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Malaria Communication Strategy National Malaria Control ProgrammeREPUBLIC
2016 - 2021OF KENYA
MINISTRY OF HEALTH
KENYA MALARIA
COMMUNICATION
STRATEGY
2016-2021
Revised 2016
National Malaria
Control Programme 1
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
This publication is a Ministry of Health document.
Any part of this document may be freely reviewed, quoted, reproduced
and translated in full or in part, provided the source is acknowledged.
It may not be sold or used for commercial purposes or profit.
The Kenya Malaria Communication Strategy
2016–2021
National Malaria Control Programme
Ministry of Health
PO Box 19982, KNH
Nairobi 00202, Kenya
Email: head.domc@domckenya.or.ke
http://www.nmcp.or.ke
2
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Table of Content
Table of content ii
List of figures and tables iii
Foreword 1
Acknowledgements 1
Abbreviations 1
Executive Summary 1
CHAPTER 1: Review of the Malaria Communication Strategy 2010-2014 1
1.1 Background 1
1.2 Process 2
1.3 Literature Review findings and implications 3
1.4 Evaluation of Malaria Communication Strategy (2010-2014) 6
1.5 Potential Challenges and Implications for Malaria Communication Strategy Implementation 8
1.6 Problem statement 10
CHAPTER 2: Malaria Communication strategy 11
2.1 Goal of the communication strategy 11
2.2 Approaches to implementing the communication strategy 11
2.3 Strategic objective 12
2.4 Specific objectives 12
CHAPTER 3: Key strategic interventions 13
3.1 Strengthen structures for the delivery of ACSM interventions at all levels 13
3.2 Strengthen program communication for increased use of all malaria interventions 14
3.3 Increase inter-sector advocacy and collaboration for malaria ACSM interventions 18
3.4 Strengthening community-based social and behavior change
communication activities for all malaria interventions 20
CHAPTER 4: Implementation Plan 2016–2021 24
CHAPTER 5: Monitoring and Evaluation Plan 2016 –2021 27
Annex 1: Terms of Reference for ACSM TWG 30
Annex 2: Contributors 31
Annex 3: References 32
3
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
List of Tables
Table 1. Potential Challenges and Implications 9
Table 2. Key audiences, messages and channels 17
List of Figures
Figure 1. Guidance on implementing interpersonal communication activities 22
Figure 2: Implementation and coordination arrangements of Malaria ACSM 23
4
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Foreword
The Kenya Malaria Communication Strategy 2016 – 2021 is a product of the review of the Malaria
Communication Strategy 2010-2014. This strategy is aligned to the Kenya Malaria Strategy (2009 -2018),
the Global Technical Strategy for Malaria (2016 -2030), the Roll Back Malaria Partnership’s Action and
Investment plan to defeat Malaria (2016- 2030), The Strategic Framework for Malaria Communication at
the Country Level 2012- 2017 and the Roll Back Malaria Partnership’s BCC Indicators reference guide.
This document spells out the operational framework for advocacy, communication and social mobilization
(ACSM) interventions in Kenya and has taken into account the achievements and gaps in the implementation
of the MCS 2010-2014 and the changes of governance in the health sector. This strategy has maintained
the vision, mission and goal of the KMS 2009-2018 by moving forward the spirit of objective 5 that is
linked to malaria ACSM of increasing utilization of malaria control interventions by communities in Kenya
to at least 80 percent by 2021. The revised strategy includes new stakeholders, articulates their roles and
responsibilities and coordination mechanism.
We are confident that the strategy will play a key role in increasing uptake of malaria control interventions
through the engagement and collaboration of multi-sector partners at both national and county levels.
I urge all our partners to put their efforts into the implementation of this strategy as we move forward
towards pre-elimination of malaria.
“Komesha Malaria Okoa Maisha”
Dr. Cleopa Mailu
Cabinet Secretary
Ministry of Health
5
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Acknowledgement
The Malaria Communication Strategy has been developed through a series of consultative meetings
involving development and implementing partners; CSO representatives and county health teams. The
stewardship provided by Principal Secretary Dr. Nicholas Muraguri, the Head Department of Preventive
and Promotive Health, Dr. Jackson Kioko, supported by the Head of Division of National Strategic Public
Health Programmes, Dr. Joseph Sitinei and Head of National Malaria Control Program, Dr Waqo Ejersa is
highly appreciated.
The members of the ACSM TWG who have participated in the discussions and giving feedback that have
enriched the final product. Of special mention are our technical partners; WHO, PMI, PS Kenya, UNICEF,
Malaria No More, ICF, PIMA, AMREF, CHAI, KEMRI and KeNAAM. We appreciate the participation of
the Ministry of Health divisions, units and agencies including Health Promotion and Community Health.
Appreciations, also go to Terry Muchoki (Independent Consultant) for coordinating and compiling the
document as per all the stakeholders’ inputs.
Financial support for the strategic review and drafting was provided by PMI/USAID through PS Kenya.
PS Kenya.
Dr. Nicholas Muraguri
Principal Secretary
Ministry of Health
6
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Abbreviations
ACSM Advocacy, communication and social mobilization
ACT Artemisinin-based combination therapy
AL Artemether Lumefantrine
ANC Antenatal care
CHV Community health volunteer
EMA Essential Malaria Action Guide
FBO Faith-based organization
GoK Government of Kenya
HH Household
HPAC Health Promotion Advisory Committee
HPU Health Promotion Unit
IEC Information, Education and Communication
IPC Interpersonal communication
IPTp Intermittent Preventive Treatment in Pregnancy
IRS Indoor residual spraying
KHSSP Kenya Health Sector Strategic Plan
KMIS Kenya Malaria Indicator Survey
KMS Kenya Malaria Strategy
LLIN Long-lasting insecticidal nets
LSM Larval Source Management
M&E Monitoring and evaluation
MOH Ministry of Health
NMCP National Malaria Control Program
RDT Rapid diagnostic test
SBCC Social behavior change communication
SP Sulphadoxine-pyrimethamine
TWG Technical working group
WHO World Health Organization
7
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Executive Summary
Malaria remains a public health problem in Kenya This Malaria communication strategy for Kenya
with about 70 percent of the population at risk of 2016–2021 (MCS) has been developed to provide a
the disease. The Ministry of Health through the framework within which advocacy, communication
National Malaria Control Program has adopted and social mobilization activities will be implemented
the vision of achieving a malariafree Kenya. The to support the core strategies of the revised Kenya
revised Kenya malaria strategy 2009–2018 (KMS), malaria strategy (2009–2018). It details in depth
the National malaria policy (2010) and the Kenya how the four strategic interventions above will be
malaria monitoring and evaluation plan (2009– achieved.
2018) provide the guiding framework for malaria
control in Kenya towards accelerating the reduction The MCS 2016–2021 advocates coordinated
of the burden of malaria and achieving the vision of implementation at two distinct but connected
a malaria-free Kenya. levels. At the national level, through a rejuvenated
ACSM working group serving as the coordinating
The KMS 2009–2018 is hinged on six strategic working group for all partners implementing
objectives that lay out the key malaria control malaria ACSM at the national level as well providing
interventions: vector control (universal coverage of technical guidance to county level coordination
long lasting insecticidal nets in targeted areas; indoor and implementation of activities. In the counties,
residual spraying and larval source management; through health promotion advisory committees
prevention of malaria in pregnancy), diagnosis and ensuring coordinated implementation, monitoring
treatment, epidemic-preparedness and response of ACSM, advocacy for resource allocation and
as well as surveillance, monitoring, evaluation and pooling of resources.
operational research, advocacy, communication
and social mobilization and program management. The goal of the strategy is to implement a
The KMS recognizes strategic communication as coordinated and effective program over the next
an integral component to achieve the vision of a five years, which will achieve change in behavior
malaria-free Kenya as outlined in its fifth strategic at different levels: political, service delivery,
objective that seeks to increase the utilization of community and individual. Chapter 1 of the strategy
malaria interventions to 80 percent at household provides background into the review process
level through malaria advocacy, communication and development of the communication strategy.
and social mobilization (ACSM) activities by Chapters 2 and 3 outline the strategic directions,
2021 through four strategic interventions: interventions and activities to address the key
problems. Chapter 4 provides the implementation
1. Strengthen structures for the delivery of ACSM plan and coordination framework between national
interventions at all levels. level ACSM and counties ACSM level while the
Chapter 5 provides details of how ACSM activities
2. Strengthen program communication for
will be monitored and evaluated towards tracking
increased utilization of all malaria interventions
progress on the national target.
3. Advocate for inter-sector collaboration for
malaria advocacy, communication and social
mobilization:
4. Strengthen community based social and
behavior change communication activities for
all malaria interventions.
8
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
1 Review of the Malaria
Communication Strategy
2010-2014
1.1 Background Objective 1: To have at least 80 percent of persons
The review of the Malaria communication in malaria risk areas using appropriate malaria
strategy 2010–2014 (MCS) was informed by two preventive interventions by 2018.
emerging issues: the mid-term review of the Kenya
malaria strategy 2009–2017; and the change in Objective 2: To have all suspected malaria cases
government structure that devolved power, roles that present to a health provider managed in
and responsibilities — including the delivery of accord with National Malaria Treatment Guidelines
health services—to counties. by 2018.
Mid-term review of the Kenya Malaria Objective 3: To ensure that all sub counties in
Strategy (2009–2018) malaria epidemic and seasonal transmission zones
have the capacity to detect and respond in a timely
Following a mid-term review in 2014, the National
manner to malaria epidemics by 2018.
malaria strategy for the period 2009–2017, has
been revised into the current Kenya malaria Objective 4: To ensure that all malaria indicators
strategy 2009–2018. This malaria strategy are routinely monitored, reported, and evaluated in
has been developed to guide malaria control all counties by 2018.
interventions in the country with the aim to reduce
malaria morbidity and mortality. The revision of
the previous strategy was informed by the Kenya Objective 5: To increase utilization of all malaria
health sector strategic plan (2014 – 2018), the control interventions by communities to at least 80
Kenya health policy (2012–2030), the new political percent by 2018.
dispensation that has devolved health some health
roles and responsibilities from the national to Objective 6: To improve capacity in coordination,
county governments in line with the Constitution leadership, governance, and resource mobilization
of Kenya (2010), the Global technical strategy for at all levels towards achievement of the malaria
malaria (2016–2030) and the Roll Back Malaria program objectives by 2018. During the mid-term
Partnership’s action and investment plan to defeat review of the Kenya malaria strategy in 2014,
malaria (2016–2030). objective 5, which is linked to malaria advocacy,
communication and social mobilization (ACSM),
The Kenya malaria strategy lays out the strategic was reviewed and revised from
framework for malaria control interventions, which
hinge on six strategic Objectives:
9
Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
addressing knowledge of malaria control 1.2 Process
interventions (which had been achieved by over In May 2016, the National Malaria Control
90%) to increasing the use of malaria control Program led the process of developing this malaria
interventions by communities in Kenya to at least communication strategy that builds on the Malaria
80 percent by 2018. This document builds on communication strategy (MCS) 2010–2014. The
the strategic objective for ACSM in the Malaria process entailed a desk study of available literature,
communication strategy (2010–2014), to align it in-depth interviews with key stakeholders and
with the new strategic objective. program implementers, as well as a stakeholder
consultative workshop.
Devolution of government
The Constitution of Kenya (2010) mandates the Developing this communication strategywas
devolution of power to 47 counties. Health service based on consensus among multiple stakeholders
delivery was devolved to the counties, with limited to ensure wide ownership. The review has been
functions remaining at the national level, making informed by the Kenya malaria strategy (2009–
counties key actors in achievement of the vision 2018), the Global technical strategy for malaria
of a malaria-free Kenya and, consequently, in (2016–2030), the Roll Back Malaria Partnership’s
achieving 80 percent utilization of malaria control action and investment plan to defeat malaria
interventions by 2018, as laid out in the Malaria (2016– 2030), the Strategic framework for malaria
communication strategy. These changes have also
seen the Division of Malaria Control evolve into the
Malaria Control Unit, and now the National Malaria
Control Program.
10Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
communication at the country level (2012– 2017), • Semi-arid zone: this zone includes the arid
and the Roll Back Malaria Partnership’s BCC and semi-arid areas of the northern and south-
indicators reference guide. eastern parts of the country that experience
short periods of intense malaria transmission
Developing this communication strategy entailed: during rainy seasons.
• Reviewing relevant malaria ACSM documents • Low risk zone: this zone covers the central
and survey reports to understand existing highlands of Kenya including Nairobi.
issues and challenges
• Undertaking key informant interviews with Implication: Malaria interventions are
relevant stakeholders implemented selectively in the different
epidemiological zones. This communication
• Conducting a consultative workshop in May
strategy will support targeted ACSM interventions
2016 at Naivasha with stakeholders drawn
that can be applied to each epidemiological zone.
from the National Malaria Control Program, the
ACSM technical working group and partners
Ownership and use of long lasting
• Drafting and circulating a zero draft of the insecticidal nets (LLIN)
communication strategy based on the literature
Ownership of LLINs has over the years been higher
review, key informant interviews and workshop
than use. However, between 2010 and 2015 there
report
has been an increasing trend in LLIN use among
• Convening an ACSM technical working group pregnant women and children under 5 years. KMIS
meeting in June 2016 with relevant partners to (2015) showed that household LLIN ownership
present the zero draft and receive comments stood at 63 percent with each household owning at
for further review least 1 LLIN; 40 percent of these households had
• Revising the zero draft and developing a first at least
draft based on comments received
one LLIN for every two people - an indicator of
• Subjecting the first draft to external peer review
universal coverage - who stayed in the house the
• Presenting the second and third draft to
previous night. In 2010, 39 percent of children
stakeholders for validation
under 5 slept under a LLIN the night before the
• Presenting the 3rd draft to the Malaria survey compared to nearly more than half of the
Interagency Committee children in 2015. Among pregnant women, LLIN
use has increased from 36 percent in 2010 to 58
1.3 Literature Review Findings and
percent in 2015. The overall usage of LLINs stood
Implications
at 48 percent, with 56 percent of children below 5
The findings of the Kenya malaria indicator survey years and 58 percent pregnant women having slept
(2015) were used to develop the communication under an LLIN the previous night. Ninety percent
strategy. The main findings are highlighted below: of the respondents were confident of hanging up
LLINs and knew the importance of sleeping under
Malaria epidemiology
a LLIN. Sixty percent of the LLINs were in good
Kenya has four malaria epidemiological zones. condition.
• Highland epidemic zone: this includes the
western highlands of Kenya where malaria Implication: The strategy advocates consistent
transmission is seasonal with considerable year- communication around use of treated nets to
to-year variation; when climatic conditions are address barriers hindering use of LLINs.
favorable malaria epidemics occur.
• Endemic zone: this zone includes areas around
around Lake Victoria in western Kenya and the
coastal region where malaria transmission is
stable.
11Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
communication at the country level (2012– 2017), • Semi-arid zone: this zone includes the arid
and the Roll Back Malaria Partnership’s BCC and semi-arid areas of the northern and south-
indicators reference guide. eastern parts of the country that experience
short periods of intense malaria transmission
Developing this communication strategy entailed: during rainy seasons.
• Reviewing relevant malaria ACSM documents • Low risk zone: this zone covers the central
and survey reports to understand existing highlands of Kenya including Nairobi.
issues and challenges
• Undertaking key informant interviews with Implication: Malaria interventions are
relevant stakeholders implemented selectively in the different
epidemiological zones. This communication
• Conducting a consultative workshop in May
strategy will support targeted ACSM interventions
2016 at Naivasha with stakeholders drawn
that can be applied to each epidemiological zone.
from the National Malaria Control Program, the
ACSM technical working group and partners
Ownership and use of long lasting
• Drafting and circulating a zero draft of the insecticidal nets (LLIN)
communication strategy based on the literature
Ownership of LLINs has over the years been higher
review, key informant interviews and workshop
than use. However, between 2010 and 2015 there
report
has been an increasing trend in LLIN use among
• Convening an ACSM technical working group pregnant women and children under 5 years. KMIS
meeting in June 2016 with relevant partners to (2015) showed that household LLIN ownership
present the zero draft and receive comments stood at 63 percent with each household owning at
for further review least 1 LLIN; 40 percent of these households had
• Revising the zero draft and developing a first at least
draft based on comments received
one LLIN for every two people—an indicator of
• Subjecting the first draft to external peer review
universal coverage—who stayed in the house the
• Presenting the second and third draft to
previous night. In 2010, 39 percent of children
stakeholders for validation
under 5 slept under a LLIN the night before the
• Presenting the 3rd draft to the Malaria survey compared to nearly more than half of the
Interagency Committee children in 2015. Among pregnant women, LLIN
use has increased from 36 percent in 2010 to 58
1.3 Literature Review Findings and
percent in 2015. The overall usage of LLINs stood
Implications
at 48 percent, with 56 percent of children below 5
The findings of the Kenya malaria indicator survey years and 58 percent pregnant women having slept
(2015) were used to develop the communication under an LLIN the previous night. Ninety percent
strategy. The main findings are highlighted below: of the respondents were confident of hanging up
LLINs and knew the importance of sleeping under
Malaria epidemiology
a LLIN. Sixty percent of the LLINs were in good
Kenya has four malaria epidemiological zones. condition.
• Highland epidemic zone: this includes the
western highlands of Kenya where malaria Implication: The strategy advocates consistent
transmission is seasonal with considerable year- communication around use of treated nets to
to-year variation; when climatic conditions are address barriers hindering use of LLINs.
favorable malaria epidemics occur.
• Endemic zone: this zone includes areas around
around Lake Victoria in western Kenya and the
coastal region where malaria transmission is
stable.
12Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Prevention of malaria in pregnancy Malaria Case Management
Prevention of malaria during pregnancy targets all KMIS (2015) showed that 72 percent of the
pregnant women in 14 malaria endemic counties. respondents sought advice on treatment during the
The women receive three doses of intermittent onset of fever with 75 percent of these respondents
preventive treatment in pregnancy (IPTp) with visiting a public health facility while 18 percent
Sulphadoxine-pyrimethamine (SP) during visits sought treatment from a faith-based facility. Thirty-
to antenatal clinic. KMIS (2015) showed that 94 nine percent of those who sought treatment had a
percent of the respondents in the survey attended parasitology test carried out with 91 percent of the
antenatal clinics during their last pregnancy; 56 respondents reported having received artemisinin-
percent of the respondents received at least two or based combination therapy, 60 percent received
more doses of IPTp while 38 percent receiving three treatment on the same or the next day; 43 percent
or more doses. The report on knowledge, attitude, of the respondents could recognize the nationally
beliefs and practices on the 10 key child survival recommended artemisinin-based combination
development and protective behaviour (KABP), therapy (ACT)/Artemether Lumefantrine (AL).
2016 stressed the fact that ANC coverage is lower Knowledge of ACT/AL among women declined
among women who need it the most: the poor, less slightly from 56 percent in 2010 to 53 percent
educated, and those living in rural areas. There is a in 2015. The National Malaria Control Program is
common belief that pregnancy is often perceived as undertaking projects aimed at increasing the use
a natural process of life. This perception may make of rapid diagnostic tests in the private sector, and
women, families and communities underestimate changing national policy to allow point-of-service
the importance of ANC. Studies reviewed in this testing at registered pharmacies. Pilot projects
report also suggested that the lack of knowledge are also ongoing in the coastal counties of Kilifi,
about danger signs in pregnancy may make women Kwale and Mombasa with the objective to increase
and families not know how to seek care when a access to use of rapid diagnostic tests through the
complication occurs during pregnancy. private sector.
Implication: The strategy aims to integrate Implication: Because most respondents (75
messages that encourage pregnant women to percent) sought treatment from public health
attend antenatal clinic as soon as they discover facilities, this communication strategy proposes
they are pregnant to receive at least three or more the use of a two-pronged communication
doses of IPTP, as well as continue to leverage approach targeting both health workers and
on the partnership with the department of caregivers. Communication efforts for health
reproductive health and other partners to increase workers as change agents will focus on ncreasing
uptake of IPTp. acceptance and use of malaria testing before
treatment. For caregivers communication efforts
will focus on prompt seeking behavior on onset of
fever and request for malaria test.
13Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Malaria and Anemia Sources of Information
The Kenya Population and Housing Census (2009) The KMIS 2015 shows that radio and television
showed that 43 percent of the population is less ownership stood at 70 percent and 36 percent
than 15 years of age while KMIS (2015) results respectively. An impressive 90 percent of
found that malaria prevalence to be high among the the households interviewed owned a mobile
5–9 year olds at 10 percent and the 10–14-years phone. According to a report released by the
age bracket with 11 percent. Prevalence was also Communication Authority of Kenya in 2015, radio,
found to be high in the rural areas while the lake mobile phones and television are the leading
region had the highest prevalence at 27 percent sources of information in Kenya and will continue
and the coastal region at 8 percent. being so for communities in the coming years.
In 2013 Kenya moved from analogue to digital
Implication: Investing in communication in broadcasting. Digital broadcasting saw a sharp rise
school health programs is critical in reducing high in the number of TV stations. The report estimates
prevalence among the 5–14-years old school- there are 130 radio stations, 61 TV Stations on
going children. The NMCP has made initial efforts digital platform, 34 newspapers, 36.1 million
towards implementing school health programs in mobile phone subscribers, 27.7 million mobile
some counties. Results from these interventions money subscriptions and 29.6 million internet
will be critical in informing future school health users. Vernacular radio stations continue to shape
interventions. More ACSM interventions will the radio landscape with approximately 23.7 million
be concentrated in rural areas where malaria listeners daily. The vibrant and solid media and ICT
prevalence remains high. infrastructure in Kenya provide wide coverage for
disseminating messages.
14Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Implication: Radio and mobile telephony can be 1.4 Evaluation of Malaria Communication
widely explored and continuously tracked to deliver Strategy (2010–2014)
the intended behavior change. While developing this strategy, it was important
to review the previous strategy in order to
Literacy
appreciate its achievements, challenges faced in
The KMIS (2015) showed that 87 percent of the its implementation and the lessons learnt. This
respondents were literate; however, literacy levels section aims to leverage on the gains and make
varied across different regions and counties. recommendations on overcoming challenges of
the previous strategic period. During the mid-term
Implication: Communication efforts will consider
review of the KMS in 2014, the ACSM objective was
literacy levels in each region or county.
changed from increasing knowledge about malaria
Gender control interventions to utilizing malaria control
interventions. ACSM interventions by the National
While children and pregnant women are biologically
Malaria Control Program and partners in the period
more susceptible to malaria, gender differences
after the review (2014– 2016) focused on utilization
are compounded due to sociocultural norms and
of malaria control interventions within the four
expectations that influence patterns of exposure,
key strategic interventions of the Kenya malaria
decision making, and economics. Neglecting
strategy 2009–2018.
the role that gender plays will undermine efforts
to reach crucial milestones and improvements The ACSM objective in the National malaria strategy
in the health of families and communities in (2009–2017) aimed at “strengthening advocacy,
Kenya. Understanding how gendered patterns communication and social mobilization (ACSM)
of behavior influence exposure to mosquitoes, capacities for malaria control to ensure that at
treatment decisions, and access to care can help least 80 percent of people in malarious areas had
in developing more effective recommendations for knowledge of prevention and treatment of malaria
preventing malaria infection (WHO, 2007). KMIS by 2014,” and deployed three key strategies to
2015 indicated that 36 percent of households are achieve this objective:
headed by women. While this data is important
• Strengthening the capacity for ACSM
in understanding decision making within the
household, it does not explain the challenges • Developing appropriate advocacy
female-headed homes face in accessing and using • for uptake of specific malaria
malaria control interventions. • interventions
• Conducting multi-sector IEC/BCC
Implication: With 36 percent of households
headed by females, this communication strategy
recognizes the important role women play in
increasing the use of malaria interventions at
household level.
15Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Strategy 1: Strategy 2:
Strengthening the capacity for ACSM Developing appropriate advocacy for
uptake of specific malaria interventions
Achievements
Working with partners, the National Malaria Control Achievements
Program developed and disseminated the Malaria Advocacy activities heightened around the World
communication strategy (2010– 2014), the Essential Malaria Day where stakeholders were rallied around
malaria action (EMA) guidelines, the Community the day’s events. The office of the Malaria Goodwill
educators manual on Malaria, and the Teachers Ambassador was established.
and pupils guide on malaria. Various partners
have used these documents to guide delivery of Gaps
content during implementation of interventions. • In the absence of an advocacy strategy to
Some partners made efforts to build the capacity guide collaboration and resource mobilization,
of the ACSM unit and of health workers (both at the advocacy events have been limited and
facility and in the community) through training in sporadic, and largely centered around World
behavior change communication. Malaria Day. This has denied the program the
advantages of sustained advocacy efforts and
Gaps therefore there has been no firm political will
• Malaria is a socioeconomic burden and requires for malaria.
sector wide participation. The engagement • The office of the Malaria Ambassador remained
with the relevant non-health sectors was not vacant denying the country the benefits this
optimally exploited. office could offer by lobbying for malaria action
• Counties continue to rely on central funding, at the political level.
with little resource mobilization being • Poor funding for the office of the Malaria
undertaken at that level. Goodwill Ambassador led to little or no
• Where funding for ACSM activities exists, focus advocacy intervention within the political arena.
has primarily been on endemic zones with little
support given to seasonal and low risk zones. Strategy 3:
The lack of a bare minimum ACSM package Conducting multi-sector IEC/BCC
to ensure malaria infections in these seasonal
Achievements
and low risk areas remain low poses the risk of
prevalence rising and hence, eroding the gains The National Malarial Control Program implemented
achieved. community-based malaria SBCC programs in 12
endemic and epidemic sub counties in western and
• Weak coordination and reporting mechanism
Nyanza regions. The results show that household
between the National Malaria Control Program
malaria indicators on use of interventions can be
and the county teams responsible for malaria
achieved by working through the community health
control.
strategy. NMCP through partners implemented
• The role of the health promotion unit in branded behavior change communication
the ACSM thematic working group needs campaigns on use of LLINs and prompt fever
to be strengthened for malaria advocacy treatment— “Msimu wowote” and “Haraka Upesi”—
communication and social mobilizations to be at the community level in malaria endemic sub
sustainable in the country. counties. These interventions were through radio
• The roles, responsibilities and membership of and TV and interpersonal communication activities.
the national ACSM thematic working group An evaluation of SBCC interventions indicated that
have become blurred and erratic. exposure to SBCC was strongly associated with net
16Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
use the previous night. Behaviour change Gaps
interventions around indoor residual spraying and • Uptake of the community health strategy
malaria in pregnancy were also undertaken. NMCP and interpersonal communication in malaria
also conducted a pilot project to increase access ACSM was low; where they exist, reporting is
to rapid diagnostic tests in the private sector. poor with partners using varied reporting tools
Innovative research interventions around the and channels that have no link to the national
malaria vaccine and rapid diagnostic tests are on reporting mechanism.
going.
• Limited translation into vernacular of ACSM
messages to reach all target audiences.
Strategy 3: • ACSM’s focus was largely on communities (and
Conducting multi-sector IEC/BCC largely women) with little or no effort or focus
directed to health workers despite the constant
Achievements provider– patient interface.
The National Malarial Control Program implemented • ACSM funding for malaria in pregnancy was
community-based malaria SBCC programs in 12 low. Low ACSM funding could lead to low
endemic and epidemic sub counties in western and uptake of IPTp doses.
Nyanza regions. The results show that household
malaria indicators on use of interventions can be 1.5 Potential Challenges and Implications
achieved by working through the community health for Malaria Communication Strategy
strategy. NMCP through partners implemented Implementation
branded behavior change communication Table 1 provides a summary of potential challenges
campaigns on use of LLINs and prompt fever (and implications) that could hinder implementation
treatment— “Msimu wowote” and “Haraka Upesi”— and achievement of positive outcomes of the
at the community level in malaria endemic sub revised Malaria communication strategy.
counties. These interventions were through radio
and TV and interpersonal communication activities.
An evaluation of SBCC interventions indicated
that exposure to SBCC was strongly associated
with net use the previous night. Behaviour change
interventions around indoor residual spraying
and malaria in pregnancy were also undertaken.
NMCP also conducted a pilot project to increase
access to rapid diagnostic tests in the private
sector. Innovative research interventions around
the malaria vaccine and rapid diagnostic tests
are on going.
17Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Table 1. Potential Challenges and Implications
Challenges Implications
Weak links between the national • Low funding and prioritization of malaria ACSM activities
and county malaria programs
• Poor delivery of ACSM interventions in counties
• Poor allocation of limited resources for malaria at the community
Inter-sector collaboration is weak level as a result of duplication of partner activities
nationally
• Over-reliance by county governments on funding from the National
Malaria Control program for ACSM activities
• Uncertainty in the devolution process regarding roles and
responsibilities where malaria control might not be prioritized
• Poor integration of health and non-health sectors resulting in low
leverage of ACSM resources amongst partners that could potentially
increase mileage for ACSM
The roles, responsibilities and • Declining inter-sectoral collaboration
membership of the ACSM TWG
have become blurred and erratic
Low communication capacity • Delayed ACSM technical assistance to counties
among ACSM staff at NMCP
Absence of an active advocacy • Low funding and prioritization of malaria ACSM activities
strategy
• Limited, inconsistent and sporadic advocacy events
Low uptake of the community • Low behaviour change at the household level—cultural barriers such
health strategy in delivery as taboos and misconceptions around malaria remain challenges to
of malaria interventions at prevention and care seeking in rural communities
household level as well as lack of
understanding of interpersonal
communication
Partners have varied monitoring • Difficulty in showing attribution
and reporting tools that have
no link to the national reporting • Apathy in funding ACSM activities
mechanism. • Lessons learnt cannot easily be integrated into subsequent
Low or no documentation of best • interventions
practices.
Low capacity and commitment of • Poor delivery at the point of contact in the health facilities and in
health workers on ACSM homes
Underutilized school health • Increasing prevalence among children age 5–14 years
program where children can be
used as change agents for malaria
control
Low funding for malaria in pregnancy • Malaria in pregnancy ACSM outcomes may continue to lag
ACSM activities
18Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
1.6 Problem Statement
Based on the situation analysis and review of the prioritization of malaria interventions remain low
communication gaps and needs assessment, the at community and household s due to suboptimal
core problem for malaria ACSM in Kenya that this implementation of malaria ACSM activities as a
malaria communication strategy seeks to address result of weak links administrative units between
is captured in the statement below: national and county levels coupled with inadequate
capacity and skills in ACSM among program and
Despite increased access to malaria control
health workers, in addition to low funding of ACSM
interventions by communities in Kenya, use and
activities.
19Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
2 Malaria Communication
Strategy
2.1 Goal of the Communication Strategy Communication Behavior change communication
The goal of the communication strategy is to is a crucial component in changing social norms;
implement a coordinated program that will achieve addressing myths and misconceptions; and
behavioral change at political, service delivery, improving knowledge, attitudes and practices
community and individual levels. Behaviour change around malaria control among various groups of
will be achieved through providing guidance to people. Effective behavior change communication
all stakeholders and partners implementing the and messages need to convey more than just the
advocacy, communication and social mobilization medical facts because on their own these facts
agenda within strategic objective 5 of the revised do not necessarily motivate people to action. The
KMS 2009–2018 to ensure coordination of effort, messages should explore the reasons why people
messages, activities and reporting during the do or do not take action on the information they
implementation period. The strategy will also guide receive, then focus on changing the actual behavior
counties and sub-counties in developing social by addressing the causes identified, e.g. social
behavior change communication (SBCC) plans that norms or personal attitudes.
address specific behavioral challenges within each Behavior change communication is a set of
county context. organized communication interventions and
Aspirational values that will guide the processes aimed at influencing social and
communication function for the NMCP include: community norms and promote individual behavioral
relevance, accuracy, integrity, transparency, change or positive behavior maintenance for a
currency, open communications (two way including better quality of life…it is based on proven theories
feedback mechanisms), flexibility and adaptability. and models of behavior change.
Communication for Social Change – engage
2.2 Approaches to Implementing the & empower communities/networks to influence/
Communication Strategy reinforce social norms: human resource & time
The communication strategy will use three intensive
approaches: Social Mobilization brings together community
Advocacy to ensure that the national government, members and other stakeholders to strengthen
policymakers, donors and media i) remain engaged, community participation for sustainability and self-
ii) are strongly committed to improving laws and reliance. Social mobilization generates dialogue,
policies for malaria control, iii) allocate funds for negotiation and consensus among players. At the
malaria control and iv) malaria control remains in heart of social mobilization is the need to involve
the public agenda. people who are most affected by malaria. Mobilizing
20Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
resources, building partnerships, networking and 4. To harmonize malaria ACSM activities
community participation are all key strategies for implemented by the different partners.
social mobilization Specific activities include group
and community meetings, partnership sessions, The malaria communication strategy complements
school activities, traditional media, music, song the revised KMS 2009–2018. The strategy covers a
and dance, road shows, community drama, soap 5 year period 2016–2021 beyond the lifespan of the
operas, puppet show, karaoke songs and contests. KMS 2009–2018. It is anticipated that the midterm
Other activities unique to a particular county or review of this strategy will be in 2018 (which is the
region may provide even better opportunities to anticipated end term review of the current KMS
engage and motivate individuals. Communication
2009–2018) with an end term review in 2021.
programs generally produce the best results when
they work across these multiple levels.
Guiding Principles
A single effort has less impact than collective The following principles will underpin the
effort. Although distinct elements, advocacy, planning, implementation and monitoring of the
communication and social mobilization are most communication strategy:
effective when used together. ACSM activities
should therefore be developed in parallel and not Epidemiology- based intervention: ACSM
separately. Chapter 3 provides details of how the interventions will be implemented based on the
National Malaria Control Program will i) engage different epidemiological zones as outlined in the
with the national government, decision makers National malaria policy (2010).
and media to provide an enabling environment
Local context approach: the strategy will
through supportive policies and legislation for
recognize, appreciate and make use of local
malaria control; and ii) work with its partners
structures and knowledge to facilitate the desired
such as county governments, community health
change.
services and health promotion unit to deliver key
malaria interventions through community units Evidence based interventions: Communication
and networks to deliver health service closer to planning will utilize accurate data and theory to
households. inform and guide the activities.
2.3 Strategic Communication Goal Gender considerations: gender-related
To increase the use of malaria interventions at information is crucial in program planning, data
household level to 80 percent by 2018 through collection, monitoring and evaluation to raise
well-coordinated malaria ACSM activities. awareness of gender imbalances, advocate for
change, address gender dimensions of health, and
2.4 Specific Objectives
demonstrate program progress and impact.
1. To influence positive behavior change among
target audiences with regard to malaria Ownership: clear and consistent interaction
control behavior that will helps to reduce the with county government is critical for coordinated
incidence of malaria in Kenya. response.
2. To galvanize action around malaria Through
advocacy aimed at increasing funding for Public private partnerships: Engaging in
malaria by county governments and to public private partnerships for malaria ACSM
strengthen links between the national and will strengthen and accelerate efforts towards
county governments. increasing utilization of malaria interventions.
3. To strengthen coordination and linkages of
Sustainable interventions: The strategy
ACSM interventions and improve the flow
envisages creating positive and sustainable
(dissemination) of information to key target
behavior change by utilizing a variety of approaches
audiences at national, county, community
that are cost effective, evidence based and
and household levels through a planned and
appropriate within the Kenyan context
systematic series of activities and channels.
21Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
3. Key Strategic Interventions
This communication strategy has four strategic ACSM program staff at the NMCP through
interventions that will be implemented in the training, coaching, mentoring and enhancing
strategic period 2016 –2021. The strategy will ACSM skills. This strategy recommends
support the achievement of objective five of the institutionalizing key skills and expertise
KMS 2009–2018 through advocacy, behaviour required in the unit and drawing up a capacity-
and social change communication and social building plan for staff to ensure that they are
mobilization approach. The four strategic areas are: well trained to offer technical support to county
governments. Capacity building at national and
1. To strengthen structures for the delivery of county levels will be a key component to achieve
ACSM interventions at all levels the objectives laid out in this communication
2. To strengthen program communication for strategy.
increased utilization of malaria interventions
• The national ACSM technical working group
at household level
will provide leadership and guidance in
3. To increase inter-sector advocacy and
the implementation of the communication
collaboration for malaria intervention
strategy. Over the years, roles, responsibilities
4. To strengthen community-based social and
and membership of the working group have
behavior change communication activities for
become blurred and erratic and this calls for
all malaria interventions
rejuvenation of membership. The strategy
3.1 Strengthen structures for the delivery calls for expanding the scope of the group to
of ACSM interventions at all levels. include new partners in the various sectors
that influence malaria control. The group
Four activities will be undertaken under this
will continue to meet every quarter to review
strategic objective.
progress in implementation of the strategy
Strengthen national level ACSM coordination and facilitate decision making through the
development of an integrated annual work
The NMCP through the ACSM unit will be
plan that captures activities implemented by
responsible for overseeing the implementation of
the national program and partners. The terms
the MCS 2016–2021. NMCP’s role will be to build
of reference and membership of the ACSM
capacity and provide mentorship and technical
technical working group is in Annex 1. The
assistance to counties on ACSM, formulate
health promotion unit will continue to chair
policy and guidelines, develop strategic plans and
the quarterly ACSM technical working group
coordinate with all partners.
meetings.
• The ACSM unit requires technical expertise on
ACSM to successfully fulfill these functions.
This calls for strengthening the capacity of
22Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Strengthen county level Malaria ACSM to the county malaria context as outlined in the
• The national ACSM TWG and partners will work county malaria profiles. County SBCC plans will
closely with the Health Promotion Unit through guide county-specific malaria interventions and will
health promotion advocacy committees (HPACs) be a tool for mobilizing resources in the county.
at the county to articulate and strengthen The NMCP ACSM unit will continuously provide
delivery of malaria ACSM interventions. HPACs technical guidance and training to counties to
are county ACSM technical working groups that ensure malaria remains a priority at the county and
bring together actors and stakeholders across that new county ACSM staff are well trained on
all health areas to discuss and determine the malaria ACSM.
direction of the health promotion agenda.
NMCP will also continue to support counties in
HPACs also provide a platform for lobbying
ACSM implementation of national policies and
and pooling of ACSM resources. The national
guidelines and in ACSM campaigns like mass
ACSM technical working group will work
distribution of nets and malaria vaccine, as and
with county malaria teams to ensure that the
when required.
malaria agenda is well articulated and that
there is adequate representation during HPAC 3.2 Strengthen program communications
meetings. Implementing partners will continue for increased use of all malaria
to play a critical in the delivery of malaria ACSM interventions
at the community levels; hence their areas of
Behaviour and social change communication
coverage need to be mapped out so that gaps
is evidence based and is most effective when
and areas of need are identified for support.
combinations of approaches are used, weaving
The national ACSM TWG will also liaise with the together mass media, interpersonal communication
Community Health Services (CHS) to provide a and structural approaches to promote new or
platform for delivering key malaria interventions modified behaviors. This multimedia approach is
at the household level through the network therefore recommended in the implementation of
of community health volunteers across the ACSM malaria control interventions. The following
counties. This will include reviewing the content of activities will be undertaken to achieve this
malaria training, defining the volunteers’ role in objective.
supporting malaria control interventions at the
community level, and ensuring that key malaria Review of existing malaria messaging and
ACSM indicators captured by the district health branding and establishment of an online
information system (DHIS). repository
The ACSM TWG will bring together the other TWGs—
Support counties to develop malaria
case management, vector control and malaria
communication plans
in pregnancy—to review messages and materials
NMCP will scale up ACSM capacity of implementers to ensure they are up to date and relevant. The
in counties and sub counties through training county following activities will be undertaken:
health teams in SBCC. Trainers of trainers will be
identified in each county to ensure sustainable and a) Review existing information education and
effective programming over time. communication (IEC) material and development
NMCP and partners will seek to collate, review
NMCP has trained county health promotion teams and establish an inventory of all the IEC materials
across 29 counties on ACSM and it is anticipated and messages both print and audio related to
that all the 47 counties will be trained in ACSM and malaria to ensure their relevance and alignment
county SBCC plans will be developed during the with the malaria communication strategy.
training sessions. The SBCC plan will be adapted
23Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
b) NMCP will also review its malaria branding and Development and dissemination of tailored
slogans used over time and adopt a national communication on surveillance and epidemic
and unifying theme and slogan. The strategic preparedness for highland epidemic, semi-
objective of branding aims at strengthening arid and low risk zones
NMCP’s public standing. This role requires This strategy recommends development and
NMCP to maintain a consistent corporate dissemination of focused malaria ACSM intervention
image and identity in all its internal and external packages (targeted to health workers, community
engagements. The key principles underpinning health volunteers and the community) for the four
NMCP branding and corporate identity shall epidemiological zones, as outlined in the Kenya
include: malaria policy 2009–2018. The ACSM package
aims at providing impetus for county governments
in highland epidemic, semi-arid and low zones
to continuously lobby for prompt care seeking
behavior, epidemic preparedness and surveillance
interventions. The ACSM packages will close the
i. NMCP will promote its logo and slogan
gap identified in the previous strategy (where little
(Komesha Malaria, Okoa Maisha) to all its
ACSM attention was given to these areas, hence
partners and stakeholders. The NMCP brand
posing the risk of resurgence of malaria).County
will be projected in all its documents e.g.
governments supported by the NMCP will support
correspondence,, PowerPoint presentations,
the development and dissemination of messages.
and advertisements and any other form of
Counties will be encouraged to secure resources
publicity.
REPUBLIC OF KENYA
and print their own IEC materials based on national
guidelines and templates.
Scale up routine multi-media activities
NMCP will, with support from partners, conduct
MINISTRY OF HEALTH multi-media campaigns for interventions that cut
ii. The MOH–GoK logos will also be promoted across all malaria epidemiological zones. Multi-
ensuring the ministry’s name is mentioned at media activities will be targeted to various audiences
all times as Ministry of Health, placed below addressing key malaria control challenges.
the words Republic of Kenya, which also Multiple media platforms that will be used include:
define the complete and proper use of the
Mass media. Mass media channels can reach
Coat of Arms of the Republic of Kenya.
large numbers of beneficiaries at a low to moderate
iii. The NMCP corporate colors derived from the cost, and are an excellent means of increasing
logo portrait are predominantly blue and red, awareness about the gravity of malaria.
as in the revised Kenya malaria strategy 2009– NMCP with support from partners will conduct mass
2018 and in this document. All publications, media campaigns for interventions that cut across
correspondence and promotional materials all malaria epidemiological zones on promotion
must be clearly identified with this image that of effective malaria diagnosis and treatment and
will be placed prominently. communicating risk preparedness as part of malaria
surveillance. Focus will be on using regional media
c) Establish an online repository The materials
channels that offer interactive radio programs
and messages will be maintained in an online
where communities can dialogue with county, sub-
repository on the NMCP website as per the
county and local implementing partners. The shift
relevant strategic interventions areas. This
from analogue to digital broadcasting has seen a
will ensure counties and partners easily
rise in the number of television stations in Kenya.
access the materials, and avoid duplication of
messaging.
24Malaria Communication Strategy National Malaria Control Programme 2016 - 2021
Talk shows and advertisement around malaria communities that can target health careworkers,
control will spur family discussions and deliver women groups including pregnant mothers, and
intended message through vision and sound. It distributing content online. It is recommended that
is imperative though for partners to establish the roll out for social media be gradual, and proper
television viewership rates of their target audiences surveillance be in place to ensure that issues that
before ad placement and ensure they place adverts arise are picked up and addressed.
where they will reap maximum impact. Outdoor advertising: can serve the purpose of
increasing awareness and recall. This could include
Mobile phone and social media penetration
billboards, wall branding, signages, bus branding.
and use:
Print materials: serve two purposes: advocacy
Mobile ownership and social media platform
and educational. Newspapers and brochures can
have grown rapidly in Kenya. KMIS (2015) places
serve as advocacy materials to attain political
ownership of mobile phones at 90 percent, it is
goodwill. Comic books, posters and magazines
however unclear the level of social media penetration
serve an educational purpose. Use of comic books
and use amongst the malaria audiences especially
for school health programs will go a long way in
in the rural areas. The short messaging service
creating an engaging platform for school going
(SMS) provides opportunity for sending messages
children to engage in issues around Malaria.
to pregnant women reminding them of their next
date for antenatal visit, as a way of increasing Table 2 provides a matrix that outlines key malaria
uptake of IPTp. Social media platforms such as control interventions, target audiences, key
Facebook and Twitter can explore innovative ways messages and channels.
of engaging malaria audiences; building new online
Table 2. Key audiences, messages and channels
Intervention Target audience Key messages Channels
LLIN use Primary: Head of Ensure LLINs are hung up properly Mass media radio & TV
households and Ensure everyone, especially children Mobile phone
school-going children under 5 and pregnant women sleeps
(5–14 years) Outdoor advertising
under an LLIN every night
Secondary: IPC
Household members
Case Primary: Take prompt action towards diagnosis Mass media radio & TV
management Individual patient and and treatment of malaria with Mobile phone
health worker recommended ACT/AL
Out of home
Secondary: Caregivers should demand for a test
Caretaker of a IPC
Complete the malaria treatment
sick child prescribed
Malaria in Primary: Attend antenatal care services as soon IPC–women’s group, health
pregnancy Pregnant women as she realizes she is pregnant early talks and household visits
Secondary: Spouses and regularly. Mobile messaging
and mothers-inlaw Take at least 4 doses of SP Radio TV Posters
Sleep under an LLIN every night and
Social Media
after delivery
IRS Primary: Household heads accept IRS in Mass media: radio & TV
Household head the house Mobile phone
Secondary: Household members adhere to key
All household Outdoor advertising
actions that follow IRS in the house
members
Household head to accept to remove
belongings during spraying
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