Lil Mosquito, Big Problem Campaign: Phase II

Following the first two years of implementation, in February 2023, Breakthrough ACTION and MOH employed a second HCD process to further refine Guyana's malaria SBC interventions. Findings from the first phase of the LMBP campaign initiated in 2019 were triangulated with new data, strategies, and guidelines, and a new set of key insights emerged:
 

• Some of the project's most effective communication channels, such as television and print materials, were also some of the most challenging to deliver.
• Recognition was mutually reinforcing: The audience interacted with the campaign more when they recognised someone they knew, and the people who were recognised were more likely to promote the campaign.
• Although SBC efforts had not yet focused on secondary audiences in a concerted way, these key influencers showed an interest in the campaign and had significant potential to drive change.
• The VMT programme did not fully respond to the needs of miners. Specifically, the number of VMTs was insufficient, inactive testers were not replaced with new ones, and testers often faced stock-outs of both SBC materials and testing and treatment supplies.
• Infrastructure challenges hindered both communication between regional Vector Control Services/National Malaria Program (VCS/NMP) and VMTs and movement to and from the interior. These challenges had repercussions for SBC interventions, delivery of essential supplies, and timely reporting.

The insights informed a two-week Design and Test sprint to generate ideas for new design opportunities, create low-fidelity prototypes, and test the ideas with intended audiences. The core design team integrated the feedback from the Design and Test phase to refine these solutions and launched a new complementary suite of interventions, which were implemented as part of the final Phase II of the campaign. They included the following:

Miners' Buzz: This entertainment-education approach wove authentic narratives from miners about life in the mines with crucial malaria messages in one- to two-minute video segments. Breakthrough ACTION produced 20 "Gyaff from the Mines" segments, "by miners, for miners", in which real miners spoke openly about topics ranging from their experiences with malaria to family life to encounters with wildlife. These recordings provided anecdotal and contextual information to then develop 10 "Yuh Ain' Know" segments, in which malaria experts responded to frequently asked questions from miners and addressed misconceptions about malaria, treatment, and prevention in the mining regions. The project dubbed five of the main Miners' Buzz segments into Spanish and Portuguese. Breakthrough ACTION disseminated Miners' Buzz through the LMBP Facebook page, WhatsApp, and television. Click here to view these videos.

Malaria Backdam Champions: The Malaria Backdam: This intervention engaged community shopkeepers and business owners, such as barbers and restauranteurs, to become points of contact for miners to access malaria information. The champions promoted prompt care-seeking behaviours and facilitated access to updated testing and treatment locations. Once champions were recruited, Breakthrough ACTION provided them with several tools to help them in their role, including a shop sticker to identify them as a champion, a tester tracker listing the names and locations of VMTs within the communities, and rapid counselling cards to address commonly asked questions about malaria. They also received a laminated card with malaria information tailored to miners and the region, as well as flash drives loaded with malaria audio content to be played on shop sound systems. In addition, as a form of recognition and appreciation, the champions had the option to have their pictures taken and featured on the LMBP Facebook page.

Malaria Super Teams: This programme sought to foster an environment of excellence and recognition within the malaria prevention and control workforce and was specially established to recognise and incentivise the outstanding commitment of VMTs and their supervisors. Breakthrough ACTION introduced a structured reward system to bolster motivation, elevate retention rates, and amplify proficiency in essential duties. For instance, VMTs were meant to be regularly assessed on testing excellence (i.e., timeliness of report submission, accuracy and completeness of reports, and maintenance of adequate stock levels), community engagement (i.e., regular coordination and communication with regional health facilities, referral of clients requiring additional care), and quality and innovation (i.e., exceptional service, implementation of an innovative intervention). Participants would qualify to win prizes such as t-shirts, caps, umbrellas, or backpacks based on their performance. Malaria Super Teams also established regional WhatsApp groups for VMTs and their supervisors to enhance communication and coordination. 

Related to this activity, regional VCS/NMP supervisors reported that the establishment of the regional Malaria Super Teams WhatsApp groups significantly improved coordination among regional supervisors and VMTs. Team members reported better alignment on objectives and a greater sense of camaraderie. Regular communication around commodities and supplies minimised stock-outs and helped to improve supply chain issues. It also led to a marked increase in the timely completion and submission of reports, which enabled more accurate tracking of malaria cases and facilitated data-driven decision-making.

Malaria Boss: Malaria Boss leveraged a network of private drivers and transportation partners to streamline the delivery of malaria test kits, treatment, SBC materials, and reports to and from remote interior locations. This initiative was designed to address the logistical challenges faced by regional VCS/NMP and VMTs in remote areas where inadequate transportation services often resulted in VMTs being periodically left without essential supplies. Breakthrough ACTION recruited trusted drivers who regularly travelled between the regional capital and the rural, undeveloped areas of Guyana. The project branded the bosses' vehicles with stickers and mirror hangers; trained them on malaria basics so they could engage with passengers and clients around diagnosis, treatment, and prevention; and equipped them with supportive SBC materials.

Cross-cutting SBC materials: Breakthrough ACTION developed several supportive SBC materials that were applicable across various initiatives:
 

• Welcome to the Mining Regions Laminated Cards: These regionally tailored materials drew attention to the fact that miners were in a high-malaria risk area, and they used actual images of camps and miners to share essential information about malaria prevention, testing, and treatment. In addition to being distributed to Malaria Backdam Champions and Malaria Bosses, the cards were strategically placed in various locations highly frequented by miners, including commuter boats, checkpoints, airplanes and airports, restaurants, and bars.
• Tester Trackers: Regularly updated and posted in visible locations, this paper-based template aimed to record the locations of testers throughout the region, ensuring miners knew where their closest malaria service delivery point was.
• Malaria Pocket Cards: This set of resource cards could be used by Malaria Champions, Malaria Bosses, and Malaria Super Teams to share crucial information on malaria with others.

Ensuring sustainability of the project: With sustainability at the heart of the programme, Breakthrough ACTION Guyana, the MOH, private sector partners, and other key stakeholders undertook several initiatives to ensure that SBC systems and structures endure beyond 2024. Initiatives included: the development of a sustainability action plan to detail the steps the institutions would take to ensure a successful transition of SBC interventions, capacities, systems, and structures from the project to the government; a partnership agreement between MOH and mining organisations; and a SBC toolkit and branding guide. Click here [PDF] to find out what was done and the lessons learned.

In brief, the following are some of the lessons learned from this Phase of the campaign as highlighted in the Breakthrough Action Guyana Activity Brief: Lil Mosquito, Big Problem Campaign: Phase II [PDF]:

• Peer-driven entertainment-education strategies enhance credibility and interest. The "by miners, for miners" peer-to-peer approach of the Miners' Buzz segments enhanced trust and engagement in the content. In particular, the audio-visual testimonial format overcame the literacy barriers prevalent within these communities, and numerous community members advocated for the creation of additional audio-visual content.
• While promising in theory, Malaria Boss faced several implementation challenges in practice. Although most were eager to display the LMBP materials and learn more about the programme, some expressed disappointment regarding the lack of monetary compensation for their participation, citing difficult terrain, increased cost to traverse this area, and limited time. Here Breakthrough ACTION recommends focusing on quality over quantity for Malaria Boss, rather than recruiting more individuals, and focusing on strengthening the existing and willing network of recruited Malaria Bosses, emphasising the establishment of trust-based relationships.
• In volunteer-based SBC initiatives, reward and recognition interventions have significant potential for increasing motivation and improving retention, but must meet volunteers' expectations. With volunteers showing mixed reaction to the rewards offered, the interventions would benefit from additional discussions with the volunteer cadres to further clarify preferred forms of recognition.