate comprehensive monitoring and evaluation plan for ACSM activities for CHS approach at all levels.

In addition, there is limited

documented evidence of effective strategies, channels or materials or best practices that can be replicated at level one. 

There is need for an all-inclusive simple package of messages targeting all cohorts: There is need to establish standardised messages and approaches

guide

the

various

players

communication

implementation in order to create harmony and consistency. Guidelines should be provided on how to customise messages to fit the needs for each region of the country.

1.5. SWOT Analysis Respondents for the situation analysis identified the following Strengths, Weaknesses, Opportunities and Threats (SWOT) that the ACSM strategy for CHS can take into account. This strategy has attempted to build on the strengths and opportunities identified in the SWOT analysis. It has further designed strategies to address some of the weaknesses and threats identified.

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Chapter 2 CHS Communication Strategy 2.1. CHS Communication Strategy Goal The goal of CHS is to improve the health status of Kenyan communities. To achieve this goal, this Communication Strategy is aimed at: 

Providing a clear and informed road map for communication planning, implementation

and

monitoring

coherent,

coordinated

programming that will support and drive the CHS and the services it offers. 

Providing

framework

for

coordination

communication

interventions for CHS and hence increasing the proportion of organizations collaborating with CHS in communication planning, implementation and monitoring and evaluation at National, County, Sub-County and Community levels. 

Increasing awareness about the CHS approach at all levels hence creating common understanding within GOK and among different partners and stakeholders.



Building commitment from GOK and partners to provide resources for CHS including communication to ensure effective implementation and attainment of goals.



Providing

capacity

strengthening

for

CHS

communication

implementers at National, County and Sub-County levels to manage the

ACSM

program

planning,

implementation,

monitoring

and

evaluation. 

Increasing uptake of health services by all cohorts facilitated by transfer of knowledge and skills at household and community levels through Advocacy, Behaviour Change and Social Mobilization.

2.2. Broad Communication Strategies To Be Employed The CHS outlines community based communication as the hub of level one health care provision.

Community level activities focus on effective

communication aimed at behaviour change, disease prevention and health promotion. 20

AFYA YETU, JUKUMU LETU

Figure 2: Socio-Ecological Model

2.4. Five Strategies of CHS Communication Strategy Based on the situation analysis, socio-ecological model and application of the three broad approaches: Advocacy, Social Mobilization and Behaviour Change, this document contains five strategies that will be employed to achieve the goals of CHS: 1. Strategy One: Advocacy to Policy Makers, Program Planners and Media Advocacy targeting policy makers, program planners and media will be planned and executed for CHS to raise political and social commitment as well as resources for service delivery to influence support or action for level one services at National, County, Sub-county and Community levels. 2. Strategy Two: Capacity Strengthening in Management for Health Communication Capacity strengthening in health communication will be conducted for ACSM focal teams at National, County, Sub-County and Community level to manage the ACSM program (planning, implementation, monitoring, and evaluation) at the different levels. 22

AFYA YET U, JUK UMU LET U

AFYA YETU, JUKUMU LETU

Chapter 3 Strategy One: Advocacy to Policy Makers, Program Planners and Media 3.1. Objectives and Target Audiences This strategy is designed to reach out to key policy makers, program planners and the media at National, County and Sub-County level. It seeks to address

four

key

issues

that

emerged from the situation analysis;

Strategy One: Policy, program

these

planners and media advocacy for

are

lack

common

CHS to raise political and social

understanding of the CHS approach,

commitment as well as resources

inadequate

for service delivery to influence

inadequate engagement in the CHS

support or action for level one

approach by key stakeholders within

service at National, County, Sub-

the Ministries of Health and partners

County and Community level.

and

lack

resources

media

for

CHS,

engagement.

Advocacy will be done at three focal points as outlined below:

1. Policy advocacy is aimed at promoting political and social commitment, mobilizing resources, and stimulating development of supportive CHS policies. It seeks to inform the relevant senior management, directors and all decision makers both within Government and among partners on the aims, strategies and activities of the level one strategy and how the CHS approach will improve service delivery and hence support in achievement of NHSSP II and NHSSP III which are in line with Kenya Vision 2030 and MDGs. 2. Program advocacy targets opinion leaders. It aims at promoting local action by explaining the role of the community and other influential people in the level one services strategy. It seeks to inform community leaders and other influential individuals about the aims, objectives, strategies and activities of the level one services strategy.

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AFYA YETU, JUKUMU LETU

3.2. Policy and Decision Makers Target Audiences Table 3 : Target Audiences for Advocacy: National, County, Sub-County levels LEVEL National Policy

AUDIENCES Primary Audience

SEGMENTS 

Heads of departments and divisions and

and Decision

staff of Ministries of Health at National

Makers

level 

Parliamentary health committee



UN Agencies, FBOs, NGOs implementing level one services



NACC

Secondary



Media

Audience



Interagency Coordinating Committees



Private sector



Professional bodies in health: Kenya Medical Association, Kenya Nurses Association

County Level

Primary Audience



Ministry of Finance



Ministry of Agriculture



Ministry of Water



Ministry of Education



County level MOPHS & MOMS, including Health Management Teams, Doctors,

Decision Makers

Nurses, Public Health Officers 

Local political leaders, FBOs, NGOs implementing level one services

Sub-County

Secondary



Media

Audience



County level gatekeepers e.g. County

Primary Audience



administration Elders, Religious leaders, Local politicians

Level and Community level Decision Makers

Community leaders: Village elders, Chiefs,

Secondary



CHEWs, CHCs, CHWs



County and National policy makers of Ministries of Health

Audience 

Level one implementing partners and stakeholders



Health care service providers



Local media

3.3. Communication Matrix for Decision Makers at Different Levels Table 4: National Level Policy and Decision Maker’s Communication Matrix Audience segments 

Heads of



Awareness and understanding

Tools and materials

Mass media

of the various components,

divisions and

activities and benefits of the

staff of MOMS

CHS



TV and Radio campaigns

Commitment by both



Press conferences and

materials (T-shirts,

briefings

caps, banners, badges,

Social media (Facebook,

stickers, desk



CHS mass media



branded campaigns

TV and radio campaign materials



CHS promotional

National level

Government and partners to

Parliamentary

provide resources and funds for

health committee

level one services including

Twitter), Emails, E-shots,

calendars, desk

UN agencies,

ACSM

PDF of print adverts

diaries, pens, flyers,

CHS

etc.)

FBOs, NGOs



implementing level one services 

Channel mix

departments and

and MOPHS at 

Desired changes

Improved dissemination and roll



heads/divisional

approach 

policies and guidelines that

surveillance,

support CHS ACSM at all levels

planning)



Outdoor media: Billboards

Formulation and enforcement of

disaster, disease 

Symposiums/Conferences

Participation, and support of MOMS and MOPHS in CHS

NACC, technical



out of CHS approach

Departmental heads (NCDs,



Understanding of level one

Interpersonal 

Meetings between

Advocacy kit with a set of IEC materials

various levels of



Media kits

Government and civil



Policy and advocacy

society organizations

communication as rights based



papers

 

Advocacy stakeholders



Sensitization

and partners forums

guidelines for training

Morning briefs &

journalists

breakfast meetings 

CHS Ambassadors



Media workshop

Activities 

Develop and execute a mass media branded campaign through multiple channels to create awareness on the CHS approach including TV/Radio spots and talk shows



Develop CHS brand and brand application guidelines



Reposition and disseminate CHS approach afresh especially in areas with major gaps in understanding within Government and among other stakeholders



Develop and disseminate an advocacy kit with different materials targeted to the National, County Sub-County and Community leaders



Conduct stakeholder, partner and private sector forums at National, County, Sub-County and Community level



Implement a branded campaign with direct communications through social media, Emails, E-shots, PDF of print adverts



Place print adverts in newspapers, industry magazines and newsletters



Conduct regular CHS national symposia/conferences as a platform for sharing best practices, lessons learnt, successes, new information etc.



Conduct media workshops for select editors and journalist to sustain CHS spotlight and accurate analytical reporting



Develop and present policy papers to top level decision makers in Government and CSOs 29



Conduct targeted meetings for health care providers and sensitization forums for the MOH staff on CHS approach, strategy, policies and their respective roles

Table 5: County Level Decision Maker’s Communication Matrix Audience segments County level MOMS

Desired changes 

Mass media

of the various components,

and MOPHS



activities and benefits of the CHS

Local political leaders,

Awareness and understanding

Channel mix



County level media engagement

approach

Tools and materials

CHS documentaries

County level media kits



CHS promotional materials (T-shirts,

Commitment by County level

caps, banners,

FBOs, NGOs

partners to provide resources

badges, stickers,

implementing level

and funds for level one services

desk calendars, desk

one services

including ACSM

diaries, pens, flyers,

Improved dissemination and roll

etc.)



out of CHS strategy and approach at County and SubCounty level 

Participation, involvement and support of MOMS and MOPHS in CHS at County and Sub-County level 30

Audience segments

Desired changes 

Improved information sharing

Channel mix Interpersonal

on CHS within Government and 

Tools and materials



Advocacy stakeholders



Advocacy kit with a

among partners

and partner forums

set of IEC materials

Understanding of level one

between various levels of

for County and Sub-

communication as rights based

Government, civil society

County levels

organizations and private



Sensitization guide

partners

for training



Technical working forums

journalists at County



Dialogue meetings with

level

key CHS players at County level 

County media workshops for journalists

Community based 

Launches, social gatherings, prize giving days, conventions



Fliers



Banners



Entertainment education (skits, music, poems, dramas, one on one presentations)

Activities 

Disseminate the advocacy kit with different materials targeted to the County leaders



Disseminate CHS and policy to County and Sub-County level



Conduct stakeholder and partner forums at County level geared at addressing CHS issues and coordination



Conduct regular County level symposiums as a platform for sharing best practices, lessons learnt, successes, new information etc.



Conduct County level media workshops for local journalist to keep CHS approach issues on the spotlight in the regions



Mobilize resources and technical assistance to support in community dialogue and health action days

Table 6: Sub-County and Community Level Decision Maker’s Communication Matrix Audience segments Community leaders:

Desired changes 



CHEWs CHCs CHWs



activities and benefits of the

Chiefs, Elders, Local politicians

Interpersonal

CHS including components,

Village elders, Religious leaders,

Good understanding of the

Channel mix

CHS

sensitization meetings

Good understanding on their

with CHEWs, CHCs,

roles and responsibilities in

CHWs

level one service delivery 

Training and

Tools and materials 

Advocacy kit with a set of IEC materials



CHS promotional materials (T-shirts, caps, banners, badges, stickers, desk calendars, desk diaries, pens, flyers, etc.)

Uniformity in dissemination and roll out of CHS approach 32

Audience segments

Desired changes 

Clear understanding of level

Channel mix

Tools and materials

Community based

one communication as rights



based

Community dialogue



community leaders

with various leaders 

Advocacy kits for

Health action days

Mass media 

Community Local



Media kit on CHS approach

Radio FM stations 

Documentaries on CHS

Activities (for Sub-County level) 

Disseminate the community leaders advocacy kit with different materials and accompanying CHS promotional materials



Conduct community leaders dialogue on CHS to enhance ownership and engagement



Advocate for local resources to support community interventions



Sensitization for CHEWs, CHCs, CHWs to build capacity on CHS in order to facilitate quality service and enhance their role in facilitating change

AFYA YETU, JUKUMU LETU

Chapter 4 Strategy Two: Capacity Strengthening in Management for Health Communication 4.1.

Objectives and Target Audience

This strategy is aimed at addressing capacity strengthening issues identified in the situation analysis both through Strategy Two: Capacity

advocacy and training. These issues

strengthening of ACSM focal

include; inadequate ACSM capacity in

teams at National, County, Sub-

planning, implementing, monitoring

County and Community level to

and evaluation at National, County,

manage the ACSM program

Sub-County and Community level, low

(planning, implementing,

priority

monitoring and evaluation) at

inadequate

the different levels.

and high staff turnover.

for

health

promotion,

promotion

staff

This section gives an analysis of target audiences, desired changes, interventions and materials needed. Table 7: Target Audiences for Health Communication Capacity Strengthening LEVEL

AUDIENCES

AUDIENCE SEGMENTS

National

Primary

National policy and decision makers

(Advocacy for

Audience

capacity



Director of MOPHS



MOPHS human resource management and development

strengthening)

National (Training )

Primary Audience



Head, department of health promotion



Development partners



Implementing partners

CHS ACSM implementing teams at National levels 

CHS ACSM unit and DHP



CHS TWG

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4.2.

Communication Matrix for Strengthening Capacities in Program Management

Table 8: Strengthening Capacities in Health Communication Program Management AUDIENCE SEGMENTS National policy and decision makers 

Director of MOPHS



MOPHS human resource management and development



Head, Department of Health Promotion



Communication development partners



Communication

DESIRED CHANGES

INTERVENTION

 Improved awareness of

 Meetings to lobby for

TOOLS 

Fact sheets

importance of ACSM in CHS

resources to strengthen



Presentations

and prioritization of health

the CHS ACSM capacity



Capacity assessment

promotion

 Meetings to advocate for

 Allocate resources to

improved human

strengthen capacity of CHS

resource needs for CHS

in communications

ACSM

 Support the CHS human resource needs to implement the communication strategy

implementing partners

findings

AUDIENCE SEGMENTS CHS ACSM implementing

DESIRED CHANGES

INTERVENTION

 Strengthened capacity in

 Communications

teams at National and County

planning, implementation,

competency based

levels

monitoring and evaluation

training



CHS ACSM Unit



CHS TWG including DHP

at the national and county

TOOLS 

based training manual 

 ACSM monitoring and

levels

training

CHS ACSM National and County level practitioners

evaluation competency

 Harmonized

CHS ACSM Competency

guide 

Communication guidelines



CHS ACSM Sub-County

communication monitoring plans for communication activities at all levels  Improved capacity to design and conduct rights based communication programming

CHS ACSM implementing teams at Sub County level

 Strengthened capacity to



Sub-County level

plan and implement

ACSM competency

interpersonal

based training with



CHEWs

communication



CHCs

interventions



CHWs

emphasis on implementation of

 Improved capacity to conduct ACSM monitoring

interpersonal

and evaluation

interventions 37

level practitioners guide

AUDIENCE SEGMENTS

DESIRED CHANGES

INTERVENTION

 Improved capacity to



TOOLS

Orientation on CHS

conduct rights based

communication

indicators

programming Activities 

Conduct ACSM capacity assessment at all DCHS levels to determine strengths and weaknesses in planning, designing, implementing, monitoring and evaluating communication programs



Design and develop an appropriate ACSM competency based training manual



Develop a tailored ACSM practitioners handbook that will guide implementation of ACSM all levels



Conduct the ACSM competency based training at all levels



Provide support supervision and technical assistance in the implementation and monitoring of ACSM at all levels

AFYA YET U, JUK UMU LET U

5.2. Communication Matrix for Behaviour Change for Each Cohort Table 10: Cohort 1: Pregnancy and the New-born (up to 28 days) Communication Matrix Audience segments Pregnant women and

Desired changes 

mothers with newborns up to 28 days

Go for at least 4 ANC visits during pregnancy



Develop a delivery/birth plan



Plan to deliver in a health facility under

Pregnant women with special needs and

Channel mix

skilled care 

Seek prompt care when you see danger

Interpersonal 

Home visit by CHWs



Health talks by HCP

dialogue

at facility

cards/guide



Mother to mother

Accept and seek IPT during pregnancy



Accept your house to be sprayed with IRS



Sleep under an LLIN every night for Recognise and seek early treatment for malaria



Community

Counselling flip chart Sign language interpreters



IEC in braille



Banners



Fliers and

Community based

malaria prevention 

 

healthcare for complications of delivery 



support groups

signs in pregnancy and prompt

disabilities

Tools and materials



Health action days



Outreach services



World health

brochures 

cost leaflets

commemoration

Adhere to malaria treatment

days

Posters and low



Vehicle stickers

Audience segments

Desired changes 

Channel mix

Hand washing with soap at 4 critical times



Practice proper faecal disposal including children’s faeces



Drink safe, clean and treated water



Take children for full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, Measles)



Practice exclusive breast feeding for the first 6 months



Delay the baby’s bath for 24 hours and place the baby skin to skin with the mother to keep warm management between 24-48 hours



Learn basic first aid skills



Prevent violence and injury



Go for TB screening and testing



Keep off from the harmful effects of alcohol, substance abuse, prescription drugs

Media 

TV and Radio



Outdoor: talking walls, Billboards



Bus & Matatu branding

Tools and materials

Audience segments

Desired changes 

Channel mix

Tools and materials

Engage in regular physical exercises for at least 30 minutes



Eat a balance nutritious meal with extra portions



Practice child spacing and timing for at least 2 years



Referral for FP method especially modern FP

Table 11: Cohort 2: Childhood (29 days to 59 months) Communication Matrix Audience segments Caregivers of

Desired changes 

children 29 days to 59 months

Channel mix

Practice exclusive breastfeeding for first Interpersonal 6 months



Complimentary feeding after 6 months and continue breastfeeding up to 24

Caregivers with special needs and

months 

disabilities

Vitamin A supplementation every 6 months for 5 years



Tools and materials

Growth monitoring every month up to 5 years 44



Home visits by CHWs



Health talks by HCP at

dialogue

facility

cards/guide



Mother to child support



Teacher to child health education



Community

Counselling flip chart

Audience segments Children 29 days to

Desired changes 

59 months

Channel mix

ORS and Zinc for diarrhoeal



management

Tools and materials

Sign language interpreters



Deworming every 6 months



Full course of immunization before first



IEC in braille

birthday (BCG, Polio, PCB 10, Pentavalent, Measles)  

Community based

Sleep under an LLIN every night to 

Health action days



Banners

prevent Malaria

Outreach services



Fliers and



Recognise and seek early treatment for 

World health

malaria within the first 24 hours

commemoration days



Adhere to malaria treatment

Media



Hand washing with soap at 4 critical



TV and Radio

times



Outdoor: Talking



Practice proper faecal disposal

walls, Billboards,

including proper disposal of children

Screen adverts

faeces



Drink safe, clean and treated water



Prevent violence and injury

Bus & Matatu branding

Brochures

Table 12: Cohort 3: Children and Youth (6 to 12 years) Communication Matrix Audience segments Children in and out

Desired changes 

of school aged 6 to 12 years

Channel mix

Sleep under an LLIN every night for malaria prevention



Children with special needs and disabilities

Recognise and seek early treatment for

children aged 6 to 12 years

Home visits by CHWs



Teacher to child support



Adhere to malaria treatment



Hand washing with soap at 4 critical



times Caregivers of

Interpersonal 

Malaria

Practice proper faecal disposal



Drink safe, clean and treated water



Full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, Measles)



Job aid for teachers



IEC materials for children

Child to child education



Tools and materials

School health clubs



Comprehensive school health programs



Sign language interpreters



Learn basic first aid skills



Prevention of violence and injury



Eat a nutritious diet everyday



Abstinence and delay in sexual debut

IEC in braille

Community based 

Outreach services



Banners



Interactive



IEC materials

community theatre

Audience segments

Desired changes 

Channel mix

Increase knowledge of HIV/AIDS

Tools and materials

Media

prevention and sexuality education



TV and Radio

Table 13: Cohort 3: Youth 13 to 20 Years Communication Matrix Audience segments

Desired changes

Channel mix

Male and female



Sleep under an LLIN every night

youth in and out of



Recognise and seek early treatment for



Peer education

malaria



School health

school Youth with special needs disabilities

Tools and materials

Interpersonal

clubs



Peer education guides



Peer



Adhere to malaria treatment



Hand washing with soap at 4 critical times

counselling in



Practice proper faecal disposal with special

schools

counselling

Sign language

guides for

interpreters

teachers



Youth Living with

attention

HIV/AIDS (YLWA)

needs/disabilities and the sick

people

with



Drink safe, clean and treated water



Practice personal hygiene including

special

menstrual management 



Guidance and



IEC in braille



Incorporation SRH/HIV in school curriculum that

Identify symptoms and signs of mental conditions and refer

responds to needs of this cohort

counselling 



Guidance and

Job aids for teachers

Audience segments

Desired changes 

Channel mix

Visit clients with NCDs and refer for



rehabilitation 

Visit clients needing occupational therapy

Community based 



Learn basic first aid skills



Prevention of violence and injury



Use condoms correctly and consistently for HIV prevention

Sports and extracurricular activities



Interactive community



Go for TB screening and testing



Abstinence and delay in sexual debut



Faithfulness to one faithful partner



Fliers and brochures



T-Shirts, caps, bangles



Branded sports

theatre

equipment

Community video centres



Puppet shows

Keep off from the harmful effects of



Road shows

alcohol, substance abuse, prescription



Community based youth friendly

drugs

centres

Engage in regular physical exercises for at least 30 minutes

Media



Eat a balanced nutritious meal



Child spacing and timing for at least 2 years



Parent –youth interactions

and refer for rehabilitation



Tools and materials



TV and Radio



Social media: Facebook, Twitter

Referral for FP method 48



TV and Radio materials



Comic books

Audience segments

Desired changes

Channel mix



Seek testing and counselling



Reduction in number of youth having



Tools and materials

Outdoor; billboards

multiple sexual partners



Local video clubs

Utilization of Reproductive Health and FP



Celebrity

services

endorsement



Delayed child bearing



Elimination of FGC and other harmful



Help lines (Calls/SMS)

cultural practices

Table 14: Cohort 4: Adulthood (20 to 59 years) Communication Matrix Audience segments Men and women

Desired changes 

Channel mix

Have regular medical check-ups for Interpersonal early

detection

diabetes, 

special needs and

Household visits by CHWs

hypertension, cancer Men and women with

Tools and materials



Accept your house to be sprayed with IRS 



Sleep under an LLIN every night



Sign language interpreters IEC in braille



Community discussion guides

Audience segments disabilities

Desired changes 

Channel mix

Recognise and seek early treatment Community based for malaria

Caregivers of sick



Adhere to malaria treatment



Hand washing with soap at 4 critical times

patients 

HIV/AIDS

Practice proper faecal disposal with special attention to people with special

People Living with

needs and disabilities and the sick 



Outreach services



Community dialogue



Health action days



Media



Women and men



Interactive



menstrual management

forums

Drink safe, clean and treated water

Media



Identify symptoms and signs of mental



TV and Radio

conditions refer



Outdoor: Billboards,



Visit clients with NCD and refer for 

Visit clients needing occupational therapy and refer for rehabilitation



Learn basic first aid skills



Prevention of violence and injury



Reduction in number of sexual partners



Counselling on Menopause and Andropause 50



Low cost easy to read leaflets



Community theatre tools

Targeted FBO/Religious

Community dialogue discussion cards

community theatre

Practice personal hygiene including

rehabilitation



groups discussions



Tools and materials



TV and Radio spots

Talking walls



Posters and Leaflets

Videos at clinics and



Videos

video joints



Wall branding

Audience segments

Desired changes

Channel mix



Go for TB screening and testing



Faithfulness to one faithful partner



Keep off from the harmful effects of alcohol, substance abuse, prescription drugs



Engage in regular physical exercises for at least 30 minutes



Eat a balanced nutritious meal



Child spacing and timing



Referral for FP method



Knowledge of HIV status and partner status



Use condoms correctly and consistently for HIV prevention



Adherence to ART treatment



Go for TB screening and treatment



Ensuring adherence to TB treatment regimens for those who are sick

Tools and materials

Table 15: Cohort 5: Elderly (60 years and above) Communication Matrix Audience segments Men and women 60

Desired changes 

years and above

Channel mix

Have regular medical check-ups for early detection of diabetes,

Interpersonal 

hypertension, cancer Men and women



Discussion guides with key

Training for Health

messages for

IRS

Workers, CHEWs,

the elderly



Sleep under an LLIN every night

CHWs on needs of



Recognise and seek early treatment for

the elderly



Accept your house to be sprayed with

malaria

People Living with HIV

Household visits by CHWs

with special needs and disabilities

Tools and materials



Adhere to Malaria treatment



Hand washing with soap at 4 critical times



Practice proper faecal disposal with special attention to mobility of elderly and people with special needs and disabilities



Drink safe, clean and treated water



Identify symptoms and signs of mental conditions and substance abuse and refer



Visit clients with NCD and refer for rehabilitation 52

Sign language interpreters



IEC in braille

Community based 

Community



Leaflets with

dialogue

key messages



Outreach services

for the elderly



Barazas



Banners



Wall branding

Audience segments

Desired changes 

Channel mix

Visit clients needing occupational

Media

therapy and refer for rehabilitation



Print: Brochures,



Go for TB screening and testing

Fliers, Posters,



Prevention of violence and injury

Newspapers



Learn basic first aid skills



Keep off from the harmful effects of alcohol, substance abuse, prescription drugs



Engage in regular physical exercises for at least 30 minutes



Eat a balanced nutritious meal



Knowledge

HIV

status

and

encouraging partner to go for VCT 

Faithfulness and correct and consistent use of condoms for HIV prevention



Adherence to ART treatment for those who are infected



Eating a nutritious and balanced diet

Tools and materials



TV and Radio



Mobile cinema



Print and Radio materials

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5.3. Behaviour Change Communication Activities for KEPH Level One 

Conduct a rapid mapping of partners implementing level one communication interventions at National, County, Sub-County and Community level



Establish/strengthen the ACSM technical Sub-committee (or existing platform) of partners implementing communication interventions at level one for each cohort at National, County and Sub-County level



Develop a rights based communication plan that clearly incorporates all the multiple interventions supporting the CHWs’ involvement at household and community level to ensure coordination and synergy



Develop clear roles and responsibilities for partnership in the implementation of communications for CHS approach at National, County and Sub-County level



Develop and disseminate targeted standard messages for each cohort jointly with the key partners implementing communication at level one



Develop, produce and disseminate a toolkit with IEC materials appropriate for each cohort



Develop, produce and disseminate a toolkit with IEC materials for people with special needs and disabilities



Provide technical assistance in contextualization of messages and materials to different counties for level one



Provide technical assistance in the implementation and monitoring of communication interventions at household and community level



Develop CHS communication specific indicators for various activities and update as appropriate

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Chapter 6 Strategy Four: Mobilization and Coordination of Communication Partners and Stakeholders 6.1.

CHS ACSM Coordination Mechanism and Structures

There is need for mobilization of different partners and stakeholders providing communication services at level one to ensure coordination and coherence, Strategy Four: Mobilization of different partners and stakeholders providing communication services at level one to ensure

programming

that

will

support and drive the CHS approach and the services it offers. Through this strategy partners

and

stakeholders

will

sensitized and motivated to work together in raising awareness and pooling resources. Community mobilization will be done to

coordination and coherence

motivate

in CHS communication

members

programming.

initiatives that are beneficial to them.

and

influence

to take

community

action and support

This will target interested organizations, individuals and health related sectors, along with NGOs, CBOs, professional associations and the private sector. Strengthening the ACSM structures, capacity and systems at all levels will ensure successful delivery of effective CHS communications. The ACSM coordination structures will be anchored within the existing CHS and National health system to ensure consistency, better sector coordination and linkages from the National to the Sub- County and Community level. There is need for partnership, collaboration and coordination to ensure success in the delivery of services. All partners and stakeholders need to board the CHS â&#x20AC;&#x2DC;vehicleâ&#x20AC;&#x2122; to roll out communications at the community level. The coordination mechanism of ACSM activities for level one seeks to address the following critical issues that emerged from the situation analysis: a) Inadequate engagement of all partners and stakeholders,

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b) Weak coordination framework of communications for level one services, c) Vertical and parallel programming of ACSM activities at level one, d) Inadequate communication guidelines, e) Communication interventions not being consistent, standardized and sustained.

6.2. National Level Coordination 6.2.1. Linkages with other Departments, Divisions and Partners The CHS fully addresses level one service delivery with complete structures and operationalized functions. The DCHS will be tasked with establishing a platform that will ensure smooth coordination of ACSM activities at all levels. Multi-Sectoral collaboration and coordination will take place at the ICC level. The National CHS ACSM TWG will be tasked with operationalizing the Communication Strategy and provide a platform for coordination of ACSM interventions for level one.

All the departments, divisions and partners

implementing communications at level one will be members of this TWG. The DHP will provide technical assistance at all levels in the operationalization of this Communication Strategy. This section defines roles and responsibilities of the ACSM structures at different levels.

6.2.2. Role of CHS ACSM TWG in the Implementation of the Communication Strategy The CHS ACSM TWG will be tasked with the following roles and responsibilities: 

Coordinate the responsibilities, tasks and contributions of various ACSM partners and stakeholders



Set standards and guidelines for CHS ACSM



Provide assistance in harmonization of CHS ACSM messaging and IEC materials



Develop ACSM partnership plan to be adapted by Counties, to include roles and responsibilities 56

AFYA YETU, JUKUMU LETU



Develop a communication plan for CHS ACSM activities which include planning, implementation, monitoring and evaluation and reflects rights based programming



Resource mobilization for ACSM



Determine and develop CHS ACSM national campaigns



Determine who should form part of the ACSM coordination mechanism at the various levels



Support implementation of the ACSM conventions, meetings and forums at different levels

6.2.3. Role of DCHS ACSM Unit in the Implementation of the Communication Strategy Capacity building for the DCHS ACSM unit will be paramount to ensure that the communication activities are coordinated and managed effectively and continuously. The ACSM unit capacity and resources will be reviewed to help determine what skills and resources will be needed and how to obtain this. Due to the multiple and multi-level health issues addressed through the CHS, it is important to nurture partnerships to enhance synergy in implementation of ACSM activities and programs. Management of ACSM activities at the County, Sub-County and Community level will be an important function of this unit. A review of capacity, skills and resources at these levels will be important in informing ACSM capacity strengthening programs. To be able to support the roll out of this strategy, the ACSM unit will be tasked with the

All

following roles and responsibilities:

stakeholders



Coordination

planning

and

implementation of CHS ACSM activities nationally 

need

programming

DCHS 57

and to

board the CHS ‘vehicle’ to

roll

out

communications at the community level.

Monitoring, review and reporting of ACSM

partners

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Figure 5: ACSM Linkages and Coordination

Departments, Divisions, Partners, DHP

DCHS ACSM Unit

MOH, Partners & Stakeholders, Health Promotion

County CHS Focal person

MOH, Partners & Stakeholder, Health Promotion

Sub-County CHS Focal person

Primary Healthcare Unit , Community Unit

CHEW

CHW, CHC

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Chapter 7 Strategy Five: CHS Knowledge Management and Documentation 7.1.

0bjectives

The purpose of the knowledge management strategy is to create a platform for strengthening information sharing, promoting data use and building skills. Strategy Five: Knowledge

This is in an effort to address the

management, documentation and

current

sharing of CHS best practices, lessons learnt, success stories and important information to catapult implementation and support for level one service delivery.

gaps

information dissemination

of and in

lack weak

adequate

information

departments

and

divisions within Government and among stakeholders. Knowledge management is a platform designed for policy and decision makers

at all levels, development and implementing partners, researchers and program managers. The following interventions are proposed to improve information sharing on CHS, promote data use and build skills. 7.2.

Key Interventions

1. Publications and information materials directed to key stakeholders and partners: o Fact sheets on thematic issues produced in the format of Frequently Asked Questions (FAQs) which is targeted and easy to read o Newsletter/ Bulletins on best practices, success, lessons learnt, or key CHS events to be shared on a quarterly basis o Policy briefs and presentations o CHS research briefs 2. CHS website 64

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The CHS website will be designed to provide information about Division of Community Health Services including: o General overview of the division o Organizational structure o Contacts o News o Events calendar o Success stories and best practices 3. CHS portal The CHS portal will be designed to provide information on the following; o National Health Sector Policies and Guidelines o CHS policies and guidelines o Training resources for CHEWs, CHCs, CHWs o Monitoring and reporting tools and guidelines o Database of IEC/BCC toolkit with complete set of materials and messages by cohort and by county o Materials by CHS for the household level and other collated materials from partners and stakeholders targeted for level one o Evidence database and research articles related to CHS o Links to useful and complementing resources o Community units database with mapping of functional units o DCHS partners and stakeholders platform o Link to data sites e.g. Central Bureau of Statistics o Listserve/discussion forum 4. Community strategy documentaries The documentaries will highlight best practices, success stories and lessons learnt that can be used both for training and resource mobilization. 5. Engage media as a strategic partner. It is important to leverage the media as a partner so that they can cover CHS issues within the right context and over a sustained basis. This will require 65

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production of tools that make it easy for media to cover CHS analytically. Media training workshops will be important to ensure accurate and quality reporting.

6. Customer relationship system The DCHS will be coordinating many partners and stakeholders for level one services and hence an effective relationship system will be critical, including a contacts database and mail management system.

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Table 17: Implementation Plan TIME SCHEDULE ACTIVITIES

PROCESS INDICATORS

2013 Ⅰ

Ⅱ

1. Advocacy 1 Develop and execute a 4-month branded mass media campaign through multiple channels at national and county level to create awareness on the CHS approaches (At least 2 National TV programs,6 radio

Number of radio/TV shows on CHS conducted during the campaign period.

programs-national and local and billboards) 2. Develop and disseminate an advocacy kit with different materials

Number of materials on CHS

targeted to the national, county and

distributed to the national,

community leaders with information

county and community leaders.

on CHS approach 3. Conduct stakeholder forum, including partners and private sector

Number of participants in

at National, County and Sub-County

forums targeting stakeholders,

level to provide highlights on CHS

development partners and

approach, success stories, address

private sectors at National,

gaps and rally for support and

County and Sub-County level.

resources.

Ⅲ

2014 Ⅳ

Ⅰ

Ⅱ

Ⅲ

2015 Ⅳ

Ⅰ

Ⅱ

Ⅲ

2016 Ⅳ

Ⅰ

Ⅱ

Ⅲ

2017 Ⅳ

Ⅰ

Ⅱ

Ⅲ

Ⅳ

4. Support the branded campaign with direct communications through social media (Facebook, twitter), emails, e-shorts, PDF of print

Number of people reached the campaign.

adverts. 5. Place print adverts in newspapers, industry magazines and newsletters.

Number of newspapers, industry magazines and newsletters printed on CHS issues.

6. Conduct advocacy workshop for local media at National and County

Number of local journalists

level to keep CHS approach issues on

participating in the workshops.

the spotlight. 2. Health Communication Capacity Strengthening 1. Conduct the DCHS ACSM capacity assessment at all levels to determine strengths and weaknesses in

Report on DCHS ACSM capacity

planning, designing, implementing,

assessment is in place.

monitoring and evaluating communication programs. 2. Develop an appropriate ACSM competency based training manual based on needs identified.

ACSM training manual is developed.

3. Develop tailored ACSM

ACSM practitionersâ&#x20AC;&#x2122; handbook

practitioners handbook that will guide

developed and disseminated at

implementation of ACSM at all levels

all levels.

4. Conduct the ACSM TOT competency based training at

Number of trained trainers.

National and County level.

5. TOT to roll out the ACSM competency based training at all levels including community level.

Number of ACSM practitioners trained.

6. Provide supportive supervision and technical assistance in the

Number of supportive

implementation and maintaining of

supervisions implemented.

ACSM at all level 3. BCC 1. Conduct a rapid mapping of partners implementing level one communication interventions at National, County, Sub-County and

Report on rapid mapping is in place.

Community level. 2. Hold a one-day workshop to develop a right-based communication plan that clearly incorporates all the

Right-based communication plan

multiple interventions supporting the

(with clear roles/responsibilities

CHWs involvement at household and

of each partner) is developed.

community level to ensure coordination and synergy. 3. Develop and disseminate a toolkit (e.g.: Job Aid) with materials appropriate for each cohort.

Toolkit for each cohort are developed and disseminated.

4. Develop produce and disseminate

Toolkit for people with special

a toolkit with IEC materials for people

needs/disabilities are developed

with special needs and disabilities.

and disseminated.

5. Hold a retreat to support counties

Messages/materials for level one

in contextualization of messages and

are contextualized at each

materials for level one.

county.

6. Conduct regular monitoring of communication interventions at household and community level. .

Regular monitoring on Behavior Change indicators is conducted.

4. Mobilization and Coordination of Communication Partners 1. Establish/Strengthen the ACSM technical Sub-committee (or existing platform) of partners implementing communication interventions at level one for each cohort at National, County and Sub-County Level.

Number of ACSM TWG operationalized (organized regularly with agenda) at National, County and SubCounty level.

2. Hold quarterly ACSM technical working groups for planning and coordination of the National

TWG meeting is held regularly.

communication plans. 3. Provide technical assistance to the

Number of counties supported in

counties in implementation of ACSM

communication planning,

activities.

implementation and M&E.

5. CHS Knowledge management 1. Publications and information materials directed to key stakeholders and partners: fact sheets, bi-annual

Number of publications

newsletters, policy briefs, research briefs.

2. Set up and manage CHS website.

CHS Website is developed and updated regularly.

3. Develop a CHS portal and manage

CHS portal is developed and

through to 2017

managed constantly.

4. Produce CHS promotion video

CHS promotion video is available to the public.

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Table 18: Summary of Key Messages Targeting Each Cohort for Behaviour Changes Desired Behaviour Changes (Key Messages) 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Sleep under on LLIN every night Recognize and seek early treatment for malaria within the first 24 hours Adhere to malaria treatment Hand washing with soap at 4 critical times Practice proper faecal disposal including proper disposal of children faeces Drink safe, clean and treated water Prevention of violence and injury At least 4 ANC visits Prompt healthcare for complications of delivery Have a delivery plan Plan to deliver in a health facility Seek prompt care when you see danger signs in pregnancy Accept and seek IPT during pregnancy Accept your house to be sprayed with IRS Full course of immunization before first birthday (BCG, Polio, PCB 10, Pentavalent, 15 Measles) 16 Exclusive breastfeeding for the first 6 months 17 Complementary feeding after 6 months and continue breastfeeding up to 24 months

Cohort 1 ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Cohort 2 ○ ○ ○ ○ ○ ○ ○

○

○ ○

Delay the baby's bath for 24 hours and place the baby skin to skin with the mother to keep worm between 24 -4828 hours

○

19 20 21 22 23

Use condoms correctly and consistently Go for TB screening and testing Keep off the harmful effects of alcohol, substance abuse, prescription drugs Engage in regular physical exercises for at least 30 minutes Eat a balanced nutritious meal with extra proteins

○ ○ ○ ○ ○

Cohort 3 5～12 13～19 ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Cohort 4 ○ ○ ○ ○ ○ ○ ○

Cohort 5 ○ ○ ○ ○ ○ ○ ○

○

○ ○ ○ ○ ○

○

○ ○ ○ ○ ○

Desired Behaviour Changes (Key Messages) 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

Child spacing and timing Referral for FP method Vitamin A supplementation every 6 months for 5 years Growth monitoring every month up to 5 years CRS and zinc for diarrheal management Deworming every 6 months Learn basic first aid skills Eat a nutritious diet every day Abstinence and delay in sexual debut Increase knowledge of HIV/AIDS prevention and sex education Identify symptoms and signs of mental conditions and refer Visit clients with NCD and refer for rehabilitation Visit clients needing occupational therapy and refer for rehabilitation Faithfulness to one faithful partner Seek testing and counseling Reduction in number of youth having multiple sexual partners Utilization of RH and FP services Delayed child bearing Elimination of FGC and other harmful cultural practices. Have regular check-ups for early detection of diabetes, hypertension, cancer Counseling on Menopause and Andropause Knowledge of HIV status and partner status Adherence to ART treatment Ensuring adherence to TB treatments for those who are sick Eating to nutritious and balanced diet

Cohort 1 ○ ○ ○ ○ ○ ○

Cohort 2

Cohort 3 5～12 13～19 ○ ○

○ ○ ○ ○

Cohort 4 ○ ○

Cohort 5

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

○ ○ ○ ○

○ ○ ○

○

○ ○ ○ ○ ○ ○

○

Table 19: Objective Indicators for CHS ACSM Table 19 below provides objective indicators for behaviour changes through ACSM. The behaviour change objectives are in line with desired behaviour changes identified in the Communication Matrix for Behaviour change in Chapter 5 (5.2). The indicators in bold are identified in the M&E Plan on CHS while the indicators in Bold and Italics are not included in M&E Plan but in the 2nd Edition Indicators and Standard Operating Procedure Manual on Health Information System. Behaviour Change Objectives

Objective Indicators

(Message Theme for Level 1)

Outcome Indicators

Output Indicators 1. Sleep under on LLIN every Number of pregnant women sleeping under ・ Number of households with LLIN ・ Number of pregnant women reached with the night Long-Lasting Insecticides Nets (LLIN) information on importance of sleeping under LLIN

Number of children sleeping under Long-Lasting ・ Number of households with LLIN ・ Number of mothers reached with the information on Insecticides Net (LLIN) 2. Recognize and seek early Number of reported clinical malaria cases treatment

for

malaria

recognition and importance on early treatment ・ Number of facility reported clinical malaria

within the first 24 hours 3. Adhere

importance of sleeping under LLIN ・ Number of persons with information on malaria

malaria

treatment. 4. Hand washing with soap at Portion of persons in the CU who practice hand ・ Portion of households having hand washing facilities ・ Number of persons sensitized on proper hand 4 critical times washing with soap at least at 4 critical times 5. Practice

proper

washing fecal Portion of households using latrines/toilet (on ・ Portion of households with proper faecal disposal

disposal including proper daily basis)

structures 76

Behaviour Change Objectives

Objective Indicators

(Message Theme for Level 1)

Outcome Indicators

disposal of children faeces 6. Drink

safe,

clean

Output Indicators ・ Number of persons sensitized on proper faecal

disposal and Portion of households with water treatment ・Number of households sensitized on water treatment

treated water

methods

7. Prevent violence and injury

Number of reported violence and injuries

methods ・ Number of persons sensitized on prevention of

violence and injuries 8. Visit ANC clinic at least 4 Proportion of pregnant women 8 months and ・ Number of health facilities with ANC services ・ Number of pregnant women sensitized on the times above who attended 4th ANC clinic 9. Prompt

healthcare

importance of ANC visits for Number of pregnant women referred to health ・ Number of health facilities with Emergency Obstetric

complications of delivery

facilities for complications of delivery

Care (EOC) services ・ Number of pregnant

women

who

understand

symptoms of complications of delivery Number of mothers who delivered with delivery ・ Number of pregnant women sensitized on delivery

10. Have a delivery plan

plan 11. Deliver in a health facility

with delivery plan Proportion of deliveries conducted by skilled ・ Number of health facilities with delivery services ・ Number of women sensitized on delivery in a health health personnel

facility 12. Seek prompt care when Number of pregnant women referred to health ・ Number of health facilities with EOC services ・ Number of pregnant women who can identify danger you see in danger sign facilities for EOC 13. Accept

and

seek

during pregnancy

IPT

sign Proportion of women provided with IPT 2 during ・ Number of pregnant women sensitized on IPT ・ Number of pregnant women reached the ANC visits information on IPT 77

with

Behaviour Change Objectives

Objective Indicators

(Message Theme for Level 1)

Outcome Indicators

Output Indicators ・ Number of households sensitized on IRS

14. Accept your house to be Portion of households sprayed with IRS

・ Number of households reached with the information

sprayed with IRS 15. Full course of immunization before first

on IRS Proportion of children younger than one year who ・ Number of mothers sensitized on immunization ・ Number of caregivers reached with information on were fully immunized

birthday (BCG, PCB10,

vaccination

Pentavalent, Polio, Measles) 16. Exclusive breastfeeding for Percentage of infants less than 6 months old on ・ Number of mothers reached with information on the first 6 months

exclusive breastfeeding

17. Complementary feeding

breastfeeding

and

supplementary complementary ・ Number of mothers breastfeeding

complementary

feeding

Number of mothers of infants aged between 6

after 6 months and

months

continue breastfeeding up

feeding practices

with

sensitized

exclusive

to 24 months 18. Delay the baby’s bath for Proportion of

mothers

practiced

the

24 hours and place the bathing for her new-born baby

proper ・ Number of mothers reached with information on proper bathing for her new-born baby

baby skin to skin with the mother

keep

warm

between 24 -48 hours 19. Go for TB screening and Percentage of HIV patients screened for TB testing

・ Number of health facilities with TB screening and testing services ・ Number of persons reached with the information on TB screening and testing services ・ Number of HIV patients sensitized on TB screening

Behaviour Change Objectives

Objective Indicators

(Message Theme for Level 1)

Outcome Indicators

Output Indicators and testing

20. Adhere to ART treatment

Number of TB patients receiving ART treatment at ・ Number of health facilities with ART treatment health facilities

services ・ Number of persons reached with the information on ART treatment ・ Number of HIV patients sensitized on ART treatment ・Number of health facilities with TB treatment services

21. Ensuring adherence to TB TB case notification rate treatments for those who

・ Number of persons reached with the information on

are sick

TB treatment ・ Number of persons reached with the information on

22. Keep off the harmful

Level of drug and substance abuse

effects of alcohol,

harmful

effects

substance abuse,

prescription drugs

alcohol,

substance

abuse,

prescription drugs 23. Engage in regular physical Proportion of persons engaged in regular physical ・ Number of persons aware of regular physical exercises for at least 30 exercises for at least 30 minutes

exercises

minutes ・ Number of households reached with the information

24. Eat a balanced nutritious meal with extra proteins

Proportion of persons practicing healthy eating

25. Eat a nutritious diet every habits

on importance of proper nutritional habits ・ Number of persons aware of proper nutritional habits

day 26. Eat nutritious and balanced diet 27. Abstinence and delay in Number of children at age of sexual debut sexual debut

・ Number of children aged between 6-19 reached with information on safe sexual practices

Behaviour Change Objectives

Objective Indicators

(Message Theme for Level 1)

Outcome Indicators

Output Indicators ・ Proportion of children aged between 6-19 who are aware of the importance of abstinence and delay in

sexual debut 28. Child spacing and timing is Number of women of child bearing age receiving ・ Number of women sensitized on family planning ・ Number of women of child bearing age reached with beneficial for mother and family planning commodities child

the information on family planning methods

29. Delay child bearing 30. Refer for family planning method 31. Use

Reproductive

and

Family

Health Proportion of women in reproductive age using a Planning

modern method of contraception

services 32. Vitamin A

Percentage of children aged 6 to 59 months ・ Number of caregivers sensitized on Vitamin A

supplementation every 6

receiving at least two doses of Vitamin A

months for 5 years

supplementation within one year

supplementation

33. Growth monitoring every Percentage of children under 5 years who are ・ Number of caregivers sensitized on getting growth month up to 5 years

attending CWC for growth monitoring for the first

monitoring

time 34. ORS and zinc for diarrheal Portion of children 0-59 months that had an ・ Number of children receiving ORS and Zinc management 35. De-worming every 6 months 36. Learn basic first aid skills

episode of diarrhea who receive ORT Number of children under fives being de-wormed ・ Number of caregivers reached with information on (1-14)

de-worming ・ Number of caregivers sensitized on de-worming

Number of injured persons who have been ・ Number of households trained in first aid 80