Making ‘what works’ work: Changing behaviour in sanitation and hygiene

Experience of integrated communications for behaviour change programmesJulius Lukwago, MSPH, MBAPSI/Uganda

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Wednesday 20 July 2011Session jointly convened by LSHTM/SHARE, WSSCC, UNICEF and WSP

In the next 10 minutes:

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• The principles of Communication for Behavioural Impact (COMBI)

• Experience of using COMBI for malaria treatment• How we can apply COMBI for sanitation campaigns

COMBI demystified

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• BCC is a widespread practice with many approaches and tools. COMBI is just one of them...but it works!

• “Consumer focus” and “Marketing sensibility” inspired from 150 years of private sector practice

• Borrows from psychology, behavioural economics, consumer behaviour theories, health education & the social sciences.

• 10 steps to apply

Does it work?

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• Proven in quick returns on behavioral impact in more than 50 countries for a variety of behaviors: malaria, TB, Dengue, HIV, leprosy, child abuse, domestic violence etc. (Everold Hussein, 2007; Elsheikh 2007, John Elder, 2005)

• Malaria treatment in Uganda

It works: increased correct & timely treatment from 4% to 29%

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Access to treatment within 24/48 hours, 2007 / 2010

20.7%

3.0%

16.2%

1.0%

19.3%

4.2%

29.5%

4.7%

25.0%

2.1%

25.8%

3.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

2007 (N=778) 2010 (N=745) 2007 (N=634) 2010 (N=857) 2007 (N=562) 2010 (N=915)

Kamuli+Kaliro Pallisa+Budaka Soroti

Same day

Same + next day

Source: MMV 2011

It works: replaced other ‘behaviours’

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Antimalarials purchased for Under Fives from Licensed and Unlicensed outlets, intervention areas

%12% 12% 14%

43%55%

45%

69%

42% 40% 20%32%

16%

19%12%

14%

5%48% 50% 59%

50%66%

28% 25% 36%24%

9% 10% 10% 6% 3% 10% 8% 5% 2%

0%

20%

40%

60%

80%

100%

Sept 08(N=238)

Oct 08(N=104)

Mar 09(N=200)

Sept 09(N=205)

May 10(N=850)

Oct 08(N146)

Mar 09(N=251)

Sept 09(N=160)

May 10(N=455)

All Unlicensed Licensed

Intervention area

OtherantimalarialQunine

CQ

ACT

Subsidized ACT

Source: MMV 2011

Our experience

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Audience InsightBehavioral

objectives

Situati

onal Marke

t

Analysis

for

Communication Keys

Behavioral ObjectivesConsumer

Need/Desire Cost Convenience Communication

How different from the usual awareness campaigns?

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Not activity wise; what is essentially different is the application of the marketing rigor and focus on consumer insight. The key issues include:• Clarify and agree on behaviour objectives• Research the consumer to generate insight• Messages have a more emotional than rational base• Have a few and stick to the core messages• MRIP (massive, repetitive, intensive, persistent)

Emotional base: example

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Information that goes ‘beyond’ the obvious

A stated need that your brand

can meetInsight

• "What really decides consumers to buy or not to buy is the content of your advertising, not its form” David Ogilvy

Personality: Ours was Nurturer

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Jungian Archetypes

RulerCreator

Hero

Regular Guy

Nurturer

LoverInnocent

Magician

Jester

Explorer

Outlaw

Sage

Source: Building Brands & Believers by Kent Wertime

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Emotional base: EXECUTIONS

From rational to emotional messaging

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How can we use it for sanitation programmes?

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• The most important parts are two: (1) narrow down to a specific behavioural objective. (2) get insight so as to generate an emotional hook that meets the deep-seated consumer need, want or desire.

• Lifebuoy’s Little Gandhi ad has some inspiration for sanitation http://www.youtube.com/watch?v=huztSICuXjA

• Uses Hero as the ‘brand’ personality...deep-seated consumer desire

Contact details and resources

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• jlukwago@pace.org.ug • www.psi.org • More on COMBI approach: http://steinhardt.nyu.edu/imc/introduction