Picture 1. IEC material in Than Cuu Nghia market in Than Cuu Nghia commune, Chan Than district in Tien Giang Province (Posters # 5, 7, 9)

Transcription

1 Review of logistics and distribution network of avian influenza information, communication and education print materials (IEC). Throughout the two conducted campaigns in the pre-tet periods of and of the Joint Government of Vietnam United Nations Programme to Fight Highly Pathogenic Avian Influenza (HPAI). Picture 1. IEC material in Than Cuu Nghia market in Than Cuu Nghia commune, Chan Than district in Tien Giang Province (Posters # 5, 7, 9) Independent Consultant Richard Cewers, Team Leader richard.cewers@gmail.com Vu Thi Phuong, Team Member / Interpreter November

2 Acronyms and Abbreviations AI BCC CHE CPC DAH FAO HPAI HQ IEC Joint Programme MARD MOET MOH NSCAI UNDP UNICEF WHO Avian Influenza Behaviour Change Communication Center for Health Education Commune People s Committee Department for Animal Health Food and Agriculture Organization of the United Nations Highly Pathogenic Avian Influenza Head Quarters Information, Education and Communication Joint Government UN Programme to Fight Highly Pathogenic Avian Influenza Ministry of Agriculture and Rural Development Ministry of Education and Training Ministry of Health National Steering Committee for Avian Influenza Prevention and Control United Nations Development Programme United Nations Children s Fund World Health Organization 2

3 Table of Contents Background... 3 Purpose of the study... 5 Methodology... 5 Constraints and limitation of the study... 6 Findings... 6 Ministry of Education and Training (MOET)... 8 Ha Nam Province... 8 Tien Giang Province... 8 Department of Animal Health (DAH) Ha Nam Province Tien Giang Province Center for Health Education (CHE) Ha Nam Province Tien Giang Province Summary and recommendations Summary Recommendations Annex 1. Distribution of UNICEF IEC material in Ha Nam Province Annex 2. Distribution of UNICEF IEC material in Tien Giang Province Annex 3. List of IEC materials with identification numbers Annex 4. List of meetings Annex 5. Terms of reference Background 3

4 Viet Nam has been one of the hardest hit countries by Avian Influenza. The first outbreak in both the avian and human populations was reported at the end of 2003 and the government of Viet Nam officially declared the presence of avian influenza on 8 January Since then, the virus has spread through bird populations in almost every city and province in Viet Nam. The country s fatality rate for AI infection is one of the highest in the region. In response to AI outbreaks in 2005 and the fear that the virus will mutate to a more deadly form the government of Vietnam, the UN and several donors established the Joint Government UN Programme to Picture 2. IEC poster of the second pre TET campaign posted at Thanh Ha Primary School, Thanh Ha commune, Thanh Liem district in northern Ha Nam Province (Poster # 11) Fight Highly Pathogenic Avian Influenza (Joint Programme) that operates under the leadership of the Government of Vietnam s National Steering Committee for Avian Influenza Prevention and Control (NSCAI). Public awareness and behaviour change communication (BCC) forms a key component in the Joint Programme. The Ministry of Agriculture and Rural Development (MARD) and the Ministry of Health (MOH) execute the Joint Programme with support from the Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO), the United Nations Development Programme (UNDP) and the United Nations Children s Fund (UNICEF). The Ministry of Education and Training (MOET) also take part in the Joint Programme since Phase II. Public awareness and behavior change communication have been a vital and cross cutting component of Highly Pathogenic Avian Influenza (HPAI or AI) control since the outbreaks began in Public awareness and BCC has also been identified as a crucial component in the Government s policy framework 1 to combat HPAI. It particularly formed a key and successful component of work in Phase I of the Joint Programme which led to the continuation of the component in the second phase of Two major communication campaigns were launched by the Joint Programme during the pre TET periods of and , which included TV spots, radio/public address system messages, street posters, pamphlets, supply kits and newspaper inserts. 1 Vietnam Integrated National Action Plan for Avian Influenza Control and Human Pandemic Influenza Preparedness an Control and the national operational programme Viet Nam Integrated National Work Programme for Avian and Human Influenza (the Green Book). 4

5 During these two campaigns, a remarkable number of information, education and communication (IEC) materials such as print materials and AI Hygiene supply kits were distributed nation wide in various volumes. These include posters, leaflets, booklets, pamphlets and communication supply kits. According to the existing distribution process, government counterparts send UNICEF requests for materials development and distribution which are in line with the component s approved work plans. As the coordinator of the Joint Programme s Public Awareness and BCC Component, UNICEF supports these requests based on their rationale which include distribution plans. Purpose of the study The purpose of the review study is to review the existing logistics and distribution network of AI IEC materials and provide recommendations on how to improve the distribution system in both nonoutbreak and outbreak situations (see annex 5. Terms of Reference). Methodology A desk study was carried out where background materials from government counterparts and UNICEF were collected and reviewed. Interviews were carried out with HQ staff responsible for the IEC material distribution at Center for Health Education (CHE), Department of Animal Health (DAH) and Ministry of Education and Training (MOET). Provinces to visit during the field visit were discussed with UNICEF and Northern Province of Ha Nam and southern province of Tien Giang were selected as they both have had outbreaks of AI and represents the northern and southern regions of the country. Both provinces are situated in either the Red River or Mekong River Deltas which are identified as high risk areas for AI outbreaks as well as densely populated. Tien Giang province has suffered human fatalities in AI. A field visit was carried out in Ha Nam and Tien Giang province. The distribution and utilization of the IEC material were implemented at different levels within the Ministries distribution network s with a focus on District and Commune levels. Each province was followed up from province level through one district and one commune to hamlet/community level. Each province was visited for three days and interviews and consultations were carried out with government counterparts, community health workers, agricultural extension workers from CHE, DAH and MOET at provincial, district, communal and hamlet levels. A total of 38 government staff and community health and agricultural extension workers were interviewed. (See Annex 4. List of meetings). If there were no documentation available of the distribution at the government counterparts or the informant could not remember the IEC materials, the review team showed samples of the IEC material to the informants in order to track the distribution of the material. Except from the government counterpart s offices the team also visited three hospitals, four markets, one CPC, and four primary schools and met with primary school students from four classes. Four classes of students and a total of 62 local people in markets, hospitals, schools, in the hamlet or in the street were introduced to samples of the IEC material and asked to identify the materials they had seen. Collected data and information were analyzed in accordance with the objectives set in the TOR (see annex 5. TOR). Review Team The review team was made up by independent consultant Richard Cewers as team leader and team member/interpreter Vu Thi Phuong. 5

6 Constraints and limitation of the study The review team only visited two out of the 64 provinces that are part of the distribution networks for AI IEC materials. The findings from the two provinces may not represent the situation in the entire distribution networks but can help to indicate strengths and weaknesses in the system. The team encountered a number of difficulties to obtain relevant documents on the distribution of IEC materials in the provinces visited. This was even the case at some of the counterpart s provincial offices where no records of IEC materials could be found. Records of IEC material at district and commune levels were also weak and none existing at the hamlet level. The review team often had to show samples of the IEC material to the informants in order to follow up on the distribution and estimate amount and dates. The team did not get access to all of the counterpart s stores. The review team discovered a great will to show positive results from the IEC distribution. Results that sometimes did not correspond to the real distribution or the use of the materials. For example were posters put up shortly before the arrival of the team and some posters were not put up in the places indicated by the informants. As the Primary school year started in September, they had a short period of time to plan and implement activities using the IEC material. In Ha Nam province the review team did not get access to local people in the hamlet selected and could not follow up on the distribution and use of AI IEC material at this level. The review team was not facilitated to interview local people in the hamlet by the authorities, although two separate visits were made. Picture 3. A teacher disseminates AI information at Thanh Ha Primary School, Thanh Ha Commune, Thanh Liem District in Ha Nam Province, using IEC material Booklet #15 Besides, the research was conducted approximately 8 9 months after the pre TET campaign when the majority of the materials were distributed. The time difference has limited the recognition and recall of the surveyed materials by the interviewees, particularly the local public. Weather conditions and public exposure are also attributed to the possible missing of materials at the places of posting, particularly at open markets and gathering places. The constraints mentioned above have to some extent influenced the accuracy on the findings and the recommendations of this review report. Findings 6

7 An impressive number of different kinds of IEC materials have been distributed to all of Vietnam s 64 provinces by the government counterparts in a short period of time. Materials have been distributed to staff at all levels of the counterparts systems, and if there has been enough material, also to local people in the communities. CHE has participated in two pre tet campaigns in 2005/2006 and 2006/2007, DAH and MOET distributed the materials through the Joint Program channel in the second campaign only. The findings of this report have to be seen in this context. UNICEF Printing Company Request for IEC material CHE DAH, MOET HQ CHE Province The distribution of IEC material was done through a top down system. According to the system, on the basis of the annual work plans the government counterparts (CHE, DAH and MOET) sent requests for the provision of IEC materials and distribution plans to UNICEF as the coordinator of the Component and the BCC Working Group. Regional office DAH District Commune Hamlet The main distribution channel for CHE is from its Figure 4. Distribution network for IEC material through Hanoi based HQs to provincial CHEs in the government counterparts. Request for material is sent to province level. Materials were printed and UNICEF and distributed from the printing company. CHE distribute through their HQ. DAH and MOET distribute produced by Suppliers and transported to CHE directly to province level and have a small distribution to Central. From there, transportation is made to their HQ. DAH also distribute to their 7 regional offices. provincial CHEs with budget supported by the MOET only distribute to district level. Joint Program through UNICEF. Some materials, however, can be kept in the HQs store for distribution in the scenario of an outbreak. For DAH, the Suppliers delivered the IEC materials to its seven regional offices across the country. The regional offices then distribute further to the provinces within their regions. In the case of contingency communication supply kits, they were kept in stores for distribution when an AI outbreak occurs in the regions. For MOET, distribution was made directly from the printing company to the provincial Departments of Education and Trainings. Both DAH and MOET also distributed a small amount of material to their HQs (Figure 4). Transportation costs were covered by the Joint Programme through UNICEF to province level. Further transportation was done from the provincial DAHs and CHEs to the district DAHs and CHEs. For CHEs, district CHE officials traveled to attend the monthly meetings at the provincial CHEs on a weekly or bi weekly basis. On these occasions, the materials were delivered to the district level together with the meeting participants. The same system with lower levels that pick up material at higher levels repeats through the provincial system. In the provinces of Ha Nam and Tien Giang the distribution of IEC print materials has been follow through the province, district, commune and community levels (see annex 1 and 2). 7

8 Ministry of Education and Training (MOET) MOET has participated in the distribution of IEC materials of the JP since the pre Tet campaign 2006/2007. They distributed school communication supply kits, standing banners and calendars by using DHL express to provincial Departments of Education and Training. 225 kits were distributed to each of the 64 provinces (figure 6). Kits were distributed to 15 high risk provinces before Tet and to the remaining 45 provinces after Tet. The materials were distributed directly from the supplier to the provinces. The kits and calendars were used in primary schools and standing banners for marching campaigns or for display at common areas at schools. Children are targeted as a vulnerable group. Ha Nam Province Province No documentation on IEC materials received was available. Although the informant when asked knew that all materials were received after Tet 2006/2007. Thanh Liem District The district received 24 school kits and 5 calendars in March The district has 24 primary schools and the kits were divided between the schools based on the number of classes. Two schools in high risk communes that had outbreaks of AI before also received calendars. Tien Giang Province Province At provincial Departments of Education and Training in Tien Giang, calendars and standing banners were distributed in high risk areas. These high risk areas were those defined as having outbreaks before or raising a large quantity of poultry or defined by PCP to be high risk areas (the informant did not know about the PCP criteria for this). The province received 30 calendars in February, 45 standing banners and 225 school kits in March The materials were distributed equally to all districts in the province. District Chau Thanh The district Office of Education and Training received 33 school kits and 6 standing banners in March The district has 33 primary schools and each school received 1 kit, although the schools are divided in to 88 different locations. The standing banners were distributed to schools in outbreak areas only. Primary schools in Ha Nam and Tien Giang Picture 5. Soap and soap holder is found brand new and un used at the Thanh Ha Primary School, Thanh Ha commune, Thanh Liem district in Ha Nam Province. Probably put up just before the arrival of the review team. 8

9 The kits were found in all 3 schools visited by the review team. The schools claimed to have AI dissemination every month since the school start in September, although only one class out of four had seen the booklets and the picture cards. Some schools have integrated the AI IEC sessions in their environmental studies and others had extracurriculum AI IEC sessions at the end of a school day or a school week. School staff shared with the team that if AI IEC sessions are integrated in the formal school system, this could open up for the possibility to distribute the booklets of the kit or upgraded versions of the booklets to all students as they would have to return them after the school year, and they can be reused in the same way as other schoolbooks. At the time of visit, there were posters on the walls at Thanh Ha Primary School in Ha Nam Province and in Tan Hoi Dong Primary School in Tien Giang Province, although students in Tan Hoi Dong Primary School when asked disclosed that the posters had been put up one week ago. In the Than Cuu Nghia Primary School in Tien Giang province they used the posters for dissemination in the classroom together with the children booklets and pictorial game cards, and had framed the posters with a wooden stick for durability (Picture 7). The review team noted that the soap and soap holder put up in all schools visited were brand new and never used, probably put up just before the arrival of the review team.(picture 5). All teachers and students found the AI IEC material appealing with a clear message that was easy to understand. All the IEC materials were received after Tet. Outbreak During AI outbreak the schools would arrange AI IEC sessions for the children more often. Extra materials can be useful in order to make it possible to disseminate in more classes at the same time. Recommendations To set up a monitoring system to make sure that the distributed IEC materials are used as intended before more IEC material is distributed. A system for regular follow up will most likely enhance the use and utilization of the material. Explore the possibility to use school children as a potential channel to distribute leaflets to IEC Material Distribution Use Date Kit 225 to each of the 64 Provinces Primary schools 15 high risk provinces before Tet 45 provinces after Tet Calendar Standing banner 30 to each of the 64 Provinces To 45 provinces Primary Schools Marching campaign After Tet After Tet Figure 6. Distribution of IEC material according to CHE head quarter 9 Picture 7. Posters mounted for durability and use in AI dissemination in the classrooms. Than Cuu Nghia Primary Scholl, Than Cuu Nghia commune, Chau Thanh district in Tien Giang Province

10 their families, both in non outbreak and outbreak time. There seems to be lack of time for AI dissemination at school. Therefore the review team recommends integrating AI dissemination in the formal school programme. MOET at all levels recommend a flipchart (see example of flipchart in Picture 10) for the teachers to use in their teaching. Another idea is to have a big version of the picture cards and booklets for the teachers to use in their teaching so all students can see what the teacher show to the class. MOET at all levels also recommend an animated film (DVD) on AI to show in school (i.e. like the animated film in the road safety campaign). Department of Animal Health (DAH) HQs DAH has participated in distribution of IEC materials since the pre Tet campaign 2006/2007. The distribution plans of IEC print materials were designed basing on the number of communes in each province. The main distribution channel was directly to province level from the printing company, a small amount of material was also distributed to the seven DAH regional offices and DAH head quarters. DAH kits for vets were distributed two times, first before Tet in December 2006 to the provinces, and the second time after Tet in April 2007 to the 7 regional offices to be kept in store for contingency and used for outbreak distribution. In April 2007 three different leaflets #18a, b, c was distributed to the provinces. Monitoring by DAH HQ and province estimate that percent of the materials reached the local people, the rest were used to inform staff or kept in store. Computers and printers have also been distributed to 23 provinces under this programme. The DAH HQs informed the review team that they would like to have a VCD/DVD on animal health (like the one CHE have on human health) for dissemination. DAH HQs suggested that the content of the DAH kit for vets was not relevant and not needed. Targeting As the AI communication supply kits were designed to support community health workers and Risk provinces were the same for DAH and CHE who have defined 33 provinces as risk provinces 2. The 2 Van Dang Ky, Chief of Epidemiology Division, Department of Animal Health, informs the review team, and refers to DAH decision no. 4008/QD-BNN-TY for a list of high risk provinces. 10

11 distributions of IEC print material is based on the number of communes in each province, there is no targeting from DAH at province level. Ha Nam Province Province No documentation available on received or distributed AI IEC material and no staff available with knowledge of the distribution. There is a new director of DAH province and the person working with AI IEC material was on maternity leave and the person now responsible was on a long term training course. The review team notes that Ha Nam province has received a computer under this programme according to DAH HQ, although no documentation can be found. The review team did not get access to the province store. The review team is concerned about the preparedness of the province in case of an AI outbreak. District Thanh Liem In April 2007 the district received a total 15,000 leaflets, 5,000 each of three different kinds of leaflets #18a, b, c. No guideline on how to use the leaflets was received. The leaflets were sent to 20 communes according to the population in the communes. The district staff 3 cannot see the point in having three different leaflets, he want to put all the information in one leaflet so people will get all the information and don t lose leaflets. The staff available when asked said that they would not have time to select and distribute to three different target groups. The district staff estimated that people will lose the leaflets after 1 2 months, therefore frequent distribution was needed. The district also received 50 big posters #9, and 2 of the posters were distributed to each commune to be put on the wall in DAH and CPC offices. Finally 20 DAH kits for vets were received and distributed to DAH staff in 20 communes. Commune Liem Can DAH was represented by the local vet, who did not have any office space at the commune but operated out of his home. The local vet received a total of 250 leaflets of three types namely #18a, b, and c. The leaflets were distributed to leaders in the hamlet and also directly to local people during vaccination campaigns of poultry; a total of 90 small posters #5, 6, 8,9,11 and 12, distributed to leaders in the hamlet and local people; approximately 300 leaflets #16 and 2000 photocopies (black and white) of leaflet #16 used for pre Tet distribution; and finally 1 DAH kit for vet, lacking boots, soap and booklet. The local vet claimed that only the JP s AI IEC materials were available at hamlet level. He had not received any feedback on the distributed materials. Hamlet Nhi DAH is not represented at hamlet level. The Hamlet Leader received 63 leaflets #18a,b,c and distributed it as a set of 3 leaflets to families that raised poultry, if they raised a lot of poultry the also received some of the material below; a total of 95 small posters #2,4; a total of 75 small posters #5,8,9; one big poster #8 put up in the hamlet meeting room (but not found by the review team) ; and finally 100 leaflets #16, the leaflets Picture 8. Poultry seller in the market of Liem Can commune had never seen any of the IEC material, but is very interested to read it. Liem Can commune, Thanh Liem district, Tien Giang province. 3 Pham Quang Trung, Director of DAH District in Ha Nam province informs the review team. 11

12 received at the end of The hamlet leader claimed that only the JP s AI IEC materials were available at hamlet. The hamlet leader recommends having only one booklet that contains all the information, then people will not lose it. He wants one booklet for each family in the hamlet. Local people Local people were exposed to samples of the AI IEC materials by the review team to see if they could recognize any of the materials. A local farmer in Nhi hamlet with 500 ducks roaming free in the field daytime had received leaflet #18a, b, c and #16 in spring 2007 from the head of hamlet. The leaflets were received by the children as the parents were out working. All materials were now lost. The person claimed to work very hard and be too tired to read the material in the evening, or would forget what had been read the next morning. Eight poultry sellers in the Market in Liem Can commune had never seen any of the materials but were very interested to read it (Picture 8). They also recommended putting all the information into one booklet in order to have all the information in one place A booklet people will keep, a leaflet people will lose, the poultry sellers informed the review team. Tien Giang Province Province The province level DAH received 10,200 each of leaflet #18a, b, c in May 2007 and still kept all of the leaflets in their store (Picture 9). The province also received 190 DAH communication supply kits for vets in March 2007 from the regional DAH offices and the province distributed 5 kits to each district in the province in June kits were still kept in the store. No guidelines on how to use the materials were received from higher levels or distributed to lower levels. The Vice Director of DAH province informed the review team by telephone that the Provincial Steering Board on AI has decided that all members will participate in a pre TET campaign and use their material and recourses in a coordinated dissemination campaign. DAH would train all levels and disseminate and distribute IEC material to local people. Some IEC materials and the kits would be kept in the province store for outbreak distribution. District Chau Thanh The DAH district claimed that they had never received any JP s communication supply kits or any other AI IEC materials from DAHs, although they were aware that DAH supply kits had been received by the District Steering Board on AI in June 20007, and distributed to district MARD in August MARD Chau Thanh District MARD District claimed that Picture 9. A total of leaflet #18a, b, c still in the DAH Province store six months after they were received, Tien Giang Province 12

13 they received 6 DAH kits but there were no guidelines on how to use the kits, although they would deliver the kits to the local vets if there is an outbreak of AI. There is no list on the content of the kits and no one knew exactly what they consisted of. Some items of the kits were kept separately in the store. The review team was concerned that the kits were split up and would not be delivered as a complete kit in case of AI outbreak. Outbreak distribution DAH HQs During an outbreak, the IEC materials were sent directly from the print company to the outbreak districts by the print company. DAH HQ could distribute material directly to communes and also arrange marching campaigns in outbreak areas. Available material in DAH regional offices will also be used. No list on outbreak distribution was available to the review team. Recommendations Strengthen the HQ monitoring of the distribution and utilization of the IEC material, a system for regular follow up will most likely enhance the use and utilization of the material. Provide guidelines on how to use the IEC material to all levels Investigate if the DAH kits for vets are suitable as the DAH HQs claimed that they are not needed. Recommended from leader of hamlet and poultry seller in the market to have only one booklet for distribution, because people will keep a booklet but lose leaflets. Center for Health Education (CHE) HQs CHE has participated in AI IEC material distribution since the pre Tet campaign of 2005/2006 as well as the pre Tet campaign 2006/2007. Materials received from UNICEF stay no more than 2 7 days in the HQ store, and were then sent to provincial CHEs with a guideline on how to distribute at lower levels. Remote areas were reached by using the postal system for delivery. Delays in delivery occurred only because material from the Supplier arrived late. CHE HQs recommended having more materials to distribute and to keep some materials in the HQs store to be used for AI outbreak distribution. Targeting The provinces are divided in different groups. Group A that is made up by 25 provinces receive more material than other provinces, 14 of these provinces also received CHE health kits. Group A is made 13

14 up of 25 provinces, although only 21 of these provinces are the same as the 33 commonly identified high risk provinces of DAH and CHE. 4 Ha Nam Province CHE staff at all levels received one set of IEC documents, if there were any documents left they were distributed in the hamlets. No assessment of the amount of material needed was carried out before distribution, but the province knew that the amount of material is not enough after they completed a distribution. No feedback received by the province from lower levels or local people on the usefulness of the material. The province claimed that they needed to evaluate this but do not have any budget for this purpose. The amount of materials sent to the districts was based on the number of communes and high risk areas. District Thanh Liem The district visited did not have enough CHE staff to administer the distribution of AI IEC material, therefore the distribution of IEC materials was handled by the prevention center. District to commune distribution plans were based on the number of people in the communes. The hospital visited in Thanh Liem district had received 40 booklets each of #13,13b; 20 small posters of different kinds and 100 leaflets #16. Booklets and leaflets distributed to staff, but not enough to all staff, and posters were put on the wall. Commune Liem Can The communal health stations distributed IEC material to the local health staff in the hamlets. Posters were put up at the health station. No follow up actions on people s understanding or maintenance of the materials were done. Hamlet Nhi Local health staff in the hamlet distributed the IEC materials to the Head of hamlet, head of party in hamlet and heads of mass organizations (6 people), for them to disseminate in meetings. If there were any materials left, they would also be distributed to the people in the hamlet. The review team noted that there were not enough IEC materials for the people in the hamlet. The head of hamlet read the content of the leaflet #16 in the commune loudspeaker system. Dissemination and distribution was targeted at Picture 10. Example of a flipchart. To use a flip chart for AI dissemination is recommended from both CHE and MOET. A flipchart with pictures on AI on one side and instructions to the disseminator on what to say on the other side. 4 Van Dang Ky, Chief of Epidemiology Division, Department of Animal Health, informs the review team, and refers to DAH decision no. 4008/QD-BNN-TY for a list of common DAH and CHE high risk provinces. 14 Picture 11. Poor utilization of AI IEC material. Posters are put up on top of each other, and other posters are put up before the arrival of the review team at a district hospital in Chau Thanh district, Tien Giang province.

15 slaughterhouse workers and backyard farming families. Hamlet health staff also supported vaccination of poultry and distribution of leaflets #18a, b, and c as organized and led by the DAH officials and staff during poultry vaccination campaigns. The review team did not get access to the people in the hamlet and could consequently not follow up on the use or distribution of IEC material in the hamlet. 5 Tien Giang Province Staff at all levels received one set of all materials. If there were any materials left, they distributed them to the local people in the hamlets. Materials were sent to districts according to the number of communes and outbreak communes. Monitoring from province level showed that some communes kept the posters in store and has not used them. The review team noted that there was no AI posters put up in the provincial CHE office. The provincial officials and staff recommended a flipchart to be used for AI IEC. A flipchart with pictures on AI on one side and an instruction on what to say for the communicator on the other side was suggested to be useful for AI knowledge dissemination in the communes (Picture 10). District Chau Thanh There was a new Chairman at the District CHE Office who had not been part of the IEC material distribution. Therefore the Head of Admin Department at the Prevention Center was interviewed. District level distributed material based on the number of people in each commune and the CHE health kits were distributed according to how many health staff there is in each commune. The hospital visited in Chau Thanh district had received big A1 size posters only (approximately 50 posters during 2006/2007) and put them all up on the walls in the hospital. No feedback or questions received from patients on the posters. The review team found that some of the posters had been put up just before the arrival of the team. Posters were poorly mounted and some posters were put on top of each other (Picture 11). The review team was concerned that the IEC materials had not been utilized in the most effective way. Reasons for this can be that other more acute local health concerns are prioritized over AI and that the top down approach to AI IEC material distribution lack ownership at the implementing level. Dengue fever is a major health concern in this province and information on dengue fever protection is prioritized. The review team found a painted metal sign on dengue fever protection at the entrance to the hospital (Picture 12). The sign is highly durable, attached to the ground and visible to all visitors to the hospital. The review team recommends that the same kind of sign can be used for AI dissemination as AI is a long term concern. Picture 12. A highly durable sign on dengue fever protection, attached to the ground and visible to all visitors to the Chau Thanh Hospital in Chau Thanh district, Tien Giang province. 5 The review team did not get access to local people in the hamlet although two separate visits were made. 15

16 Commune Than Cuu Nghia when following up on the posters claimed to be put up in the commune no posters were found except posters put up in the Than Cuu Nghia market the same day that the review team visited the market (Picture 1). IEC materials on display at public places were at risk to be removed and exposed to weather conditions, although none of the counterpart s staff or the local people pointed out this as a problem. CPC received one big poster #7 from the commune health center one week ago. In an AI outbreak there is cooperation between the Commune Health Center, DAH, Police and Army. CPC expressed their wish to have a small poster with the content of the leaflet #16. CPC recommend distributing materials through the leader of the hamlet as this was the normal distribution channel and the local health staff did not have capacity to distribute to all people. Hamlet Cuu Hoa Local health staff in the hamlet received one CHE health kit without guidelines. He would keep the kit and use it in AI outbreak. Posters were put up in his house where he also runs a pharmacy. Some of the posters hung up in the hamlet were put up just before the arrival of the review team. The local health staff claimed that poor people in the hamlet had most difficulty to remember the content of the IEC materials, because they worked very hard and were most of the time very tired. He wanted leaflets to distribute in the hamlet as all information is in one place and he can distribute in meetings or at his house. The big A1 size posters were too big; he could not find any place to put them up in the hamlet. There was no hamlet meeting room in this hamlet. The hamlet health staff informs the team that he only has capacity to distribute IEC material in the part of the hamlet he belongs to (hamlets are often divided in smaller units). Outbreak distribution HQs Materials sent directly from CHE HQs store to affected hamlets in 10 days. Materials requested to the JP arrived from UNICEF after 1 2 weeks. Ha Nam Province Teams from the province and its districts went directly to hamlets for distribution. This was often done in cooperation with DAH. Available materials from province store were used and extra materials were requested from HQs store (but the province do not specify how much material they need), 2 3 days delivery time from HQs store. AI IEC focused on risk groups such as people selling or slaughtering poultry in markets and backyard poultry farmers. During an outbreak, affected districts received leaflets from the Preventive Medicine Center in province, 10,000 leaflets but not UNICEF IEC material (the informant do not remember from where, maybe MoH material). Marching campaigns were carried out in one market and two hamlets, standing banners were used. Tien Giang Province If there would be an outbreak of AI the district would disseminate directly in the commune and coordinate with the DAH system. The Commune level would organize AI dissemination and put up posters in public places and hamlet level would disseminate in hamlet and cooperate with the DAH. There were no lists on outbreak distribution were available to the review team. Recommendations Strengthen monitoring of the distribution and utilization of the IEC material, a system for regular follow up will most likely enhance the use and utilization of the material. Evaluate the use, usefulness and utilization of the material. Provide guidelines on how to use the IEC material to all levels. 16

17 Enhance targeting of high risk areas and high risk groups. Present distribution is mainly based on the number of communes and the number of people in each commune. Assess the capacity of the local health staff in the hamlet to distribute AI IEC material and utilize the head of hamlet for distribution when suitable. Summary and recommendations Summary An impressive number of information, education and communication materials such as print materials and AI Hygiene supply kits were distributed nation wide in various volumes for each type of materials through the pre tet campaigns 2005/2006 and 2006/2007. These included posters, leaflets, booklets, pamphlets and supply kits. The government counterparts DAH and MOET participated in the pre tet campaign 2006/2007 and CHE in both of the campaigns. The distribution of IEC material was done through a top down system where the government counterparts CHE, DAH and MOET send requests for materials development and distribution to UNICEF, as coordinator of the Joint Programme s AI Behavior Change Communication Component, for support with rationales regarding their plan and location of distribution. Materials have been distributed to staff at all levels of the counterparts systems, and if there has been enough material, also to local people in the communities. The distribution network through the different government counterparts is working although some IEC materials in the provinces reviewed are still in the store at province level. IEC material is reaching the staff of CHE, DAH and MOET but there is still room for improvement on how the material is used and utilized. Targeting of the IEC material to high risk areas or high risk groups is weak. The IEC material is mainly distributed according to the number of communes in each province. The main targeting of the IEC material seems to happen at hamlet level and being done by people outside the government counterpart systems, i.e. the head of hamlet. Only the CHE HQ target 25 of the provinces with more materials, based on other criteria than only the number of communes in the province. Distribution in the provinces differs. In one province the IEC material can still be found in the DAH province store over 6 months after it was received, the material has recently been planned to be distributed through training courses. In another province the same type of material has been distributed within one month to local people raising poultry in the hamlet. The majority of the IEC material was delivered after Tet to the end user of the material. Outbreak distribution goes directly from the head quarter to the affected areas in two weeks for the CHE and DAH systems. If there is material in store at province level it will also be distributed directly to the areas affected by AI outbreak. The review team could not find documentation on outbreak distribution. The DAH system has enough material to distribute to local people at hamlet level although they do not have any staff to carry out the distribution, but use the hamlet leaders to distribute. The CHE system has staff at hamlet level and a potential to disseminate and distribute at hamlet level but do not have enough material or capacity to distribute. In some hamlets CHE staff support DAH commune staff during poultry vaccination campaigns by carrying out vaccination of poultry and distribute DAH IEC material. 17

18 MOET distribute AI IEC kits to teachers to be used for dissemination in primary schools, the school kits are used for the first time from the start of the school year this September. The kits have been distributed equally in the same number to all provinces. The IEC material is interesting and appealing to the students, but the teachers request teaching material to be used with the school kits. The want same type of material or a flipchart, but bigger, so all students can see it when they use it. The review team sees a potential to use school children for dissemination and distribution of IEC material in their homes. One general recommendation from all ministry counterparts at all levels is that more material is need. Although the review team finds that only a part of the IEC material received has been used or utilized fully. To distribute more material will not necessarily increase the impact of the programme at this point. To increase the impact of the programme the distribution of IEC material has to be complemented by improved utilization of the material received. Ministry counterparts claim that there is no feedback from lower levels on the use or usefulness of the material. There are no budgets for follow up and needs assessments. Informant s claim that guidelines on how to use the IEC material received often is missing, and they do not know how to use the material. The material is therefore kept in store to be used in case of an AI outbreak. Recommendations Set up a monitoring and evaluation system to make sure that the distributed IEC material is used and utilized as intended, before more IEC material is distributed. A system for regular follow up will most likely enhance the use and utilization of the material. Explore possibilities of a joint follow up team from the ministers. Informants at province level claim that they receive no feedback from lower levels or local people on the use or usefulness of the material. Informants claim that they need to evaluate this but do not have any budget for this purpose. Documentation on distribution at different levels in the provinces visited by the review team was weak, partly due to limited human resources and staff turnover. Future distributions have to ensure stronger ownership of the programme at all levels. This can be done by informing and educating the implementers of the programme so that they feel that AI is an important and prioritised issue for them to get involved with. One motivating factor can be to emphasise added values to AI preventive behaviour. For example, positive effects on both human and animal health including child nutrition and livelihoods. To further enhance ownership and engagement in the AI activities implementing levels needs to be involved in assessments of needs and follow up on results of implemented activities and have a possibility to influence programming. Be clear on target areas and target groups and assess the amount and type of material needed for the distribution and plan accordingly. The majority of the IEC material distributed was based on equal distribution to all provinces and levels in the provinces. The main targeting of the IEC material seems to happen at hamlet level where specific households are selected to receive IEC material. The selection is often carried out by people outside the government counterpart systems, i.e. the head of hamlet. Have clear guidelines on how the received material shall be used, as well as clear roles and responsibilities for the implementation. Informant s claim that guidelines on how to use the IEC material received often is missing, and they do not know how to use the material. The material is therefore kept in store to be used in case of an AI outbreak. Ensure early planning of printing and distribution of IEC material, to make sure that the distribution to the end user of the material is carried out timely (i.e. before Tet). The majority of the ICE material was distributed after Tet. 18

19 Follow up on the usefulness of the IEC material distributed and explore possibilities to simplify the distribution by decreasing the variety of material. For example the three different DAH leaflets #18a, b, c was distributed together as a kit, as no one understood why there was three different leaflets, or did not have the time and capacity to select three different target groups. Other comments from local people and staff are that people will lose leaflets quickly but they will keep a small book like #13a, b for a long time. It is also preferred to have all information in one place and not scattered in many different types of material. The leaflet #16 is popular and staff as well as CPC proposes to make a small poster with the content of the leaflet. In one commune 2000 photocopies of leaflet #16 was used for pre Tet distribution. DAH HQ claims that the DAH kit for vets is not suitable and not needed. Integrate AI dissemination in the formal school programme as there is lack of time for AI dissemination in the schools. School staff informs the team that if AI dissemination is integrated in the formal school system they will not have to struggle to find time for AI dissemination. It will also open up for the possibility to distribute AI booklets to all students as they have to return them after the school year, and they can be reused in the same way as other schoolbooks. Explore the possibility to use school children as a potential channel to distribute AI IEC material to their families, both in non outbreak and outbreak time. Especially in outbreak time this can be an effective channel for distribution as the dissemination to school children can be complemented with materials for distribution in their families. Have a joint ministry inventory of all IEC material in stock that can be used for outbreak distribution. Keep enough material in stock in order to be prepared for outbreak distribution and document outbreak distributions that have been carried out. No lists of outbreak distribution were available to the review team. Ensure coordination between the ministries if the EC material is to be distributed to local people, to avoid duplication, because some items are identical for the different ministries. Explore distribution possibilities outside the government counterparts systems at hamlet/community level as they have limited (CHE) or no (DAH) human resources to carry out distribution here. One hamlet health staff informs the team that he only has capacity to distribute IEC material in the part of the hamlet he belongs to (hamlets are often divided in smaller units). Strengthen the counterparts systems for distributing AI IEC material at community level and combine material distribution with interpersonal communication on AI, to enhance impact. Complement the counterparts system by using local community base organisation that can support selection, information and distribution of IEC material to all selected target groups. Complement distribution of IEC material with verbal information or training on AI risks and prevention in order to increase the target group s interest in reading and keeping the IEC material for future reference. Recommended focus for future distributions of IEC material Focus on the MOET for future distributions and integrate AI dissemination in the formal school curriculum. The MOET has comparative advantages for AI IEC material distribution, information, education and behaviour change purposes. Their target group is already in a learning environment in the primary 19

20 school and receptive to information. Information/knowledge/behaviour and material can be distributed through this channel. School children can share information and material in their homes as well as influence their surroundings by their AI preventive behaviour (i.e. wash their hands or not playing with poultry). The review team believe the combination of educating students by using specific AI education material together with distribution of information material, to be highly effective in order to increase awareness and change behaviour. To educate this group in AI preventive behaviour will be sustainable for the future and can also help to improve human and animal health on a broader scale than only AI. The AI activities have the potential to be expanded to other levels of the education system if appropriate. Although, for this to be effective AI prevention has to be integrated in the official school system curriculum to ensure that the issue is prioritised and that time and resources are allocated for this purpose. Distribution through MOET goes directly from province level to the schools. This will decrease the risk of material getting stuck in the counterpart s stores and make it easier to monitor the distribution of the material. Furthermore it is convenient to monitor the education of the school children as it easy to get high quality information by asking them directly in class about their AI education. Children can also inform about AI IEC material they distributed and the situation about AI knowledge and behaviour in their home environment. Implement outbreak distribution through the main responsible ministries counterparts CHE and DAH systems, as well as through MOET by targeting outbreak areas with additional education on AI for school children and extra information material to be distributed by them in their homes. Annexes Annex 1 Distribution of UNICEF IEC material in Ha Nam Province Annex 2 Distribution of UNICEF IEC material in Tien Giang Province Annex 3 Annex 4 Annex 5 List of IEC material with identification numbers List of meetings Terms of reference 20