Uganda’s Nutrition and Early Child Development project - Counting on Communication
Cecilia Cabanero-Verzosa
In 1998, a $34 million World Bank loan for the Nutrition and Early Child Development Project (NECDP) was approved to support the National Program of Action for Children. The NECDP covered about 8,000 communities in 20 of Uganda’s 39 districts, selected based on levels of malnutrition, infant mortality, and primary school enrollment rates.
The project sought to halve malnutrition among preschool children, raise primary school enrollment, reduce dropout and repetition rates, improve psycho-social and cognitive development, and increase the number of mothers practicing appropriate childcare.
A strategic communication program was designed to help mothers and other caregivers adopt new behaviors needed to achieve project outcomes. It helped the NECDP team identify necessary changes in behavior, knowledge or attitude for all target audiences; frame project-related issues relevant to different stakeholders, such as parliamentarians, mothers, community leaders, educators, and local government administrators; craft persuasive messages according to their needs, concerns and perceptions; and use the most appropriate communication channels.
The communication strategy included a:
- National advocacy effort aimed at parliamentarians, health and education ministry officials, district officials and community leaders;
- Multi-media campaign that emphasized three behavior change interventions: weaning practices, de-worming and ECD-related behaviors;
- Training program for health workers and pre-school teachers on their role in improving the health and nutritional status of pre-school children; and
- Monitoring and evaluation component to ensure that materials were disseminated via cost-effective channels of communication and that messages reached target audiences.
How Communication Helped Mobilize Parliamentary Support
Parliamentary support was not readily apparent as little as three months prior to project approval. Parliamentarians were locked in heated debates on whether it was in Uganda’s interest to borrow money for such a project. Many were asking why Uganda needed to incur debt to learn how to take care of its children since Ugandans have been raising children for generations. To gain support within Parliament, a Parliamentary advocacy group was established. This helped raise awareness of the issue of stunting and its implications both for children’s cognitive development and for the long-term development of the country. Members of the advocacy group were given media skills training to help in their advocacy efforts and audiotapes with latest information project activities and status.
How Communication Helped Parents and Caregivers Improve Childcare Practices
The national multi-media campaign C.H.I.L.D. (Community and Home-based Interventions for Long-term Development) aimed to raise awareness of caregivers of the risks and negative implications of stunting and to address behavior changes needed to prevent it.
Communication activities focused on three practices: hygiene and sanitation (including de-worming), complementary feeding, and positive parental interaction. The main objective was to help caregivers understand the relationship between specific behaviors they undertake (such as feeding practices) and stunting. Communication sought to help correct misconceptions about hygiene and de-worming and publicize the availability of de-worming tablets at Child’s Days events and in health centers. Radio messages were aired to announce the schedule for Child’s Days in communities and reminded parents to bring children for de-worming.
Communication research demonstrated that current perceptions of proper childrearing were at odds with the new childcare concepts of encouraging the child to be active, inquisitive, and to explore his/her surroundings. Beliefs and attitudes about the “attention” a child needs emphasized meeting the infant’s basic needs for food, clothing and shelter, and downplayed the value of play and affection.
Communication activities to trigger behavior change included modeling the new behavior through radio dramas and street theatre, disseminating information to clear up misconceptions about specific child rearing practices, and mass media edutainment via roadshows, songs, awareness raising workshops in district and community centers. Posters/pictographs, newspaper inserts and radio spots carried messages about healthy diets, prevention from illnesses, helping a child achieve their potential, brain development, nutrition, hygiene and hand-washing practices. A community guide and training booklet were also distributed. Community-based activities (nutrition counseling, group meetings, home visits, training of community health workers and teachers) complemented and reinforced media-driven messages.
What The Project Accomplished: Evaluating Communication Impact
Improved knowledge and practices in childcare, health and nutrition
Source: Evaluation of Communication Activities. Steadman Research Services, Uganda, June 2003
Improved health and nutritional status : Malnutrition among children (0-36 months) was reduced by 30% in the project area. Exclusive breastfeeding, supplementary feeding, immunization rates, and intake of Vitamin A, and de-worming among children less than 72 months of age improved.
Effective
delivery of services : Child Fairs, an existing service
delivery channel for integrated health and nutrition, was successful
in increasing demand for de-worming medicine and Vitamin A. Child’s
Fairs proved to be a cost-effective channel to reach people with both
health services and strategic messages, with a cost per child of about
$1.00 to $1.33 for services, including inoculations, growth monitoring
and Vitamin A supplements. They were also one of the more effective
channels of communication for the delivery of messages through demonstrations,
skits and songs to provide information about child care, food production
and income-generating possibilities because they conveyed messages through
interpersonal contact, a more effective channel than written materials.
Higher school enrolment : Campaign
messages on the benefits of ECD practices appear to have had reinforcing
effects on increasing demand for early schooling. The longitudinal study
confirmed a positive impact on enrollment both relative to the control
group and relative to the initial enrollment in the project communities,
particularly for pre-school age children. Findings further suggest that
by age 12.5, the average child in the project area will have higher
school attainment than children in non-project areas.
Lessons Learned
- Develop a comprehensive communication strategy during project design. This can provide a clear understanding of the perceptions and positions of key stakeholders and address perceived fears and barriers to change.
- Integrate upstream and downstream communication. While upstream communication is necessary to obtain support of the project’s key “influencers”, downstream communication is needed to help project beneficiaries learn about new development concepts and practice new skills.
- Design a client-centered, research-driven and participation-based communication strategy. Effective communications is grounded on knowledge of the client’s perspective.
- Articulate behavior change required in Project Appraisal Documents (PADs). Include a communication strategy that identifies what knowledge, attitudes, and behaviors need to change for each target group.
- Measure behavior change, not behavior change communication inputs.
- Create national partnerships and build national capacity for communication. Behavior change is a long-term process; national groups are best able to maintain activities over the long term.
This article was written by Cecilia Cabanero-Verzosa, EXTCD. For more information, e-mail cverzosa@worldbank.org
The “Good Practice Infobrief” series is edited by P.C. Mohan, mail stop J-8-811, Knowledge and Learning Center, World Bank, 1818 H Street NW, Washington D.C., 20433. Tel. (202) 473-4114; e-mail: pmohan@worldbank.org