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Communication for Development (C4D)

Applying C4D to curb maternal mortality in Cambodia

© UNICEF/Cambodia/2012
Volunteers launch of the ANC campaign in Stung Treng, Cambodia

PHNOM PENH, Cambodia, 4 September 2012 - For the first time in decades, families in The Kingdom of Cambodia have adopted health seeking behaviours that may finally curtail the nations’ high maternal mortality which is among the highest in the East Asia and Pacific region. Between 2005 and 2010 Antenatal Care (ANC) and delivery by skilled birth attendants has increased significantly. A key contributing factor behind this has been sustained support from UNICEF and The European Commission since 2005 to strengthen the national health promotion capacity.

In 2002 Cambodia’s Ministry of Health identified behaviour change communication as one among a set of key strategies to improve the health of women and children in the country. The European Commission and UNICEF therefore jointly established ‘The Health Behaviour Change Communication (BCC) Project’ providing technical assistance and 5 million Euros to strengthen the national health promotion capacity between 2005 and 2009. The implementing partner was Cambodia’s National Center for Health Promotion (NCHP) with 60 staff based in the capital Phnom Penh, supported by Provincial Health Promotion Units (PHPU) in each of the 24 provinces. While nationwide in scope, the BCC Project was in particular focused on demonstrating good BCC practices in seven of the least developed provinces. Activities were implemented in close collaboration with Provincial Maternal and Child Health Managers and Supervisors.

For the first three years the project provided intensive capacity building support to national and provincial level and by 2008 Cambodia had re-attained a robust and qualified national system to engage effectively with communities and families to improve health seeking behaviours. To demonstrate its renewed capacity, the National Health Congress made an evidence-based decision to prioritise promotion of ANC. NCHP was awarded the responsibility for developing, implementing and monitoring a campaign to increase the utilisation of recommended ANC services in Cambodia.

NCHP successfully took on the challenge and with technical support from UNICEF developed a communication strategy using the COMBI (Communication for Behavioural Impact) planning model. UNICEF and NCHP hired a professional advertising agency and jointly oversaw the development of innovative and engaging audio-visual and printed campaign materials targeting mothers, fathers and other family members. This was guided by consultations and pre-testing with representative community members, families and health staff. Simultaneously, NCHP and PHPUs oversaw the training of around 300 health workers from health centres and 4,400 village health volunteers in the seven demonstration provinces, to provide and promote quality ANC services. Many of these where volunteers and mother support groups that UNICEF had also successfully nurtured and worked with in the past to promote exclusive breastfeeding.

In January 2009 Cambodia launched the ANC campaign on national television and radio supported by the trained interpersonal communicators in the seven demonstration provinces. Throughout the country, potentially pregnant women were encouraged by colourful, innovative and captivating radio and TV spots, mobile phone ring tones, posters, banners and leaflets, to come in for their first ANC visit within a month of missing their period. This core message was communicated massively and intensively in the media several times a day, and reinforced at community level by the trained interpersonal communicators. Everybody talked about it – some even whistled the catchy campaign tune.

The 12 month communication objective was to increase the percentage of women seeking ANC within the first 8 weeks of pregnancy from 5 per cent to 25 per cent in the seven demonstration provinces. In turn this would enable them to receive a set of ANC services including confirmation of the pregnancy and related medical check-ups, vaccination against tetanus, iron-folate tablets, and education on birth planning and proper health and nutrition during pregnancy. An external evaluation of the BCC project and the ANC campaign in 2011 documented that the communication objective was met well beyond expectations: Already within the first 12 month of the ANC campaign, 36 per cent of potentially pregnant women came in for their first ANC visit within the first 8 weeks of pregnancy. This supported the achievement of key maternal health programme objectives; the proportion of pregnant women completing all four recommended ANC visits and receiving the recommended two Tetanus Toxoid vaccinations almost doubled in demonstration provinces. Key to the success of the campaign was the use of both mass media and interpersonal communicators which added credibility to the campaign and enabled genuine community engagement on the importance of ANC. Other key enabling factors were provision of financial incentives for midwifes for delivering a live birth as well as improved road infrastructure.

The Cambodia Demographic and Health Survey (CDHS) in 2010 registered and documented the related and overall improved maternal health indicators. Since 2005, ANC coverage increased from 69 to 89 per cent, delivery by skilled birth attendants increased from 44 to 71 per cent and delivery in health facilities increased from 22 to 53 per cent. Furthermore, the proportion of women delivering with the support of traditional birth attendants at home decreased from 55 per cent in 2005 to 28 per cent in 2010. The ANC campaign has now been expanded to intensively provide and promote ANC in 16 out of the 24 provinces in Cambodia.

Written By Try Tan, C4D Specialist, UNICEF Cambodia, and Tomas Jensen, Communication Specialist, UNICEF Pacific (Health Education Specialist, UNICEF Cambodia from 2005 - 2009) - in collaboration with Denise Shepherd-Johnson, Chief of Communication, UNICEF Cambodia; Penelope Campbell, Chief, Health & Nutrition, UNICEF Cambodia; Malalay Ahmadzai, MCH Specialist, UNICEF Cambodia; Vanny Ung, Health Education Officer, UNICEF Cambodia; Viorica Berdaga, Chief, Health & Nutrition, UNICEF Lao PDR (Chief of Health & Nutrition, UNICEF Cambodia from 2008-2012); and Everold Hosein, Founder of COMBI.



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