INTERNATIONAL SBCC SUMMIT 2016 Elevating the Science & ART of SBCC Addis Ababa, Ethiopia February 8-10, 2016

Background  TCDC is a local organization  Leader in social behavior change communication and social development in Tanzania  TCDC uses a multiple approaches to address key health and education issues  TCDC operates in 17 regions each lead by Regional Managers who oversees sub granted CBOs at district level  At ward level there are Community Change Agents (CCA) assisted by 2 village volunteers in each village

Linkage evidence from TZLinkage evidence from TZ  Communities need to be educated about health issues and informed about availability of health services in their respective areas of residence  The key need in demand creation is to assure that those receive education/information are successfully linked with health services  Tracking successful referrals/linkages is a challenge which is experienced by many countries

Linkage evidence from TZLinkage evidence from TZ  Using of multiple channels to create demand including media campaigns, community events, community mobilization and launching activities bring large number of people together  The existing of Community Change Agent (CCA) in each ward is an opportunity to provide education and linkage to services to population that otherwise do not regularly access health services  CCA provide educational sessions using CRK in one to one or small group. They conduct one session per week  Village volunteers assist CCA to organize and gather people for educational sessions

Linkage evidence from TZ Case Study #1: Linkage evidence from TZ Case Study #1: Community Mobilization Referral Forms July 2015, TCDC in collaboration with the Ministry of Health and Social Welfare introduced referral forms to CCAs The form has 2 parts; upper part filled by CCA and lower part by health provider after attending the client TCDC team started with modified referral form and then realized it was received better to use the standard one from the Ministry of Health and Social Welfare

Case Study #1:Case Study #1: Community Mobilization Referral Forms CCAs conduct participatory community outreach sessions with small groups using a comprehensive community resource kit (CRK) Following the sessions, CCAs fill out the top portion of a referral form and give it to participants to take to the referred health facility. Following service delivery, the provider fills in the lower portion

Case Study #1: Case Study #1: Community Mobilization Referral Forms  Ideally the client is supposed to return the lower part of the form to a person who gave him/her a referral after being attended  In most cases in Tanzania clients do not return the lower part of the form because they do not resides in the same area with the CCA/volunteers  TCDC structure of having CCA in each ward is an advantage for clients to return back the lower part to CCA  CCAs are trusted and well received by the community because they live in the same ward with their clients

Case Study #1: Case Study #1: Community Mobilization Referral Forms How to track complete referrals: 1.CCA establish good rapport, relationship and trust with clients and ask them to return lower part of the form to CCA 2.TCDC and health facility in-charges agreed to have one place e.g in Medical In-charge office to put the lower part of the forms 3.CCA allocate a day every after 2 weeks to go and collect the lower part of the forms from the agreed place 4. CCA identify those who did not attend the service and plan follow up by calling, SMS or home visit to encourage them to visit health facility This has resulted in improved monitoring and an increase of completed referrals

Referral Data from 3 Regions July – November 2015

RegionReason for referral Number of Male completed referral Number of Female completed referral Total TaboraHIV Testing and counseling Malaria71421 VMMC101 Family Planning52126 TB178 eMTCT011 Care & Treatment 011 Others (pregnant test) 011 Total205979

RegionReason for referral Number of Male completed referral Number of Female completed referral Total KataviHIV Testing and counseling Malaria VMMC404 Family Planning21012 TB022 eMTCT000 Care & Treatment 000 Others000 Total

RegionReason for referral Number of Male completed referral Number of Female completed referral Total SimiyuHIV Testing and counseling Malaria202 VMMC000 Family Planning303 TB314 eMTCT000 Care & Treatment 000 Others000 Total282957

Case Study #2: Service Provision at Community Events Community events create demand using entertainment education and large number of people are reached Combination of events and service delivery at one point in time, resulting in significant increases in service uptake compared to daily routine services In February 2015, TCDC in collaboration with several service delivery partners conducted a 3 days community-wide event

Case Study #2: Service Provision at Community Events

Public announcement using roadshows and media messages to advertise the event is conducted a week prior to event Using of entertainment pulled many people to the ground and get services compared to regular days Communities were reached with SBCC and linked to multiple disease services/screening on the ground During the event; 1,957 people received malaria testing, 1,038 received family planning (FP) services, 2,358 were tested for HIV, and 107 were referred for VMMC at a health facility nearby.

Case Study #3: Mobile Health Referrals  Is the text messaging platform for free to refer audiences to mobile for Reproductive Health (m4RH)  All Tanzanian’s national FP campaign materials has the free mobile number to access information on FP  One of the main menu options users can select is FP clinic locations. After entering the first four letters of their ward, users receive a list of FP outlets nearby  From December 2013 to July 2015, 16,520 users accessed this function

Challenges  Some health facilities are very far from where the CCA lives which make hard for them to go to collect lower form  Some wards do not have health facility they use HF in another ward which sometimes is very far  Modified forms were not well received by health providers therefore not filled  Inadequate of referral forms from the Ministry of Health  Some community trust traditional healers

Lesson Learned & Recommendations  Successful linkages between demand creation and services requires the concerted involvement of government and implementing partners in the SBCC, service delivery, commodities, and RM&E sectors.  Through the creation of inter-disciplinary Task Forces led by the Ministry of Health and Social Welfare, TCDC has been able to strengthen such ties.  Good rapport and trust between CCA and community in his ward made one of Ward Councilor to organize transport for referrals outside his ward

Lesson Learned & Recommendations  Meaningful acknowledgement of all stakeholders in campaign materials increases ownership and contributes to sustainability.  Using of the government referrals forms yield good response in completing referrals  Clients are motivated because they believe that using referral forms make them to be attended fast at the HF  While indicative of knowledge-seeking behavior for m4RH, more research is needed to see if these requests translate into uptake of services

“TAKE HOME MESSAGE”“TAKE HOME MESSAGE”. Different audiences have different information needs