Lil Mosquito, Big Problem Campaign: Phase I

The LMBP campaign was designed using an HCD approach that engaged the MOH, mining organisations, and miners every step of the way. The process involved extensive qualitative and observational research with miners, VMTs, mining camp managers, and others in mining camps and other sites, allowing the design team to experience first-hand the challenges of living and working in rural, undeveloped areas of Guyana (also called the backdam). This strategy enabled the design team to better empathise with the audience and accurately reflect their daily life in the campaign executions, from depictions of sleeping spaces to the use of local dialect and leisure activities. See Related Summaries below for more information on the HCD process, as well as "Insights Report: Using Human-centered Design to Strengthen Guyana's Malaria Testing and Treatment Adherence Program" [PDF].

The LMBP campaign that emerged from this process uses a visual low-literacy approach to achieve its SBCC objectives, which were to increase the proportion of gold miners perceiving themselves to be at risk of malaria, testing for malaria within 24 hours of experiencing symptoms, completing MOH-approved treatment, and sleeping under a long-lasting insecticide-treated net (LLIN) every night. The campaign used a mix of animated characters (mainly "Mike the Miner"), live actors, and real miners in the local mining context to appeal and relate to the intended audience. All LMBP materials carried a campaign logo, brand colours (blue, yellow, and white), and a slogan. The materials were first piloted early in 2019 and then brought to scale later that year.

The particular SBC activities included the following:

• "Jungle Feevah" radio serial drama: This eight-episode entertainment-education mini-series served as the original centrepiece for the LMBP campaign and the lead-in for several other products. The mini-series had both animated and radio versions that explored the life of the fictional miner, Mike, and his work in the mines, his interactions with fellow miners, his relationship with his family, and his experience with malaria.
• Campaign theme song and music video: "Big Problems Coming" is a Soca song performed by Brandon Harding, a popular Guyanese artist. The song uses phrases from the local dialect to position the little mosquito as a big problem that can transmit malaria but can be addressed through testing and full adherence to treatment following a positive test. Breakthrough ACTION produced an animated music video to accompany the song and illustrate its key messages.
• Radio spots: Four radio spots featuring conversations between miners or between miners and their partners elevated the seriousness of malaria in mining areas and encouraged prompt care-seeking, adherence to treatment, and correct and consistent LLIN use. The spots addressed behavioural barriers identified during the HCD research, such as the concern that using an LLIN can cause a rash and the tendency to stop taking treatment once symptoms start to go away.
• Live actor TV spots: Two types of video-recorded live actor spots (one minute each) were used to promote malaria prevention, testing, and treatment messages on social media and television. Some featured real-life gold miners sharing their experience with malaria and steps they took to prevent and/or overcome the disease. Others used performance actors who employed Guyanese Creole and humour to highlight issues such as: how to obtain and maintain an LLIN; the importance of getting tested as soon as symptoms such as fever, headache, joint pains, or vomiting appear; and the importance of adhering to the MOH-approved treatment.
• LMBP Facebook page: This page initially presented posts from the perspective of the fictional miner Mike detailing his experience with malaria and giving advice on malaria prevention, testing, and treatment adherence. Based on feedback from miners during monitoring visits, Breakthrough ACTION subsequently used the page as a platform to share materials related to the LMBP campaign, disseminate malaria-related information, and spotlight real-life malaria champions in the regions. During the height of the COVID-19 pandemic, Breakthrough ACTION integrated subtle COVID-19 prevention messages into the social media content. For instance, the characters wore masks to cover their mouth and nose.
• DVDs: Due to limited internet in the mining areas, the campaign developed a package of audio-visual materials in a digital format on DVDs to expand reach. The DVDs, which included the theme song "Jungle Feevah", animated miniseries, and four radio spots, were distributed to mining camps, local restaurants, shops, and other public places.
• Banners/billboards: Banners highlighting prompt care-seeking were initially mounted on fences at ports of entry (airstrips, boat landings), health facilities, and high-traffic junctions by project and/or MOH staff. Later, they were placed in wooden frames as billboards to improve their durability. The content was provided in English, Spanish, and Portuguese.
• Road signs: Road signs were placed near tester locations, which were previously poorly or not identified, to promote testing and treatment sites.
• Brochures: "Malaria: What You Should Know" bi-fold brochures used simple language and illustrations to describe how malaria is transmitted; highlight malaria symptoms; outline when and where people should go for a malaria test and why they should complete their treatment; show the benefits of LLINs; and explain how to care for their nets. Developed in English, Spanish, and Portuguese, the brochures were primarily distributed to health facilities and formal mining camps and displayed in waiting and dining areas. Community members could also obtain brochures at community talks by malaria community groups that were formed as a part of an MOH initiative. MOH field staff replenished brochure supplies during follow-up visits.
• Posters: The colourful posters in the three languages were used to prompt care-seeking, treatment adherence, and LLINs. They were distributed to mining camps, testing locations, health facilities, restaurants, hotels, and transportation hubs. The posters were produced in vinyl material to withstand exposure to weather and environmental conditions in the interior.
• Branded flash drives: Breakthrough ACTION integrated popular music with malaria messages by influential disc jockeys (DJs) on flash drives branded with the LMBP logo. The MOH and project staff distributed the flash drives to bars and shops in mining communities and transportation providers that traverse interior locations.
• Support to volunteer malaria testers (VMTs): The Breakthrough ACTION Guyana project supported the MOH in developing a package of SBC interventions to increase the visibility of the MOH VMTs, to equip them with the necessary tools to counsel clients effectively, and to recognise the VMTs for their efforts to improve retention. Click here [PDF] to find out more in a Breakthrough ACTION Activity Brief.
• Strengthening SBCC capacity: One of the main goals of the Breakthrough ACTION Guyana project was to increase the capacity of local institutions such as the Guyana MOH to coordinate, design, implement, evaluate, and advocate for high-quality SBC programmes. Click here [PDF] to find out more about this activity and the lessons learned.
• Support to LLIN distribution campaigns: Breakthrough ACTION provided SBC support to the MOH's 2021 and 2024 LLIN distribution campaigns. Click here [PDF] for more information.
• SBC activities around COVID-19: As the campaign was running at the time of the COVID-19 pandemic, it also supported SBCC in relation to COVID-19. More information about this support can be found in the following two publications:
  • Protecting You, Protecting Us COVID-19 Prevention [PDF]
  • Sleeves Up Increasing Uptake of COVID-19 Vaccines [PDF]
     

Following the first two years of implementation, in February 2023, Breakthrough ACTION and the MOH employed a second HCD process to further refine the SBC interventions. Insights were used to launch a new complementary suite of interventions that were implemented as part of the final Phase II of the campaign. See Related Summary below for a separate programme description of Phase II.

Formative research conducted by Breakthrough ACTION and stakeholders early in the project showed that gold miners working in the interior and hard-to-reach regions of Guyana viewed malaria as routine and commonplace. They believed that getting malaria "in the bush" was inevitable and not a significant concern when it happened. They also considered life in these areas to be inherently risky; work in the mines was dangerous, and the health risks posed by the job outweighed those of malaria. Breakthrough ACTION used these insights to co-create the LMBP campaign.

Breakthrough ACTION conducted a rigorous mixed-methods, theory-based evaluation of the project to assess the reach and behavioural impact of its SBC activities. Cross-sectional quantitative surveys conducted in 2019 and 2022 - pre- and post intervention, respectively - measured key results from the project's two primary interventions: (i) the LMBP campaign and (ii) support to the VMT programme. Breakthrough ACTION also conducted qualitative interviews with 19 VMTs, regional Vector Control Services/National Malaria Programme (VCS/NMP) supervisors, mining camp managers, and NMP staff in 2022. See Related Summaries, below, for the evaluation report. A summary of the findings can also be found in this brief: "Effect of Social and Behavior Change Activities on Malaria Behaviors in Guyana" [PDF]. 

Lessons learned, in brief, included: 
 

• Immersive discovery interviews and "listening to learn" yielded deep contextual and behavioural insights that shaped the strategic direction of the campaign.
• Multi-purpose field visits conducted jointly with regional VCS/NMP provided invaluable opportunities to monitor implementation and adjust the campaign accordingly. From these field visits, for example, the team learned that TV spots that featured real miners and humour appealed greatly to the priority audience. While the campaign initially utilised an animated approach, pivoting to TV spots that featured real people resonated with miners since they enjoyed seeing themselves or people they knew, and they were more likely to engage with social media content.
• Effectively reaching gold-mining populations in the hinterland regions requires innovative dissemination strategies, as gold miners do not follow a "typical" schedule or have easy access to traditional forms of media.
• Merging malaria topics with other health and entertainment content helps keep the campaign content fresh and interesting. Continuously generating novel content for one vertical health area was a challenge for Breakthrough ACTION early in the project. Knowing that message fatigue is likely if content is overly repetitive, the campaign made an effort to develop content that was unique and engaging while striking a balance in tone that was simultaneously serious and humorous, informal yet trustworthy.
• Seasonality influences implementation. While malaria is present year-round, it is more prevalent during and immediately after rainy season. Breakthrough ACTION designed its activities to take this seasonality into account.
• The LMBP SBC campaign is reliant on the accompanying service delivery infrastructure to succeed. Where SBC generates demand, the appropriate supply-side service delivery mechanisms must also be in place to meet this demand.

For more information on programme results and lessons learned, click here [PDF].