In the context of the implementation of ACCESS-SMC, Social and Behavior Change Communication (SBCC) is an essential part of an inclusive program that seeks to reduce child mortality due to malaria. SBCC is a cross-cutting component and an interactive process with communities to develop tailored IEC (Information, Education, Communication) messages and SBCC approaches using a variety of communication channels to promote healthy behaviors and sustain individual, community and societal behavior change. Effective SBCC involves the development and implementation of messages and activities and the creation of a supportive environment needed to promote and sustain behavior change.
Within ACCESS-SMC, the implemented SBCC interventions are aimed at helping to increase the target communities’ adherence to SMC and their perception and understanding of malaria as well as promote care seeking attitudes and behaviors that will have a positive effect on families’ lives. All malaria control interventions, and SMC in particular, are interventions with a strong community engagement component.
Community engagement is defined by the World Health Organization as “a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to active change.” Involving community stakeholders in the development and implementation of malaria prevention programs can be a challenging, resource-intensive, and often frustrating process. However, it can also be a highly creative, energizing, and rewarding experience leading to significant improvements in program design and outcomes. For example, research has shown that in programs that involve high levels of community participation and control, there is greater participation in health improvement activities. Community engagement also builds “social capital” (social ties, networks, and support) which is associated with better community health and well-being. Finally, participatory decision-making can uncover and mobilize community assets, strengths, and resources that would have been otherwise overlooked.
Madaoua, located in the valley of Tarka, in the region of Tahoua, Niger, is malaria endemic. In this region, live the Gobir Toudou, a community marked by a long history of migration and a very hierarchical organization. At the very top of their societal structure is a traditional leader, the Chief Gobir Toudou, Mr. Manirou Magagi, assisted in his governance by a council of high dignitaries. Within ACCESS-SMC, the Chief has been instrumental since the inception of the intervention in Madaoua in 2015. He has been a powerful advocate of this community-based health intervention.
“We have all seen Chief Gobir Toudou take ownership of this campaign. We have seen his efforts to raise awareness. He brought together all the marabouts, neighborhood leaders, community leaders to encourage them to help educate mothers on malaria prevention and ensure they protect their children from malaria. Since 2015, he has been bringing together heads of household, mothers and even goes from door to door to inform mothers of the distribution and urge them to take their children to the distribution sites. He sits on his doorstep (his home is located next to the distribution site), to watch and follow from a distance those who bring their children and asks about those who did not come" said Mohamed Waziri, Gobir Toudou Deputy Chief.
Such implication of local leaders reminds us that before individuals and communities can reduce their level of risk or change their behaviors, they must first understand basic facts about malaria and SMC, adopt key attitudes, learn a set of skills and be given access to appropriate products and services. They must also perceive their environment as supporting behavior change and the maintenance of positive behaviors, as well as supportive of seeking appropriate treatment for malaria prevention and care. Thanks to a thorough planning process, we can enable local leaders to become champions by building their capacity to participate in demand-driven health programs. The ultimate goal of community engagement within the context of ACCESS-SMC is to impact conditions that influence the health of children under five and contribute to communities’ health.