Using SBCC to Create Demand for Mosquito Nets in the Private Sector

"Malaria Consortium Uganda set out to create a ‘malaria control culture’ in Eastern Uganda, Tororo District, through a 3-year project."

According to this presentation for the International SBCC Summit 2016, Addis Ababa, Ethiopia, February 8-10, the Malaria Consortium created this social and behaviour change communication (SBCC) project using mass LLIN (long lasting insecticidal nets) distribution as an entry point for fostering a malaria control culture by:

• "developing routine LLIN distribution channels through ante-natal care services and schools, to ensure the continuous flow of nets into communities, following a universal coverage campaign
• "enhancing community value of, and demand for, LLINs through both public and private sectors"

The communication intervention objectives were:

• '"To create a culture of sleeping under an LLIN every night:

              - To enhance value attached to mosquito nets

              - To create sustainable demand for nets in the private sector, beyond the free distributions

• To promote the other malaria control key behaviours:

            - Seeking treatment within 24 hours of fever onset
            - Testing before treatment
            - Adhering to the test results
            - Adhering to the prescribed treatment"

The channels for focusing on "the eco-system of behaviours" included: mass media, in particular, radio; person-to-person dialogues through drug shops; and mobilisations and information, education, and communication (IEC) materials at health facilities.

Key elements included:

Push - key SBCC motivator messages, such as "Have a good night's sleep" and "It is a way of life".
Pull - support to private sector development, such as:

• "Trained and mentored the drug shop owners on how to leverage on the SBCC campaign
• "Promote the participating private outlets as your source of quality mosquito nets"

A monitoring and evaluation framework was developed that includes, for example, a household survey each year, focus group discussions, and private sector LLIN yearly sales surveys. Results include charts on:

• frequency of sleeping under nets (up from 89% in year one to 96% in year two)
• willingness to buy a net (74% in year one, 79% in year two)
• reported actions after exposure to campaigns, including, for example: encouraging others to sleep under nets, buying a net, and talking to others about using nets.
• increase in LLIN sales from 2,535 to 3,200.

Sustainability elements include, for example :drug shop owners seeking ways to pay for the SBCC campaign; private sector seeking to produce LLIN; Malaria Consortium training and mentoring of private sector on marketing, sales, and distribution; and district health team support for the private sector distribution of LLIN.

Lesson learnt include:

• "Constant reminders and incentives are needed to create sustainable demand
• An SBCC campaign designed with private sector involvement and promotion support elements helps attract the interest of the private sector
• Anchoring the products and behaviour(s) being promoted in the local values and beyond health gains helps communication efforts reach the target audience
• A campaign designed to target the eco-system of the audience and involving all stakeholders gets more traction
• Changing behaviours requires addressing both push and pull factors in an integrated manner."