1. Essential Malaria Actions Guidelines for program harmonization at country-level

2. The Challenges of Evolving Interventions, Evolving Behaviors, & Evolving Determinants and Actions Long-lasting Insecticide- treated Nets (LLINs) Artemisinin-based Combination Therapy (ACTs) Rapid Diagnostic Tests (RDTs) Intermittent Preventive Therapy for Pregnant Women (IPTp) Indoor Residual Spraying (IRS)

3. What are the Essential Malaria Actions? Identification of specific prevention and treatment-seeking behaviors Conveyable Identifiable Demonstrable Harmonized and uniform

4. Origins Identifying household-specific do-able actions Interaction of biomedical interventions with demonstrable action Illustrating desired behaviors

5. Minimum Essentials of State-of-the-art Communication Four Principles: Systematic and evidence based Theory based Systems based Appropriate approaches to reach change at multiple levels

6. Essential Malaria Actions and Country Programs Engagement of NMCP programs and partners Standardization of themes and concepts Country and context specific Health workers, Community health workers Community conversation and “Model Families”

7. Ethiopia  National harmonization meeting with partners  Development of relevant actions  Guide development  Field testing  Roll out and integration  “Model Family” strategy

8. Model Family _____ Implementation of Community Mobilization Activities

9. Net usage and treatment-seeking behavior for <5 in the past two weeks, Oromia, Ethiopia Treatment seeking behavior Study arms, n(%) C-ChangeComparison Total number of <5 children 569425 No. (%) of U5 with who slept under an LLIN last night 49 (8.6)36 (7.8) No. (%) of U5 with fever who sought advice or treatment from any source 48(75.1) 27 (75.0) No. (%) of U5 with fever who took anti malarial drug for the fever at any time during the current illness 18 (66.7) 6 (24.0) No. of days between the start of fever to first taking any antimalarial drug Same day Next day Two days after the fever Three days after the fever Four or more days after the fever Did not know 3 (16.7) 6 (33.3) 2 (11.1) 1 (5.6) 0 (0.0) 0 (0.0) 4 (66.7) 0 (0.0) 1 (16.7) 0 (0.0) 1 (16.7)

10. Kenya  Aligned with National Malaria Policy and National Malaria Communication Strategy  Standardized messaging across public and private sectors  HEW and CHEW tested; Community-approved  Distributed to field workers  ACSM Technical Working Group leading incorporation

11. DRC  Policy guidelines and basis for a communication intervention  Materials development  Field testing  Roll out and integration

12. Value Message harmonization at the national level Standardization of messages reduces message confusion NMCP, Health Promotion Dept., and partners organizations prefer uniformity of core action Material production easier Coordinated interventions Common reference guide Scale-able and can be cascaded

13. Implications Tool for harmonization and policy Simple, easy to remember, easy to replicate Contextually appropriate Focused on household level “do-able” actions Calls for direct action

14. What does this all mean? Research—determinants show the complexity of malaria-related behaviors EMAs engage partners and countries to standardize within a cultural context Direct engagement using EMA’s refocuses on desired actions and changes the focus from awareness raising to action taking.

15. Thaddeus Pennas, Ben Adika, Shoa Girma, Phillis Kim, Tara Kovach Ferdinand Ntoya, Renata Seidel, Thank You