Publications

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Communication Impact! 6

Uganda Communication Campaigns Spur Integrated Health Programs (October 1999)

A series of strategically designed, integrated behavior change communication campaigns in Uganda contributed to an increase in the contraceptive prevalence rate from 12.6% to 18.6% from 1995 to 1997 (DHS 1995 & DISH Survey 1997). The campaigns also helped increase condom use among men to prevent sexually transmitted diseases (STDs) from 7.8% to 11.8% (DHS 1995 & DISH Survey 1997); and contributed to a 55% increase in the number of monthly client visits at 75 sentinel health facilities (Figure 1).

The DISH Project

The Delivery of Improved Services for Health (DISH) Project, in partnership with the Uganda Ministry of Health and the District Health Services of the participating districts, has launched a series of multimedia campaigns on various reproductive, maternal and child health topics. The campaigns direct potential clients to health facilities for information and services and encourage improved individual health attitudes and behavior. The slogan Family Health Made Easy emphasized easy access to many services under one roof and the Rainbow-over-the-Yellow-Flower logo identifies health facilities offering these integrated services.

The interrelated communication campaigns were designed to promote, complement and reinforce simultaneous DISH Project efforts to: train nurses and midwives to provide integrated maternal, infant and reproductive health services (meaning that clients can get a full range of services during the same visit, often from the same health worker); train doctors and medical assistants in the syndromic management of STDs; expand HIV counseling and testing services; and provide training in logistics and management information systems.

To date, a total of seven campaigns have been launched (Figure 2). Since 1995, the DISH project has encouraged married men and women to use modern family planning (FP) methods to Plan today and enjoy tomorrow. A simultaneous 1995 Safer sex or AIDS campaign encouraged youths 15-19 years old to wait until marriage to have sex or to use condoms to prevent HIV/AIDS.

In 1997 DISH designed, distributed and publicized the Rainbow-over-the-Yellow-Flower logo, referring audiences to facilities displaying the new symbol for services and information on FP, antenatal and postnatal care, immunizations, STD treatment and HIV counseling.

A 1998 DISH campaign encouraged women to begin antenatal care during the first trimester, to attend antenatal clinics at least three times during each pregnancy, and to recognize signs of pregnancy complications. In 1998 DISH also released materials and organized district-based activities that encouraged men and women to prevent and/or treat STDs correctly. In February 1999 DISH launched a campaign encouraging men and women to Take control of your life and go for HIV counseling and testing, preferably together, at newly established rural counseling and testing sites. In June 1999 the project launched another campaign promoting exclusive breastfeeding for the first six months of a child’s life.

Campaign Design

Each communication campaign was developed to reach specific audiences with tailored messages, materials and interventions, strategically designed to meet specific objectives. The STD campaign’s objectives are to increase the number of married men with multiple sexual partners who practice safer sex and who attend a health facility with established services for STD treatment. The Maternal Health campaign aimed to increase the number of rural married women who attend antenatal care services at least three times during a pregnancy.

The campaigns were designed to be implemented in three stages: first, promoting existing FP services and addressing HIV/AIDS prevention; next, focusing on STDs and maternal health services, to coincide with training activities to enhance the provision of these services; and then promoting HIV testing and counseling services as they became more widely available. Each stage was built upon and reinforced the previous one. While each stage focused on a different service or issue, it simultaneously promoted the issues of the previous campaign. At any one time since 1997, as many as four separate communication campaigns have been going on simultaneously (Figure 2).

The campaigns include a mix of television, radio, print and community education activities (such as the weekly "Choices" radio program which won the 1998 Global Media Award for Best Radio Program on Population Issues), drama performances, video shows, village meetings, soccer matches, special World Cup promotions during the event (June-July 1998), bicycle rallies as well as training and client education materials such as flip charts and cue cards. All materials are produced in three or four languages, for different audiences.

Critical to the success of the campaigns was the role of the District Health Services personnel. Strategy sessions helped District Action Committees, comprised of NGO and government officials, to incorporate strategic communication campaign management into their planning. Innovative administrative mechanisms were developed to place responsibility for funds management and much decision making at the district level. This decentralization of project management through the empowerment of district-level personnel has resulted in a strong sense of project ownership and active support by the local population.

Impact

In July 1998 the DISH Project interviewed clients attending 26 selected health facilities to evaluate the impact of the campaign on care-seeking for different services. Of 224 new STD clients interviewed, almost every one (99.6%) had seen or heard at least one campaign message; most had been exposed to messages from at least six different channels. More than half of the clients could name two or more consequences of improperly treated STDs. The more different channels they had been exposed to, the more likely they were to name at least two consequences. More than two-thirds stated that the campaign messages had influenced them to come for services that day. The Men’s Challenge Cup, a series of promotional activities of the STD campaign, was launched during the six-week-long 1998 World Cup, and helped produce the largest monthly number of client visits to 75 sentinel health facilities from August 1997 to December 1998 (Figure 1).

Among 674 clients attending maternal and child health or family planning services at the same 26 facilities in July 1998, 90% were familiar with the logo and 60% were able to name at least two services available at health facilities with the symbol. Some 28% knew that the services they sought were available because they had seen the family health logo.

Additional interviews at the same time with 220 new antenatal clients found that 95% had been exposed to at least one campaign message and more than half stated that the campaign messages had influenced them to attend antenatal services on the day of the interview. Some 43% of clients could name three pregnancy warning signs.

In Uganda the DISH Project’s health communication campaign promotes each service individually and as part of an integrated program. By promoting new services as integral to existing ones, each successive wave of messages reinforces the concept that all of the services are related and available under the Rainbow-over-the-Yellow-Flower. Furthermore, the synergy created by the comprehensive nature of the DISH Project-- communicating about, training for, managing and providing health services--is helping to make the integration of family health services in Uganda a reality. The project, in partnership with the Uganda Ministry of Health and the District Health Services, is indeed helping to make family health easier for the people of Uganda.

To learn more about the Uganda DISH Project, contact:

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