Madagascar
"Samia Mitondra Telo": Each One Invite Three
Activity Dates
2006-2007
Activity Summary
In November of 2004 the President of Madagascar, Marc Ravelamanana, convened a National Family Planning (FP) Promotion conference. During the conference, the President addressed participants stating that family planning was the highest priority of his administration. Donors subsequently lined up to support the President's initiative. Eight months later, however, with little progress having been made, USAID requested HCP to assist the Malagasy Ministry of Health with the design of a FP promotion strategy.
Together with the MOH and USAID-funded partners, HCP developed Samia Mitondra Telo (Each One Invite Three), a promotion strategy built upon the understanding that Madagascar had already passed the FP "tipping point." That is, with close to 20% of women using modern contraceptives and 44% stating that they would "like to use contraceptives in the future" a total of two-thirds of all women now have favorable views of family planning. Despite this dramatic shift, documented by the 2003 DHS, health officials were still operating under the assumption that FP was a hard sell.
The promotion strategy is based on the concept that the women who would "like to use contraceptives in the future" can be further subdivided into groups. At the leading edge are those couples who are very eager to begin using FP (e.g., usually following the birth of a child, a difficult delivery). The FP invitation cards target this group. The assumption is that in any population a small percentage of the population is so ready that they only need to be invited to the FP center by someone they know and trust. The communication catalysts of the strategy are "family planning invitation cards" which satisfied clients hand out to their friends and neighbors who they think are ready to visit a FP center.
Key strategic components include:
- Radio: By broadcasting via 20 or more stations, the strategy seeks to "saturate" the environment with FP promotion messages. Achieving the appropriate balance between central initiatives and local efforts has been an important consideration. A 3-month mini-campaign in early 2006 helped lay the groundwork for this component.
- "Direct mail" (Malagasy style): This effort will take the notion of the FP invitation card and bring it to maturity. Tapping into a network of trusted friends has great potential, especially if cards are tied to TV and radio spots.
- High FP Visibility at Health Centers: This involves a series of "FP promotion" elements that will add a little class, warmth and color to the overall FP effort.
Between August and October 2006 the strategy was tested in six communes, two active in the USAID-funded SanteNet project, two engaged in the World Bank funded Rapid Results Initiative, and two in communes without any FP promotion program. The results were spectacular--a 45% CPR increase in 3 months. The MOH was eager to expand activities across the country. As of June 2007, one-third of the districts across Madagascar are engaged in Samia Mitondra Telo. UNFPA, which manages the FP funding for the other two-thirds of Madagascar's districts has promised funded at the start of its next fiscal year in July 2007.
Implementation
FP Providers and DBC agents are equipped with note pads of postcard size FP invitations. The provider or DBC agent simply asks FP clients if she has any friends or family members who might be interested in using modern FP methods. Experience has shown that even in regions where the contraceptive prevalence rate is very low, every client knows 2 - 3 other women whom she thinks would be interested in FP.
 Invitation cards have been designed for specific target groups--the rural population, urban professionals, special cards for men, etc. The client takes several invitations home (each card cost less than 2 US cents; the unit price is usually for a note pad of 100). When a client gives a card to a neighbor or, perhaps, her sister, the card frequently catalyzes discussion about FP. "I had no idea that you were using family planning" is a common reply. This of course prompts the contraceptive user to explain the benefits.
In this respect, family planning invitation cards work like direct mail--except that instead of the postman delivering the invitation, a good friend or trusted neighbor does. What network could possibly be more efficient? As with direct mail, frequently the potential client acts only after receiving 2, 3, or 4 invitations. Often the invitations are just enough to lower the anxiety that accompanies the first visit to the FP Center. Couples often show up at the FP center and display the card, as if to say "this isn't my idea, where should I go?" The provider then can signal to the new client where the FP services are located with out any potentially embarrassing discussion.
An equally effective variation is to present invitation cards to mothers right after they give birth. These cards promote exclusive breastfeeding and also set a rendezvous for a new mother to return to the health center in 4 months. When the mother returns, providers ask if they would like to switch from the natural FP method (exclusive breastfeeding) to a modern method. FP invite cards can be distributed through women's or men's groups too. The key is to insure that they are not handed out en masse but are always linked to a network of trusted advice and friendship.
With a FP communication strategy in place and excellent logistic support, Madagascar is poised to make important gains in its contraceptive prevalence rate in the next 5 - 10 years. A formal evaluation scheduled at the end of 2007 will determine exactly to what extent friendly invitations to use family planning can catalyze the uptake of this national health priority.
Audience
Adolescents
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