6 - Community Mobilization in CMAM Jan 11

Community Component in
CMAM
Learning Objectives
• Importance and aims of Community mobilization

• Stages of community mobilization
• Required elements of community mobilization in the
context of Pakistan
• Community providers and their training
• Health Education
• Active case finding and referrals
• Considerations for developing and using CMAM
messages
Community Mobilization
• UNDERSTANDING: of the
main socio-cultural
characteristics of the
beneficiary communities.
• DIALOGUE: with different

segments of the community
to help develop more
context-specific CMAM
programmes.
• PARTICIPATION: of the
community in the processes
of programme design,
implementation and long-
term integration
Core Components of CMAM
Aims of Community mobilization in
CMAM
• Increasing programme coverage
• Strengthening case-finding, referral, follow-up

and monitoring activities
• Empowering the community and increasing

programme ownership.
• Providing a platform for the demand of similar

services from existing national structures
Stages of Community
Mobilization
•  Community’s Cultural Understanding
•  Identification of key community leaders and
influential people
•  Identification of existing structures and community
groups
•  Formal and informal channels of communication
that are known to be effective
•  Attitudes and health seeking behaviors
•  Existing nutrition and health interventions
Stages of Community Mobilization
Community’s
Cultural
Understanding
Community’s Cultural
Understanding
• Identifying key features of the community that
directly or indirectly affect the planning and
implementation of CMAM programmes.
• Methodology: from consolidation of existing

knowledge (e.g. national and local staff), collection
of data (through FGD) to triangulation of information.
• Therefore, guiding the process of cultural

understanding can help make it a more practical and
feasible efforts.
Understanding
Understanding
Key Community
Figures
Key Community Figures
• Who are the main stakeholders in the
community?
• Influential in the community & key to

programme success
• Different areas: socio-political, spiritual &

religious, economic and health.
Community Cultural
Understanding
Key Community
Figures
Community
Groups &
Organisations
Community Organizations &
Groups
• What brings people in the community
together?- agriculture/ health issues e.g.
HIV/AIDS
• Self-created (grassroot) or NGO-

supported groups and organisations
• Motivated, community-driven individuals.

Stages of Community Mobilisation
Cultural
Understanding
Key Community
Figures
Community
Groups &
Organisations
Formal and
Informal
Channels of
Communication
Types of Communication Channels
: Formal & Informal

• How does information
100
travel within and between
50 East
West
communities?
0
1st 3rd North
Qtr Qtr • Both ‘visible’ channels and
the more ‘subtle’ ones.
• Tap into local systems that

are known to be effective
for communicating
information.
Cultural
Understanding
Key Community
Figures
Community
Groups &
Organisations
Formal and
Informal
Channels of
Communication
Health Attitudes
& Health Seeking
Behaviour
Health Attitudes & Health Seeking
Behaviours
• What are some of the general
views regarding child health and
malnutrition?
• Local terms for malnutrition,

perceived causes and
acceptable treatment
• Identifies challenges and

opportunities of each context
and helps define the most
appropriate strategy
Community’s Cultural Community Case Follow Ongoing
Understanding Sensitisation Finding Up Engagement
Key Community
Figures
Develop Active Outreach Periodic
Sensitisation Case- Workers Meetings
Community Finding
Messages
Groups &
Organisations
Volunteers
Formal and
Informal Sensitisation Community
Channels of Plan (Activities) Self- Outreach
Communication Referral Workers &
Volunteers
Health Attitudes
& Health Seeking
Behaviour
Basic requirements for community
outreach in Pakistan…
• WHO ? Community Providers: Lady Health
Workers, Lady Health Visitors and
community health workers and community
volunteers
• WHERE? at the community level. But also at
OTP site to assist health care providers and
linkages between the health facility and
community.
• WHEN? Active case finding and follow up is
ongoing. Community meetings and dialogue
can be periodically high default.
Community Providers Trainings
• Programme aim and target population
• Active case finding (identification of

malnutrition cases
– Kwashiokor
– Marasmus
• Anthropometric measurements
– MUAC-using MUAC tape
– Weight-using Salter scale
– Edema
– Height using height boards
Community Providers Trainings
(continued)
• Follow-ups and home visits
• Health Education
– Breast feeding
– Balanced diet
– Personal hygiene
– WASH
• Community Sensitisation & Mobilisation

Community Providers Selection &
Support
• Who?
– Context specific
– Link into existing networks, (GMVs, village
committees, TBAs, leaders)
– Motivated individuals
• Motivational factors
– Community recognition/status
– Feedback and involvement from Health
System (certificates)
– Incentives:- cash, t-shirts etc
– Refresher trainings
Conclusion
• Community mobilisation is an ongoing process
that is most effective when sustained throughout
the duration of the programme
• Motivation is key to the success of community
participation – the rapid recovery of children is
the single biggest motivating factor at
community-level
• Mobilisation strategies need to be adapted to
individual contexts – e.g. emergency vs.
development, challenges and opportunities
relating to local capacity.
Health Education
Health Education is the process of

identifying, segmenting and targeting
specific groups/audiences with particular
strategies, messages or training
programmes through various mass media
and interpersonal channels, traditional
and non-traditional.
Overall Objectives and Scope of
Health Education Program
• To improve the nutrition status of
children and women.
• To reduce the % of acute and

chronic malnutrition.
• To aware and sensitize the

community about the nutritional
issues.
Health Education A Tool for…!
• Change of Knowledge
• Change of Perceptions/ Attitudes
• Change of Behaviors/ Practices

Methods to be used in Health Education
for Promotion of Nutrition Programme
Use Media Mix
a.Electronic media (TV, Radio etc. )
b.Print media
News papers
Posters/pamphlets.
c.Interpersonal Communication (IPC)
Face to face.
Considerations for
Standard CMAM Messages
The most important messages to be delivered:
1- How do malnourished children look like?
2- How OTP/SFPs will serve them? What is the
whole process?
3- What are RUTF and ?
4- Where and which days services are available t
each locality?
5- How to use RUTF, RUSF, UNIMIX and medicines
correctly?
6- Messages must be simple and very local?
7- Images are always useful
Groups Exercise…
Message development!
The CMAM operation in village Ziba Abad is about to
start. The team is planning to have weekly visits to
the site, on Mondays.
The team is conducting a community public
mobilization campaign to introduce the CMAM and
its program in that village.
Develop a message in groups, be creative and use
whatever tools…
And also explain how the message will be
dissimilated?
HEALTH
EDUCATION
Health
SOCIAL
Providers MOBILIZATION LHWs &
CHWs
NGOs
Intersector-
al support ADVOCACY
Public/co- Religious NGO
leadership
mmunity • Leaders field
administratio Staffs
Service n Artists
Clubs • donors/UN Entertainers
Support Television
materials
Corporations
Mosques
Folk media
Radio
Communication for Promotion of Nutrition

Importance of active case finding and
referral
It helps to ensure that children with SAM

are detected early;
- before the onset of medical complications
- referred for treatment, leading to better clinical
outcomes and decreased strain on in
patient services
Active case finding for early
detection and referral
• Case follow up in the home

– Check on a child who is not thriving or
responding well to the treatment
– Learn why a child was absent from a out-patient
care follow up session
– Learn why a child defaulted (defined as missing
three out-patient care follow up sessions in row)
Barriers to Access: Role Play
• Community Worker
• Nutrition Volunteer
• First Neighbour (in community)
• Husband
• Second Neighbour (returning on the road)
• Outpatient care nurse
Obstacles to participation
in CMAM
• Poor awareness
• Community mobilization is overly broad
• Referral and admission criteria are not aligned
• Local medical or cultural traditions do not connect
advance wasting or swelling with under nutrition
• Community mobilization or site selection may have
overlooked important gatekeepers
• Other services at the PHC facility not well regarded
• Location of the outpatient care site
• Participation interrupted by seasonal labour
36
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Community Component in

• Importance and aims of Community mobilization

• DIALOGUE: with different

• Strengthening case-finding, referral, follow-up

• Empowering the community and increasing

• Providing a platform for the demand of similar

• Methodology: from consolidation of existing

• Therefore, guiding the process of cultural

• Influential in the community & key to

• Different areas: socio-political, spiritual &

• Self-created (grassroot) or NGO-

• Motivated, community-driven individuals.

: Formal & Informal

• Tap into local systems that

• Local terms for malnutrition,

• Identifies challenges and

• Active case finding (identification of

• Community Sensitisation & Mobilisation

Health Education is the process of

• To reduce the % of acute and

• To aware and sensitize the

• Change of Perceptions/ Attitudes

• Change of Behaviors/ Practices

Communication for Promotion of Nutrition

It helps to ensure that children with SAM

• Case follow up in the home

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