Viva! Campaign

The VIVA! campaign package of activities is built upon insights gathered through an HCD process and is guided by applying the principles of behavioural economics (BE) and Cass Sunstein's adapted FEAST framework. Using the HCD approach, the campaign's interactive activities were co-created, tested, refined, and adapted to ensure that activities are grounded in practical solutions (which began as prototypes and now serve as campaign interventions) identified by community members themselves. The key design question was: How might we encourage EHHP and facility-based care-seeking for pregnant women and parents of children under age five experiencing diarrhoea, cough, and fever? For more information on the HCD process and the insights and solutions leading to the VIVA! campaign, see:  
 

• Insights Report: Using Human-Centered Design to Encourage Essential Family Practices and Healthcare Seeking in DRC [2019, PDF]
• Design & Test Report: Medium Fidelity Prototyping - Using Human-Centered Design to Encourage Essential Family Practices and Healthcare Seeking in DRC [2019, PDF]
• SBC Flow Chart: Democratic Republic of the Congo Spotlight [2021, PDF]

The resulting VIVA! campaign activities include the following: 

Community-based activities, which are led and facilitated by trained community health workers and health agents. A Viva! Campaign Implementation Guide [in French, PDF] was developed to assist with the implementation of the community-based activities. They include:
 

• Cost comparison activity: This interactive game is designed to help community members overcome the perception that health services are too expensive. It encourages community members to compare the costs of non-essential daily living needs and various health services, such as antenatal care (ANC) visits, childbirth, FP, and malaria treatment costs. The activity is carried out in community settings, at the market, health facilities, and other places where community members congregate. For this activity, cost comparison activity posters [PDF] were developed in French, Swahili (Katanga), Swahili (South Kivu), and Tshiluba.
• Savings boxes: These boxes are designed to help families save for health expenses and other important household expenses and are integrated into most VIVA! campaign activities. The goal is to overcome financial difficulties and reluctance to use health services by offering information sessions on financial education (how to set savings goals and differentiate between emergency and planned expenses), soliciting pledges for individual saving, and providing two savings boxes, one exclusively for health services and one for other planned family expenses.
• Couples parties: Community health workers lead these fun events for married couples, particularly for parents of children under 5 years old, that are designed to allow men and women to participate as a couple in a social and educational activity. Research shows that couples who communicate are more likely to discuss the health of their household, and these parties facilitate couple communication through knowledge tests and by strengthening dialogue between couples. The intervention promotes practicing essential family health behaviours, speaking with an FP provider, and sharing health information.
• Listening clubs and Healthline 42502: The clubs, mostly composed of community health workers, meet regularly to learn more about health by listening to and discussing reliable information through a toll-free telephone line. Community health workers use this platform to strengthen their understanding of health issues before engaging in community education. By fostering dialogue and sharing knowledge, the clubs are designed to build collective capacity and address health problems in a coordinated way. The use of the toll-free service ensures access to accurate, up-to-date health information without requiring a significant financial investment.
• Reminder tickets: Distributed during VIVA! community activities to remind participants to use health services, the tickets also help improve the traceability of health service use following participation in VIVA! interventions. In 2021, the proportion of reminder tickets that were redeemed for services was between 6% and 21%, depending on the province. Men and women redeemed the tickets to receive health services for fever, ANC, and coughs. 
• Market quiz: In the markets throughout the intervention areas, community health workers organise lively, short quizzes with sellers and shoppers on health topics like malaria, ANC, WASH, and FP. This activity allows the campaign to reach people who were not exposed to home visits or community engagement activities because they are working at the market and are able to reach a wide audience, as everyone can hear the questions, responses, and correct answers. Savings boxes are presented during the contest, and reminder tickets are distributed to participants.
• Quality feedback on health centres: The campaign includes a system that allows the community to anonymously evaluate their local health centre. The evaluation is based on three criteria: politeness/respectfulness of providers, the availability of personnel, and the cleanliness of the facility. These three criteria are represented by three compartments of a small, portable box that is accompanied by green, orange, and red cards that the community uses to vote and thus provide their feedback on their most recent visit to the health centre. The boxes are managed and maintained by relais communautaire (RECOs)/community health workers and are opened at the end of each month during monthly health zone meetings in order to analyse the feedback and take corrective action at the health centre level. 
   

Mass Media
 

• TV spots: The campaign produced and broadcast a series of educational TV spots that covered issues such as TB, cholera, FP, nutrition, menstrual health, and COVID-19.
• Qui Dit Vrai? (Who Is Correct?) TV and audio quiz show: This health-focused quiz show launched the VIVA! campaign in 2020 and was used to reinforce and broaden exposure to the messages of the community activities. To engage audiences, the interactive quiz features a roving talk show host who directly engages with regular passersby in the streets and communities in fun and educational discussions, using an entertaining and engaging question-and-answer format. The key messages delivered through the conversations promote priority behaviours on malaria, TB, FP, WASH, and nutrition. The show is an example of how the campaign applies an entertainment-education approach and the FEAST framework.
• Spots: Spots on malaria, FP, nutrition, and TB are available in Tshiluba, Swahili (Katanga and South Kivu), Lingala, and French.

Health, Family Planning, Malaria, Nutrition, TB, Child Health

Breakthrough ACTION has monitored VIVA! using activity reports, periodic mini-surveys to gauge intermediate effects, qualitative interviews with campaign participants, and the referral ticket system to measure service use attributable to campaign activities.

According to Breakthrough ACTION, from the campaign launch in March 2020 until September 2021, 466,160 people participated in community-level VIVA! interventions, and 3,138 community health workers (RECOs) and 9,354 community leaders, including religious and traditional leaders, as well as other civil society actors, have been involved in the implementation of the campaign.

Campaign surveys show that people exposed to VIVA! are more likely to report EHHP and facility-based care-seeking. A survey to gauge exposure to the campaign and assess associated intermediate and behavioural outcomes conducted in August 2021 showed that:
 

• 87.3% of respondents had heard of the VIVA! campaign.
• 70.6% remembered seeing the VIVA! campaign logo in the last 3 months.
• 60.8% of respondents agreed with the statement that the VIVA! campaign was relevant to their or their family's lives.

The campaign also notes large differences in practice of behaviours by exposure. For example, 64% and 72% of parents of children under 5 who reported exposure to the VIVA! campaign sought treatment for diarrhoea and fever, respectively. Among parents who had not been exposed to the VIVA! campaign, only 44.4% sought treatment for a child with diarrhoea, and 55.6% sought treatment for fever. Similarly, 78.6% of married couples who had been exposed to VIVA! reported having discussed FP with their partner in the 3 months preceding the survey, compared to 42.9% of married couples who had not reported exposure. Finally, 73.8% of VIVA! exposed married couples had put money aside for eventual health needs, compared to 57.1% of couples not exposed to VIVA!