Urban Primary Health Care Services Project (UPHCP-II)
The Second Urban Primary Health Care Project (UPHCP-II), initiated by the Local Government Division of the Ministry of Local Government, Rural Development and Cooperatives, has been targeting health care of the urban population, especially the poor. With the aim of increasing access to primary health care services, UPHCP-II provides services in 24 partnership areas in six City Corporations and five selected Municipalities of Bogra, Sirajganj, Savar, Comilla and Madhabdi, with a special feature of providing at least 30 per cent of each of the services for free to the poor. The project operates its health care services through 24 Comprehensive Reproductive Health Care Centers known as Nagar Matri Sadan, 161 Primary Health Care Centers known as Nagar Shastha Kendra and 600 Satellite Clinics located in the selected 24 partnership areas.
Acting as the Behavior Change Communication and Marketing (BCCM) firm of UPHCP-II since July 2007, BCCP was responsible for designing, implementing, coordinating and evaluating the BCCM component of the project. At the initiation, BCCP undertook a stock taking exercise and conducted a Needs Assessment Study to assess the BCCM needs of the project. Then a Behavior Change Communication and Marketing (BCCM) Strategy was developed by BCCP under the guidance of the Project Management Unit (PMU) of UPHCP-II involving all concerned officials, partners and stakeholders. Following this strategy, year-wise work plans were developed and all BCCM activities were then conducted according to the work plans.
First of all, a Knowledge, Attitude, Behavior and Practice (KABP) survey was conducted to generate base-line data of the level of awareness among people living in the project areas about the services delivered by the UPHCP-II service centers, their attitude towards the health centers and the extent of utilization of services by them. Simultaneously, with a view to brand the services and the service centers with a common symbol, a branding logo was designed and developed. The newly developed logo “rainbow” was then promoted by conducting a well orchestrated campaign both at the national level and the local level that involved production and utilization of a number of BCC materials. Another objective was to develop BCC capacity of different categories of service providers to enable them to plan, conduct and evaluate BCC programs at the local level. As a result, service providers of different tiers were given BCCM training as well as Inter-Personal Communication and Counseling (IPC/C) training, and also Advances in Health Communication Workshops and Message Development Workshops were conducted. In a bid to involve other stakeholders, leaders and influential people, different advocacy workshops, orientation programs and Future Search Conferences (FSC) were conducted utilizing a well-designed Advocacy Toolkit and other BCC materials as appropriate.
Alongside these major activities in the first three years, BCCP also carried out a number of supporting activities including production and supply of BCC materials and regular monitoring visits to the PA Units to help them plan, implement, monitor and evaluate local level BCC activities. In the fourth year, the main attention was on consolidating BCCM interventions aiming a marked increase of client flow in the UPHCP-II service centers. This special drive included production and airing of a 13-episode Television Drama Serial and launching special campaign supporting the airing of the TV drama serial.
Airing of the TV Drama Serial Gari Chole Na
To promote the health care services and the service centers of UPHCP-II, a 13-episode entereducate television drama serial Gari Chole Na was produced as part of planned major BCC interventions. Each of the episodes dealt with a message on a particular health topic which was delivered in an entertaining way as part of the drama. Written by the noted playwright Humayun Ahmed and directed by talented Director Animesh Aiech, the drama was aired in the popular TV channel, ATN Bangla once a week beginning from June 18, 2010. Centering on the common elements of various social issues, the drama projected different characters in families, social harmony vis-a-vis conflicts, social discrimination among the rich and the poor, widely believed superstitions, negative vis-a-vis positive attitudes of family members etc. Matching with the normal flow of the drama, health-related messages were conveyed appropriately which were reinforced by using ‘fact pack’ technique that involved repeating the main messages by the main characters at the end of each episode of the drama.
To have the best possible impact from the airing of the drama, specially designed national and local level campaigns were conducted. At the national level, a press conference was held, press ads were given, road show was organized, TV ad was given in the cable channels, posters and leaflets were produced and distributed, campaign guideline for local level campaign was developed and distributed. On the other hand, local level activities included miking, distribution of posters and leaflets, arranging display of ad in the scroll message given by local cable channels, organizing live shows in the clinics and other public places, motivating owners of shops and local organizations having television to arrange live show, allowing discount for the health service charges during the entire period of airing of the drama etc. In addition, some PA Units made some special arrangements like publishing of press ad in the local newspapers, organizing quiz competition, involving local elites etc.
The Technical Officers of BCCP made extensive travels to the PA Units to provide technical assistance in effectively conducting the local level campaign activities centering round the airing of the drama. At the last leg of the airing program, the Technical Officers talked to different level service providers and stakeholders to get a sense of the impact of airing of the dramaserial and the associated campaign activities. Initial responses suggest that the drama was liked very much by the intended audience and that the client flow has started increasing.
Advocacy Video to Project UPHCP-II at a Glance
With a view to project the aims and objectives of UPHCP-II, its functions, partners, donors, areas of operation, major achievements and success stories, a 13-minute Advocacy Video was developed by BCCP under the guidance of the Project Management Unit of UPHCP-II. Developed in Bangla, the video also contains English sub-titles so that all concerned can have an understanding about what the project is all about. This video is suitable for using in any gathering including meeting, group discussion, workshop, seminar etc. to let the audience know what is going on under the project. Copy of this video has been supplied to the concerned officials, stakeholders, partners and the PA Units so that they can use it when needed.
Advocacy Activities
BCCP conducted two awareness raising workshops with Ward Primary Health Care Coordination Committee members in Sirajgonj in April 2011 and in Rajshahi in May 2011. Partner NGOs Srijoni in Sirajgonj and PSTC in Rajshahi organized these events.
Training for Health Care Service Workers
To improve the skills of health service providers, BCCP collaborated with Management, Support and Training (MS&T) firm and organized several training sessions on "Interpreting Non-Verbal Communication" between November 2010 and March 2011. Each session had 25-30 participants and was conducted in Dhaka, Rajshahi and Khulna. Additionally, a couple of training sessions on ‘Individual and Group Counseling’ were held in Dhaka in November 2011. BCCP facilitated and provided other technical support to MS&T in conducting the sessions.
Message and Theme Development Workshop
As part of the BCC Capacity Building Initiative, a Message and Theme Development Workshop was conducted at BARD, Comilla, in November, 2010. Facilitated by senior professionals of BCCP, it was attended by 32 participants among whom, 25 were different categories of service providers and 5 were creative persons having creative skills and experience in developing messages and materials. The main objective of the workshop was to enhance message development skills of service providers and take initiative to develop message for promoting UPHCP-II activities. The participants of the workshop developed 10 messages by following the message development procedure.
Guidelines and Curriculums
To equip the PA Units with needed documents for conducting BCC and advocacy activities and training programs, a number of guidelines and curricula were developed and distributed amongthe PA Units. These include guideline for dialogue sessions for the formal and informal leaders, TOT curriculum for peer education on ARH issues, guideline for discussion with slum leaders, religious leaders and other influential leaders etc.
Newsletter
Nagar Shastho Barta, a quarterly newsletter providing activities and success stories of UPHCP II was produced and distributed regularly.
End-line Evaluation
To have an understanding of the trend of the program resulted from the BCCM interventions already introduced and at the last stage of BCCM program, an end-line evaluation was conducted to get the latest data with regard to the knowledge, attitude, practice and behavior of the people in the project areas which could be compared with the base-line data to analyze the impact of the BCCM program. Accordingly, an external, independent research organization named Org-Quest Research Limited was selected for this purpose following a competitive selection process. Subsequently, the organization was oriented on UPHCP-II and introduced to the concerned officials of PMU, PIU and the PA Units to enable them to work smoothly and independently. Data collection of this survey has been completed and currently processing of the data is in progress. Preliminary findings suggest that the BCCM interventions had a remarkable positive impact on the program. The overall coverage of UPHCP-II is on the rise.