Use of community conversation to engage religious and traditional leaders and impact behavior change in pneumonia prevention and management among children under five, Ethiopia

Summary:

The Ethiopian Red Cross Society (ERCS) with the support of the Netherlands Red Cross (NLRC) is implementing a pneumonia mortality reduction project in Ethiopia, targeting 3 regions (Oromia, Amhara and Somali) and 51,320 beneficiaries. An integrated communication strategy, using Community Conversation (CC) as a key approach is employed to facilitate positive behavioral outcomes in pneumonia prevention practices and timely referral of sick child at community level. The key messages and channels were designed based on a formative research that identified barriers, motivators and competitors of the desired behaviors ( identifying pneumonia danger signs in children under five and timely health care seeking). The community conversation is carried out bi-weekly and brings between 40-60 participants (head of households, care providers, persons with disability, and religious leaders) together in a given sub-location (Kebele). The meeting dates are set by the community members based on the cultural (coffee ceremony) and religious practices. The CC sessions employ various communication channels such as storytelling, community theatre, personal testimonies, role plays, structured question and answer sessions as well as practical demonstrations. The preliminary result show that the communities are able to recognize pneumonia danger signs, reject some of the harmful practices in pneumonia management (burning of the childs chest in Somali region, taking the child to traditional healer in Amhara and Oromia regions) and bring the sick child to health facility with no delays. This has contributed to timely case management and positive treatment outcomes according to the data at the health facilities.

Background/Objectives:

ERCS with NLRC presents the interim results from a community health project focused on pneumonia reduction in under-five year old children in 3 regions of Ethiopia. Following formative research informing on the cultural practises relating to child care, CC were organized to increase uptake of behaviours promoting pneumonia prevention and management. The Socio-ecological model is used as a guide to facilitate the SBCC interventions. The main objective of the project is by 2020 communities in the selected Kebeles have increased the uptake of practices that help protect against and prevent Pneumonia infections and support timely diagnosis and treatment. Description of Intervention and/or Methods/Design: Community conversation(CC) is one of the major approaches identified by the ERCS to bring behaviour change among the community in pneumonia prevention and management. The community conversation approach / strategy was initially introduced by the UNDP in the 90s, and then was promoted by the Ethiopian government (MoH) and other NGOs to address the HIV epidemic (UNDP 2014). The CC approach allows the beneficiaries household care givers (heads of households) come together to discuss major community health and development needs / problems and find local solutions with the support of a trained facilitator. The project trained more than 200 CC facilitators (community volunteers) using a manual that was developed in Amharic and Oromifa following a formative research. The meetings are facilitated by trained facilitators over a period of 4 months. The community conversation sessions employ various communication channels / medias to communicate the key messages in pneumonia prevention and management.

Results/Lessons Learned:

Religious leaders ( Priests in Amhara region, Imam in Somali Region) and traditional leaders ( Geda in Oromia region) did take part in the CC sessions as they are influential leaders that can encourage communities to take sick children to health facilities and stop malpractices that contribute to delays in health seeking behaviour. In the target Kebeles, care givers are now more willing to take children with pneumonia to health facilities compared to previous years, as they now appreciate the importance of timely action. In the past communities first consulted religious leaders, gave children holy water before bringing them to health facility which contributed to delays in treatment seeking and poor treatment outcome / severity of the disease.

Discussion/Implications for the Field:

The CC approach is found to contribute to beneficiary engagement and accountability, as the CC platform gives opportunity for the beneficiaries give their feedback. The facilitated dialogue and decision-making process assists the community generate insights on the underlying factors that fuels pneumonia morbidity and mortality in their community. The process allows participants to reflect and explore solutions together.

Abstract submitted by:

Selam Jiffaro - Red Cross Netherlands 
Libertad Gonzalez - Red Cross Netherlands