To improve access to care for women and vulnerable groups with VL in Bihar, it is first important to understand access. Objectives for this activity are:
- Establish reasons for lower reported number of female VL cases at village, household and individual level
- Improve attitudes of Accredited Social Health Activists (community health workers) and health care providers in terms of identification and referral of female patients with suspected VL
- Based on Operational Research findings, work with the National Programme on Information-Education-Communication/Behaviour Change Communication strategies to improve access to care for female VL patients
In 2016, training modules and materials were developed, and field level training started as well. Since then, over 28,000 health workers have been trained in VL and PKDL related issues, such as identifying and referring suspected cases to UHCs, screening for VL and PKDL and managing them clinically, and delivering IEC/BCC interventions. Training has addressed clinicians working in medical colleges and tertiary level hospitals in endemic areas, private practitioners and informal healthcare providers, as well as frontline government workers, NGO health workers, and other community leaders such as high school head teachers.
Sensitization of the community through KalaCORE supported IEC/BCC interventions is estimated to have directly covered over 2.2 million and indirectly reached over 10 million people from 2016 to 2018.
Community members have been reached at monthly grassroots government led meetings, via school activities (e.g wall painting) or during school awareness programmes. Other BCC activities at endemic areas included screening of a purposely developed docudrama, participatory Gazigaan (local folk song) sessions, and the distribution of materials with information on VL – e.g. handouts, penholders, posters installed in strategic places like pharmacies or local health providers’ chambers.
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IEC/BCC activities in Nepal started with the development of a national IEC/BCC strategy together with national stakeholders. The IEC/BCC messages for VL control were endorsed by government stakeholders, including the Epidemiology & Disease Control Division, and the National Health Education, Information & Communication Centre and the WHO country office for Nepal.
Female Community Health Volunteers (FCHVs) and Community Health Workers (CHWs) have been trained on VL/PKDL identification at the community level. IEC/BCC materials were developed following a review of the strengths and weaknesses of existing communication materials. New materials were produced over the years includes posters, leaflets and flip books which have been distributed during the training of Female Community Health Volunteers, health care providers in the early recognition / identification of VL. Radio messages have also been broadcasted through local FM radio in local languages. By Oct 2018, we estimate that about 6.5 million people have been reached by IEC/BCC activities in Nepal.
KalaCORE has worked on improving awareness and treatment seeking in South Sudan through development and updating of appropriate IEC materials in coordination with the Ministry of health, UNICEF and WHO. The IEC materials were officially launched in October 2017. The IEC materials have also been translated into 4 local languages which are spoken in the Kala Azar endemic States. These languages are Arabic, Nuer, Dinka and Toposa, training of health workers and community leaders on the use and dissemination of the IEC materials and the health messages and distribution of the IEC materials to all the endemic States. By February 2019, around 61,235 people have been reached by IEC/BCC activities and a total of 5,972 IEC materials had been distributed.
Health education in Sudan was implemented by the WHO with support from KalaCORE. Innovative and cost-effective strategies for health education were developed in close collaboration with the MoH and began in early 2016 in the state of Gedarif.. After further development of the health education strategy, an array of Behaviour Change Communication (BCC) and Social and Behaviour Change Communication (SBCC) interventions also started and by April 2018, sensitisation on VL reached not only populations in endemic Gedarif and Sinnar states and in new VL foci locations in Kassala and Red Sea states, but also seasonal workers from Ethiopia and Eritrea, refugees from South Sudan and IDP populations. Health education of patients was undertaken in all 44 KalaCORE-supported VL treatment centres in 12 states across the country. Health promotion training was also provided to women volunteers, community workers, teachers and 'kala azar ambassadors' (former patients).
A range of activities have taken place to increase community awareness of VL: from home visits, child-to-child activities, distribution of BCC materials (street banners, posters, T-shirts, side caps) to organisation of forum theatres and mobile cinemas, participation in local festivals and radio programs. An estimated 2 million people were reached by October 2018.
The clinical mentoring teams have also actively contributed to health education activities in Sudan during visits to VL treatment facilities. On top of supporting VL clinical management they have also trained health promoters, conducted community awareness during supervision visits and met with local stakeholders to advocate and encourage community commitment on VL control.
One of the barriers to effective vector control is the acceptance of IRS in the communities. In order to improve the uptake of IRS in India, KalaCORE decided to support the sensitisation of the community pre-IRS by delivering IEC/BCC interventions together with New Concept Information Systems.
Large scale Information-Education-Communication and Behaviour-Change-Communication campaigns started in 2015 in 7 districts in Bihar to support IRS in districts where synthetic pyrethroid insecticide was being newly introduced. These were coordinated with the IRS micro-plan to raise public awareness prior to IRS delivery in the village. By 2016 more IEC/BCC interventions were developed and delivered in Jharkhand and West Bengal.
Such interventions have consisted of group communication sessions using films on Kala-azar developed especially for this purpose, information sessions with communities using flip books and leaflets, orientations of ASHAs and other community-level influencers and the display of KA posters at PHCs and in endemic villages. Also screening the kala-azar film in schools, using SMS Alerts and using public announcements and displaying information through mobile vans during IRS campaigns. More innovative approaches have been adopted to deliver IEC/BCC messages for VL in India, including engagement with Self Help Groups and training of female community members as sahelis to help educate, and refer suspected VL cases to diagnostic/treatment providers.
Data on IRS coverage and refusal rates at block and village level were not initially available. KalaCORE together with NCIS collected this coverage data together with information on reasons for refusal, which then informed Behaviour Change Communication messages. Preliminary data suggests that the presence of IEC/BCC messages had a positive impact, with a reduction in IRS refusal rates and a general increase in IRS uptake by the whole community.
KalaCORE has worked with the WHO to help raise awareness about VL in communities. An Integrated Health Promotion and Communication Guide for Leishmaniasis Prevention was developed in 2016. Media slots, brochures, posters and banners/billboards were produced. Training was also given to a range of media professionals and public relation officers in Amhara and Tigray. By April 2017 media campaigns to raise public awareness on prevention of leishmaniasis were undertaken through local radio and regional television.
After a pause in activities in 2017, educational activities resumed in 2018 using targeted prevention messages to raise awareness, encourage behaviour change and improve health seeking behaviour in relation to VL. Some of these activities have included:
House to house education, peer education in schools, at health facilities and in farm areas, health extension workers, teachers and land managers have been reaching their target groups with educational messages, alongside relevant ‘sign posting’ - brochures, posters and billboards with prevention messages.
By October 2018 over 1.4 million people were estimated to have been reached by KalaCORE supported health education; around half of these represent the seasonal worker population who are most at risk group of people in Ethiopia of being infected and developing VL.