36280 New Twist for Madagascar: Community Listeners' Groups As an Integral Part of the Behavior Change Empowerment Strategy to Enhance Synergies and Boost Impact

Elysée Ramamonjisoa, BA, Behavior change unit , CBIHP/JSI MAHEFA / USAID, Antananarivo, Madagascar (HEALTH PROGRAM), ANTANANARIVO, Madagascar and Linda Morales, MA in International Policy Studies, Behavior change unit , CBIHP/JSI MAHEFA / USAID, MAHEFA

Background:  In Madagascar, the maternal mortality rate is 498 per 100,000 live births[1], while it is 62 per 1000 live births[2] for infant.  Suffering the most are the primarily non-literate, rural community members, who often live more than 5 km from a health facility and typically have very limited access to health information.  Results from the 2008-2009 DHS show that radio remains the preferred communication channel for the majority of Malagasy: Listeners’ rates are 54% for women between 15 and 49 years, and 59% for men. Usually, the majority of radio campaigns are limited to broadcast of radio spots or programs with basic follow-up to determine impact amongst the population. 

[1] MDHS( 2008-2009


Program background:  The USAID-funded Madagascar Community-Based Integrated Health Project (CBIHP), known locally as MAHEFA, is a five-year health program that is providing basic, quality health care to isolated populations in six north and northwestern regions of Madagascar Results from MAHEFA’s formative research showed that radio spots and theatrical programs on health topics were considered by rural Malagasy populations to be the most used and appreciated behavior change communication tools, expanding the usual radio channel to enhance and create synergies between the classic channels of message transfer. While CHWs orient community to seek their own solutions to overcome barriers via interpersonal communication (IPC) activities, community dialogue within the listeners’ groups (LG) incites participants to develop an attitude of mutual assistance and jointly devise solutions, thus favoring social understanding and mutual support for change. This approach has demonstrated: -          value added (intensified impact) of the listeners’ groups to the overall BCE approach in increasing demand and use of CHW health services in remote area -          effectiveness of partnership for cost sharing -          discounting of media costs due to the volume of broadcasts

Evaluation Methods and Results:  Monitoring and evaluation occurs on two levels: (1) Measuring the coverage and functionality of the listeners’ groups; (2) Measuring the increase in improved practices in MCNH, WASH at the level of listeners’ groups. In the last 24 months: -50 spots, 6 tales, and 5 theatrical programs have been regularly broadcast by 26 local radio stations across 6 rural regions. -608 listeners’ groups were established to encourage community dialogue between participants who have become community agents of change in driving households towards good health practices. Over 500,000 individuals participate. -Over 1,941,371 individuals have been reached by key messages, 23% are women of reproductive age and 17% are youth. -Each person is reached 5.4 times with a key message

Conclusions:  Quote from LG member : « MAHEFA’s  program brought significant change to our community. We are going to construct latrines and end Open Defecation »[1]                

[1] TESTIMONY -  VAVIHITA, Port –Bergé, Sofia  

Implications for research and/or practice:  In FY2013 & FY2014, MAHEFA invested $925,000 in this program component, or 47 cents per person over 2 years.