1. Introduction. 2. Brief situation analysis

Transcription

1 Behaviour Change Communication Strategy Viet Nam Red Cross Society (VNRC) Response to the Evolving Hand, Foot and Mouth Disease (HFMD) Outbreak April December Introduction This strategy outlines the set of communication interventions and activities which Viet Nam Red Cross Society (VNRC) will undertake, as part of its nine-month emergency operations 1, to help address the increasingly disturbing outbreak of hand, foot and mouth disease (HFMD) which has continued to cause unnecessary suffering and death among susceptible under five children. The VNRC Behaviour Change Communication (BCC) strategy was developed in close consultation with the Ministry of Health and country offices of the WHO and UNICEF. During the development process, VNRC with support of the International Federation of Red Cross and Red Crescent Societies (IFRC) undertook reviews of the disease and its impact in Viet Nam, studies and research related to hygiene and sanitation knowledge and practices which are believed to have strong influence in the HFMD transmission, as well as the experience of VNRC in contributing to control efforts of the outbreak in The strategy aims to reach parents and caregivers (as well as members of households) of children under five, as well as teachers and workers of informal day care centres, as primary target groups. The communication interventions will include interpersonal communications, community mobilization, mass media and advocacy, as well as a capacity building component for BCC agents (who are commune volunteers). As part of the emergency response, the strategy is covered by the monitoring and evaluation plan which includes a baseline assessment, on-going monitoring activities, end-line assessment and an internal operations review. 2. Brief situation analysis 2.1. HFMD in Viet Nam and perceived challenges in control HFMD is a common infectious disease caused by a group of enteroviruses, including Coxsackievirus A16 and Enterovirus 71. Children, particularly those under five, have been most commonly affected by HFMD, characterized by fever, skin eruptions or blisters on hands and feet, and vesicles in the mouth. Currently, there is no vaccine for prevention nor specific medication for treatment. While the majority of the cases are mild to moderate, the increasing circulation of EV71 has raised concerns as it can cause severe disease and even death in children. Widespread epidemics have been reported in many countries in Asia Pacific, including Australia, Brunei Darussalam, China, Japan, Malaysia, Mongolia, Republic of Korea, Singapore and Viet Nam; less is known regarding the epidemiology of HFMD or EV71 infection in other countries outside the region 2. HFMD was first detected in Ho Chi Minh City in 2003, and since then, has occurred yearly in Viet Nam with annual caseloads of between 10,000-15,000 recorded in recent years and which seems to continue to intensify. In 2011, HFMD has infected an unprecedented number of people from all over the country with 112,370 cases and 169 deaths but with substantial concentration in the southern region 3. However, ten weeks on in 2012, the Ministry of Health (MOH) reported that a total of 15,218 cases have already been recorded. This has already surpassed the annual caseloads in recent years (except 2011) and is 7.5 times higher than the number of cases at the same time last year 4. Almost IFRC Viet Nam: Hand, foot and mouth disease emergency appeal. Accessible via: WHO A guide to clinical management and public health response for hand, foot and mouth disease. Accessible via: GDPM/MOH HFMD Situation in Viet Nam in Unpublished report. MOH Report on the HFMD situation nationwide and implemented activities, dated 9 March 2012.

2 2 VNRC HFMD Behaviour Change Communication Strategy half of the cases come from the southern region, followed by the northern (33%), central (14%) and central highland regions (5%). While the number of cases reported per week is substantially lower than the figure during the peak of the 2011 outbreak (an average of 3,000 cases per week), MOH reports also noted slight increases in new cases per week. During weeks 8, 9 and 10, there were 1,709, 1,993 and 2,127 new cases, up by 14.2% and 6.3% in weeks 9 and 10, respectively 5. There is concern of a further surge in cases in the coming weeks because the country usually experiences HFMD case outbreaks between April-May and September-October. To avert the evolving situation, MOH 6 since January 2012, has issued decrees and letters to guide People s Committees and provincial health authorities in the strengthening of HFMD prevention efforts including early detection, containment, treatment and control; in the monitoring and evaluation of prevention and control efforts, as well as in the allocation of additional resources for these activities. It has also deployed 12 teams to assist and supervise HFMD prevention and control activities, as well as closely monitor the situation in provinces with the most reported cases. The Provincial Committees and MOH have also asked the Viet Nam Red Cross Society (VNRC) 7 to extend its support in addressing the current situation by carrying out HFMD communications at community level through its network of branches and trained volunteers. It can be recalled that in 2011, VNRC undertook between August-December 2011 an intense HFMD outbreak communications at community level in five severely-affected provinces in the southern region which has contributed in the reduction of HFMD cases in intervention areas 8. On the other hand, MOH has regarded HFMD to be evolving in a complex manner it continues to infect children despite prevention and control efforts. It has also considered HFMD to be difficult to communicate and influence risk perception within the community about the disease and the appropriate response. It added that while many people in the community are neglecting the diseases, others usually the parents of sick children are anxious about the potential impact of the disease on their children Hygiene knowledge and practice among mothers and caregivers Recent research on hygiene knowledge and practice in Viet Nam indicate an improving trend, compared to studies conducted in A baseline survey for an impact evaluation of the Viet Nam Scaling Up Handwashing Project in reported very high incidence of handwashing among mothers and caregivers of children under five: 92 per cent of mothers reported rinsing hands at critical junctures. While the survey indicated that there is no need to promote the practice of handwashing per se, there is still a need to improve handwashing with soap practices in the target population, particularly among the poorest. Some of the key times during which handwashing should take place are not at the top of the mind for caretakers of young children, since less than one-third reported handwashing with soap after cleaning a child s bottom and before cooking or preparing food, and just around one-third before feeding children. While a little over 80 percent of households have a place for handwashing with soap and water present, the poorest households are 23 percent less likely to have access to a place for handwashing. Mothers in rural areas are more likely to wash hands less frequently MOH Report on the HFMD situation nationwide and implemented activities, dated 15 March Ibid. IFRC Viet Nam: Hand, foot and mouth disease emergency appeal. Accessible via: IFRC Viet Nam: Hand, foot and mouth disease DREF final report. Accessible via: Sub-Committee on Communication, Steering Committee for Severe and Emergencies Disease Prevention, Project Proposal for the Development of Communication Action Plan for Health Emergencies ( ) Based on Lessons Learned from the HFMD Situation in 2011, Nov 2011 June GDPM/MOH and UNICEF Summary of National Baseline Survey on Environmental Sanitation and Hygiene Sanitation in Viet Nam. Supported by the Water and Sanitation Programme (WSP) and carried out in 540 communes across 56 districts in 10 provinces

3 3 VNRC HFMD Behaviour Change Communication Strategy Another study conducted by the Health Environment Management Agency of the Ministry of Health and UNICEF in in six provinces representing the six ecological regions of the country revealed that only 59% of the households had soap/gel at the hand washing facilities, with the highest in Nam Dinh (84.5%) and lowest in Dien Bien (29.1%). While noting that the proportion of mothers washing hands with soap in the study was higher than the national baseline survey on environmental sanitation in as well as the observational study conducted by the Centre for Water Supply and Hygiene Reference (Thai Binh Medical University) in 2007, the practice of HWWS still needs to be improved to better protect children from getting ill according to the study, mothers who regularly wash hands with soap after defecating accounted for only 36.2%, followed by washing hands with soap before eating (22.8%), before and after preparing food for children (19%), and after helping children go to stool and cleaning children s bottom (14.9%). While handwashing with soap is universally-accepted as a respectable thing, the Scaling up Handwashing Project baseline survey noted that actual practice are influenced by mothers notion of dirtiness and the availability of soap. Nearly all focus groups and interview respondents indicated that they wash hands with soap only when their hands are visibly dirty or smelly, and though washing hands with soap is said to be important particularly after defecation and before meals they may likely to forget do this if they are in a rush. The study also noted that handwashing with soap has correlation with mothers education, (moderately on) age and location: 75% of mothers who have complete 10 or more years of education washed hands with soap or detergent, while mothers under 35 years of age use plain water a little less than older ladies Communication context Hygiene behaviour studies which looked into the primary sources of information about health for parents and child caregivers referral revealed the television as the popular medium for mass communication. Local authorities such as commune leaders, health workers and members of Women s Union who are directly in contact with every single household also serve as information source within the commune. The Scaling up Handwashing Project survey reported that more than 80% of mothers watch television, while 20% listen to the radio and at most 15% read newspapers. It added that mothers watched TV every dinnertime between 6 to 9 pm and usually follow films, news and music shows. Sampled mothers accordingly showed limited interest in TV ads, and less than 2/3 remembered any TV ads about handwashing. In the delivery of communication interventions that primarily target parents and caregivers of children under five, mass media campaigns are to be completed by interpersonal communication activities to reinforce new positive habits. Peer support, facilitated through focus groups and with the involvement of Women s Union members may be a good tactic. 2.4 HFMD communications While communication efforts for the prevention and control of HFMD have been done, these seem to have mixed outcomes. These were attributed to (a) the inability of recent IEC materials to reach key target population of caregivers, (b) the limited resources for risk communication, (c) the insufficient assessments on appropriate IEC messages, or (d) the lack of a comprehensive communication plan to set the direction for HFMD communication. While MOH, with the support of WHO, has embarked on a project to address the above, it is critical at this very moment that effective HFMD communications are brought down to community level and able to reach target population HEMA/MOH and UNICEF Report on the study on the correlation between sanitation, household water supply, mother s hygiene behaviours for children under 5 and the status of child nutrition in Viet Nam. Accessed via: GDPM/MOH and The Centre for Water Supply and Environmental Sanitation, Survey on rural environmental sanitation in Viet Nam. Sub-Committee on Communication, Steering Committee for Severe and Emergencies Disease Prevention, Project Proposal for the Development of Communication Action Plan for Health Emergencies ( ) Based on Lessons Learned from the HFMD Situation in 2011, Nov 2011 June Unpublished document.

4 4 VNRC HFMD Behaviour Change Communication Strategy 3. Strategy development Viet Nam Red Cross Society, with the assistance of IFRC, undertook a number of processes to inform the development of this strategy which aimed to develop/identify: a. (Messages) Key messages to be promoted by trained community volunteers during the operation b. (Target audience) Primary and secondary population groups who will be targetted by interventions as well as involved in the operations c. (Communication plan) Priority communication interventions and activities which will be carried out by staff and volunteers for specific population group The strategy development processes included the following 15 : a. Review of the disease, its epidemiological pattern including mode of transmission and measures that reduce risk of infection b. Review of studies and research related to hygiene and sanitation knowledge and practice, and health seeking behaviour of populations, particularly of parents and caregivers of children under five, in Viet Nam c. Review of studies and reports of VNRC response to the HFMD outbreak in 2011, as well as information, education and communication (IEC) materials and tools being used d. Consultations/discussion with parents and caregivers of children under five, as well as teachers and workers of informal and household-based day care centres, during pre-intervention field visits to communes targetted by this operation. e. Consultations with national, provincial and local leaders, health and education authorities, including mass organizations (such as the women s and youth unions) and representatives of WHO and UNICEF country offices. f. Review of preliminary findings of the baseline survey on HFMD knowledge, attitude and practice (KAP) conducted in eight provinces as part of the 2012 HFMD emergency response. 4. Messages and materials The strategy development processes resulted in the identification of the following messages: a. Children and caregivers need to wash hands regularly with soap and clean water (particularly during the following critical times: after going to the toilet, before cooking, before eating, before feeding children, and after touching a sick child or after disposing items used by a sick child) b. Children who are ill should stay home and should not have close contact with other children in the household c. Give children well-cooked food and safe water; do not share utensils and toys d. Regularly clean children s toys, as well as surfaces and floors with liquid soap first and then use a common disinfectant To facilitate and support the delivery of these messages, VNRC identified and developed a set of communication materials after determining the primary target populations and communications interventions that comprise the strategy. These include: (a) a leaflet which will be distributed to households and day care centres, (b) five posters which will be displayed in strategic locations and during commune campaigns, (c) a video clip for TV broadcasts, and (d) HFMD handbook and flipcharts which will be used by community volunteers during face-to-face and group counselling sessions. These materials were adapted from existing VNRC and IFRC communication campaign 15 Following development and humanitarian standards, the latter includes the Sphere standards.

5 5 VNRC HFMD Behaviour Change Communication Strategy materials 16 to the Viet Nam context. All of the IEC materials were reviewed and endorsed by the General Department for Preventive Medicine (MOH) and WHO before VNRC proceeded with reproduction. 5. Target groups/audience The VNRC health communication strategy primarily aims to reach (a) parents and caregivers of children under five (including members of households with children under five) as well as (b) teachers and workers of informal day care centres in communes supported by the operation. In order to maximise the impact of the strategy, it endeavours to engage with other groups and sectors within and outside the communes supported by VNRC. These target groups/audience will be reached through a range of communication interventions and activities: Target group/audience Interventions Activities Parents and caregivers of (including members of households with) children under five Teachers and workers of informal day care centres Provincial, district and commune leaders, health workers, officials of mass and community organizations Commune members Interpersonal communications Community mobilization Mass media Advocacy Community mobilization Community mobilization Mass media Face to face and small group counselling sessions between trained volunteer to target group members, or between/among target group members, through house-to-house or informal day care centre visits. Engage in community campaigns and activities, such as district level or inter-commune public campaigns that include street theatre, drama and songs (entertainment education), display of banners and posters at the start of the operation. Broadcast/public service announcements (PSA) of prevention messages via national and regional/local TV during dinnertime for six months. Broadcast/PSA of HFMD situation and operation updates, prevention messages via local radio stations during dinnertime for six month. Press releases on HFMD situation and operations updates and prevention messages via local newspapers twice a month for six months. Regular monthly coordination and consultation meetings Establish alliance with commune leaders, health workers, mass organizations and relevant partners. Engage leaders (as champions and role models), organizations and partners in community activities, particuarly district level or intercommune public campaigns that include street theatre, drama and songs, display of banners and posters at the start of the operation. Engage in community campaigns and activities, particularly district level or inter-commune public campaigns that include street theatre, drama and songs, display of banners and posters at the start of the operation. Broadcast/public service announcements (PSA) 16 Particularly from the IFRC Epidemic Control for Volunteers toolkit: IFRC Best Defense is You communication campaign:

6 6 VNRC HFMD Behaviour Change Communication Strategy Target group/audience Interventions Activities of prevention messages via national and regional/local TV during dinnertime for six months. Broadcast/PSA of HFMD situation and operation updates, prevention messages via local radio stations during dinnertime for six month. Press releases on HFMD situation and operations updates and prevention messages via local newspapers twice a month for six months. Commune volunteers Capacity building Training in the technical aspects of HFMD, and in interpersonal communication, community mobilization and facilitation skills. On-going support through coaching, mentoring and guidance from peers and VNRC staff and trainers during supervisory/ monitoring visits VNRC branch staff and trainers MOH and members of the national steering committee on infectious diseases Capacity building Advocacy Update/refresher training in the technical aspects of HFMD; in interpersonal communication, community mobilization and facilitation skills; including volunteer mobilization and support. Participate in committee meetings organized by MOH. Regularly update and consult MOH and committee 6. Communication interventions and activities The strategy will employ a range of communication interventions and activities in order to make a significant contribution to national HFMD control efforts. While there are activities conducted at national, provincial and district levels, a large majority of the activities will be carried out at commune level Interpersonal communications The mainstay of the strategy, this intervention ensures that key HFMD-related messages reach priority target groups in communes and are reinforced not only in increasing awareness but also in facilitating positive change in behaviour. Through face-to-face/individual and focus group counselling sessions involving parents, caregivers and members of households with children under five as well as teachers and workers of informal day care centres, community volunteers will lead discussions on the disease, its signs and symptoms including danger signals, ways of transmission as well as measures to reduce risks, but will facilitate understanding of the current condition and practices including perceptions, motivations and barriers, and in exploring, negotiating, agreeing and supporting the adoption of positive behaviours among members of the target groups. This will entail a set of mutually-agreed follow up sessions from the initial meeting; the latter will include discussions about the disease and impact on their children and family and about perceptions on the measures and practices that reduce risks of HFMD. Succeeding sessions focus around risky conditions and behaviour, the difficulties and barriers to change, the options and suggestions in changing practice. These will also involve agreements on: the possible changes which are divided into sequential steps and which target groups can take in a certain period of time; the timeline and manner in which target groups (individually or collectively) review progress; and, the support required to increase the likelihood of successful change. To enable community volunteers to adequately support and follow through households in a commune, there will be 10 volunteers who will work together in a common. They will be supervised by VNRC branch staff and trainers, and will be supported by commune health workers and women s union members who are looked upon by parents and caregivers as credible sources of health

7 7 VNRC HFMD Behaviour Change Communication Strategy information and guidance. Each community volunteer, in addition to their past trainings, leadership qualities and commitment, will be prepared for this work through a two-day update/refresher training, provided with communication and facilitation materials to be used during counselling sessions Community mobilization This intervention will be employed to emphasise the important role of the whole community, and the shared responsibility of its members, in addressing issues that affect public health. This also aims to maximise the synergies between the operation and existing health initiatives in the commune, taking also into consideration the limited timeframe of this operation. As part of start up activities, VNRC coordinated with district and commune leaders, health and education sectors, mass organizations and other relevant partners to ensure that its operation are in line with with priorities and fill critical gaps in local efforts. In the course of implementing the operation, it will work in alliance and symbiosis with authorities and organizations in order to maximise impact and effect of all activities related to HFMD control. In particular, the operation will organize district level campaigns which will include rallies, public programmes with street threatre, dramas, songs and demonstrations on handwashing with soap and other practices that reduce risks of HFMD. These events will also involve talks of commune champions and role models, as well as participation of youth, mothers/women and men (through their respective organizations). Through community volunteers, the operation will also continue to engage in commune discussions which may result to decisions that contribute to HFMD control. This may include commune support to the expansion of HFMD communication and behaviour change campaigns, continued support to handwashing and hygiene campaigns in day care centres, disinfection of day care centers and schools, or improving handwashing stations in day care centres and schools. In the course of implementing the strategy/operation, it will also work with MOH and their local counterparts in understanding better why communes are affected than the others by looking for communes not affected by HFMD in the last two years, and observing people/groups of people who are already practicing behaviours ( bright spots ) that contribute to limiting transmission of the disease Advocacy This intervention is envisaged to generate support, cooperation and acceptance from officials and authorities at various levels national, provincial, district and commune on the VNRC operation which primarily aims to contribute to the national HFMD efforts, as well as on providing continued priority to these efforts. While the operation will be able to facilitate behaviour change, VNRC recognises that these are initial gains and need continued support after the life of the operation. To meaningfully achieve this and through leadership and guidance by VNRC headquarters, the different levels of the national society will be engaged in specific advocacy work with lateral organizations and partners for the following purposes: Target group Purpose of advocacy work Responsible MOH, members of the national steering committee Provincial, district and commune leaders, health workers, officials of mass and community organizations Encourage sustained efforts to address HFMD, particularly providing more attention to community-level initiatives Generate commitment and support to the VNRC response which primarily contributes to national efforts. Encourage sustained efforts to address HFMD, particularly providing more attention to community-level initiatives Garner commitment and support to the VNRC response. Act as champions in HFMD control in their respective communes or districts VNRC SG with guidance from health department VNRC branch leaders and staff

8 8 VNRC HFMD Behaviour Change Communication Strategy Target group Purpose of advocacy work Responsible Commune members Ensure commitment and support to HFMD control efforts Generate and sustain involvement in prevention and control activities at commune level Support target groups in making and sustaining positive change in behaviour Community volunteers VNRC branch staff and trainers 6.4. Mass media This intervention will be employed to complement MOH mass media campaign primarily to raise awareness of the general public. Considering the reach of mass media, particularly television, the operation will capitalise on the potential of these communication channels to extend the reach of campaign messages outside the operational sites. As the materials will be repeatedly broadcast on specified time of day for a number of months, this intervention also provides reminder materials to identified primary target groups of this strategy. Particularly, the mass media interventions under this strategy will include the following: a. Broadcast through national and local television channels of a video clip highlighting HFMD prevention messages. The clip is an adaptation of the IFRC Your Best Defense in You campaign 17 which promotes proper handwashing, coughing and sneezing, separating the sick and disposal of waste. On the basis of the revised HFMD messages produced by MOH late last year and through on-going coordination mechanisms, the video clip will be reviewed and updated when needed to ensure continued relevance as well as consistency of messages delivered to the public. b. VNRC will also broadcast through local radio stations public service announcements (PSA) highlighting HFMD prevention messages. The PSA will also include information to update communes about the HFMD situation and the VNRC operation. c. Finally, VNRC branches will regularly produce press releases which will be provided to local newspaper outlets. While containing prevention messages, these articles will also include updates about the HFMD situation and the VNRC operation Capacity building This intervention will be directed towards (a) community volunteers to ensure that they are prepared and equipped in the delivery of HFMD communications and BCC activities in assigned communes, as well as (b) VNRC staff and trainers who will be tasked to train and to provide on-going support to community volunteers. Before volunteers are mobilized to respective communes, community volunteers will undergo a twoday trainings which will include basic information on HFMD, the operation and roles and responsibilities of volunteers, and will provide refreshers on interpersonal communications, community mobilization and facilitation skills. The training will be carried out using adult learning methods, and will allow participants to practise the use of the HFMD handbook and flipcharts as part of their tools 18. Volunteers will also be provided with leaflets and posters which are to be distributed to reinforce interpersonal communications and community mobilization activities. While in the communes, volunteers will receive on-going support from volunteers through coaching and supervisory visits from VNRC staff and trainers. Concerned VNRC staff and trainers will also receive a three-day orientation and update before they commence the conduct of volunteer trainings. Conducted by a team comprising of senior officers from VNRC health and training departments, as well as experts from the Pasteur Institute and MOH, the orientation/update will cover the following: basic information on HFMD and the situation in Viet Campaign materials, including video clips and posters, can be accessed via: The HFMD handbook in particular is taken from relevant sections of the disease, action and community messages tools of the IFRC Epidemic Control for Volunteers. For details of the toolkit, please visit:

9 9 VNRC HFMD Behaviour Change Communication Strategy Nam; the objectives and key components of the operation, including management structure and processes (including reporting, monitoring and evaluation), and the roles and responsibilities of volunteers; review and refresher sessions on BCC activities, including facilitation, mentoring and supervision skills. 7. Monitoring and evaluation While this strategy will guide the emergency health response of VNRC which centres on behaviour change communication to the evolving HFMD outbreak in Viet Nam, the national society will follow a monitoring and evaluation framework that will cover the whole operation to determine whether the BCC interventions have contributed to: a. Improving the HFMD knowledge and practice of target groups, and to what extent? (outcome measurement), and thereby - b. Reducing unnecessary suffering and deaths of young children due to HFMD, and to what extent? (impact measurement) The M&E framework will also capture operational processes (or practices) as well as lessons which will inform VNRC emergency health preparedness and response capacity strengthening. Summarised through a plan matrix, M&E started in the operational design and planning phase through the conduct of a baseline KAP survey and a similar survey at the end of the interventions. The operation will also include monthly monitoring, quarterly reviews and an end-of-operation review. These activities will be carried out using participatory processes which means involving and getting feedback from target groups and people in communes where the operation are carried out, and which reports will be made available to internal and external partners Impact evaluation A reduction of HFMD cases and deaths in the communes and districts during the period where BCC activities are carried out implies that the operation has a positive impact. An analysis of the epidemiological situation in intervention communes and districts before, during and after the operation, as well as a comparison of this situation with non-intervention communes and districts (in communes of the same district, or other districts in the same province with similar profiles, in particular) will be undertaken. While disease is a notifiable disease in Viet Nam, the quality of HFMD data at commune level is uncertain. VNRC also recognises that it will be difficult to attribute changes to the operation because there are other factors that influence these changes which are beyond the control of the operation. VNRC will work with MOH and provincial health authorities in identifying and agreeing on ways to produce essential data that will help the former in measuring impact of the operation. VNRC will also explore if the impact of BCC interventions vary across different target groups, geographic areas, and over time Outcome evaluation VNRC will assess the effectiveness of the strategy in improving HFMD knowledge and practice of target groups. It will also document effects of the intervention intended or unintended, positive or negative. To facilitate outcome evaluation, the operation has scheduled baseline and endline KAP surveys related to HFMD. The following outcome indicators have been identified during the operation design/planning phase and which will be revisited during endline (by comparing baseline survey findings): Proportion of target population can identify at least three signs and symptoms of HFMD as well as identify at least three key hygiene and sanitation measures to reduce risks of getting the disease. Proportion of target population can correctly identify at least three critical times when to wash hands. Proportion of target population can properly demonstrate washing of hands with soap.

10 10 VNRC HFMD Behaviour Change Communication Strategy Proportion of under five children in informal day care centres can demonstrate washing of hands with soap Process monitoring In the implementation of the strategy, it is in the interest of VNRC to know how well the BCC interventions have progressed and whether the different activities contribute to meeting the outcome. The implementation of the strategy will be monitored regularly, identifying strengths, weaknesses and areas that need adjustments/improvements. Inputs and resources will also be assessed if these have been allocated or mobilized, and if activities are being carried out as planned. For example, process monitoring would like to see if community volunteers are able to lead and facilitate individual and group counselling sessions as well as use handbooks and flipcharts properly. It would also like to assess progress of other BCC interventions, as well as supportive items such as IEC materials and soap were available when these were needed. The M&E plan has outlined indicators, reporting and monitoring activities to facilitate process monitoring. [END OF DOCUMENT]