Ensuring a steady supply of commodities and high quality services for malaria prevention and treatment is only half the battle. These services must also be demanded and used by the people who need them most. Demand creation means achieving increased community awareness and demand for effective malaria prevention and treatment.
Demand for services was not always high. At the beginning of the project, use of long lasting insecticidal nets (LLINs) – one of the most effective methods of preventing malaria – was low, at just 3.9 percent of women between 15-49, and 4.6 percent of pregnant women using nets (Nigeria Demographic and Health Survey 2008). Rapid expansion was an urgent priority. As a result, SuNMaP focused on using advocacy and communications to increase community awareness and stimulate demand for effective malaria treatment and prevention services.
SuNMaP’s demand creation strategy centred on promoting the correct use of LLINs and intermittent preventive therapy in pregnant women (IPTp). Activities included public policy and media advocacy, improving service delivery, including increasing client-centred counselling and risk awareness, and a wide range of community mobilisation initiatives, such as ‘edutainment’ dramas and music, TV and radio spots, and print and electronic materials – all informed by formative research among target communities. These activities communicated a range of public health messages – the radio jingles addressed the proper use of nets as well as diagnosis and treatment of fever in pregnancy, while SuNMaP also worked together with the National Malaria Elimination Programme to develop a malaria ‘brand.’
What we accomplished
The outcomes of SuNMaP’s demand creation activities are as follows:
Formative research conducted and strategic framework and implementation plan produced. Research was carried out to assess knowledge, attitudes and practice of communities, clients and service providers regarding malaria control communications. The results fed into the NMEP’s Strategic Framework and Implementation Plan, which in turn informed the annual operational plans of the NMEP and state malaria control programmes.
Creating a brand for malaria services and products. With SuNMaP support, the Advocacy, Communication and Social Mobilisation committee created a malaria logo in 2010 as a unifying symbol of quality, trust and authority for malaria control products and services, with the tagline: “For a malaria-free Nigeria, play your part.”
Creating demand in routine health centre services and within communities. In addition to service strengthening, SuNMaP worked at the community level to demonstrate the hanging, use and care of LLINs as well as helping initiate community discussions on malaria control.
Creating demand for long lasting insecticidal nets. The programme worked to increase knowledge of the benefits and use of LLINs, leading to an increase in use from 35 percent in 2010 to 47 percent in 2012 in SuNMaP focal states.
Creating demand through radio jingles and dramas. Radio jingles have covered a range of topics, including myths and misconceptions relating to LLIN use, instructions on net use, and case management and prevention of malaria in pregnancy. A radio drama series also reached 10 million listeners, motivating audiences to adopt healthy behaviours and advocate for social change regarding malaria prevention and control.
Creating demand through print materials and branded buses. More than 1.5 million posters, wall charts and leaflets have been distributed in SuNMaP states, covering topics such as net use, case management and malaria prevention in pregnancy. Key messaging has been consistent, but materials are adapted to local context according to language, cultural and geographical differences. In Lagos, SuNMaP has used branded buses to spread public health messages.
Creating demand through television advertising. SuNMaP supported the production of a TV spot aired during the Africa Cup of Nations in 2013. Spots were also aired on two national and satellite stations.
Base communication campaigns on research findings. Formative research influenced the development of materials as well as the selection of communication channels. Evidence should also be used to explore new methods of communication.
A multimedia approach increases the reach and impact of the campaign. Using a mix of communication platforms has helped SuNMaP to reach diverse audiences. Radio proved invaluable, as did interpersonal discussions supported by print materials.
Coordinate demand creation activities with service provision. When creating demand for malaria services and commodities, it is essential that providers meet the increasing demand. For SuNMaP, integrating demand creation into the NMEP, rather than working in isolation, was a critical factor in ensuring that both demand and supply were in harmony.
Planning and cost sensitivity are critical factors. Ensuring value for money is essential to make best use of limited resources. Advance planning is also important – development of materials takes a long time, especially when they are adapted to conditions in multiple states. Long lead planning is required to ensure that materials and demand creation activities are timed to coincide with the provision of services and supplies.
Public suspicion of ‘foreign’ products and services can be a barrier to coverage. In order for malaria programmes to be successful, the public must accept them. So when products are seen as ‘foreign’, unpleasant, unaffordable or uncomfortable to use, use of services and products will be low. Strategies for behaviour change and demand creation should incorporate and seek to overcome these barriers.