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Performance Monitoring and Evaluation Essay Background and Context South East Asia was the region that experienced the first wave of H5N1 in both animals as well as humans. As of 1 march 2006, the following is the epidemiological situation: Human infection: no new cases of human infection have been reported since 13 Jan 2006. To date, out of a total of 21 cases of human infections (animal- to- human transmission) 12 are confirmed by WHO reference laboratory as H5N1 infections. The number of deaths due to the infections is 4, and is included in the 12 confirmed cases. All others cases were treated successfully. All 12 cases involved directed close contract with poultry. No human- to- human transmission has been observed. Animal infection: between 15 December 2005 and 23 march 2006, a total of 191 outbreaks across 48 provinces were confirmed and dealt with. All outbreaks were reported from backyard poultry premises, except for one which involved a small- scale poultry farm. A total of 2,304,445 poultry have been culled as part of the national response. To date, 33 individual cases of avian flu have been found in wild birds. No cases have been detected in individual poultry farms. With no new human cases being reported after the last case of 13 Jan 2006, South East Asia has moved from ‘crises response’ to ‘risk management’ mode. Per WHO guidelines, the region is currently maintaining avian flu pandemic alert phase-3. Communication Challenges and Approaches Following the national response to the ‘first wave’ of H5N1 infections in both animals as well as humans, from a communication perspective, at least three categories of ‘audiences’ now exist in South East Asia. the thousands of rural families who have directly experienced their poultry flocks being culled, and with it, at least temporarily, perhaps their source of live hood and nutritional security. the million of viewers who ‘ experienced’ the effect of H5N1 outbreak prevention and containment operations through the media and information channels, without necessarily developing a full understanding of the reasoning and science behind the response. An unknown number of people who neither experienced the outbreak response directly nor received it through the media. The current and future behavioral intent of all these ‘audiences’ in future outbreak responses is largely unknown. This unknown element constitutes a significant concern with regard to national ‘preparedness’, and falls squarely in the communication domain. Field visit and some rapid small-scale surveys in urban and rural areas reveal that through most people have heard of avian flu, there is enormous confusion, lack of clarity, and a felling of dismay among people with regard to the disease, its mode of transmission, its symptoms and treatment, and compensation for the loss of live-stock. There have also been instances of families hiding poultry from culling teams in outbreak areas, and reports of stigmatisation of families who underwent treatment for symptoms. Towards development of a comprehensive communication strategy, an inter- agency, inter-sectoral, unicef- supported workshop on al communications was held under the leadership of the child- intersectoral board (CIB) in Ankara on 9-10 February 2006, to reflect on emerging lesson and planning for future responses.   Key findings and recommendations from the workshop Review all current communication materials, including strategy documents and plans of various agencies working on avian flu, to ensure that messages and plans are harmonized, to minimize duplication, improve coordination, and enhance the impact of intervention. Establish an inter- sectoral strategic communication working group on avian flu to coordinate all communication intervention, under the leadership of the child inter-sectoral board (CIB), governments of South East Asian region. Fill information gaps with regard to community perception of risk and behavioral intent. Conduct of rapid, participatory KAPB studies and the involvement of communities in decision- making and planning are critical for long- term solutions especially since backyard poultry- keeping is a wide – spread culture practice in rural South East Asia. In parallel to clear and improved messaging through the mass media, implement a strong inter- personal communication component to ensure outreach to rural population, with comprehensive and relevant information on bird flu. The mass media is currently providing information in a fragmented manner, and has not been responsive to community concerns. Additionally, frontline workers and community leaders need to be sensitized and comprehensively trained to carry out information and behavior change outreach work, especially in hard-to reach areas and populations. Much of the â€Å"preparedness† can and should be done in advance. Establishing a closure and more engaged partnership with the media, and developing and pre-testing messages and products for the full spectrum and epidemiological scenarios, should be done as soon   as possible. In short the national response calls for the implementation of an integrated communication strategy which addresses the social/political domain through advocacy; strengthens BCC communication capacities and skills of the AI service delivery system; and promote adoption of AI preventive behaviors among communities and individuals through social mobilizations and inter personal communication interventions. Messages and interventions need to be harmonized across all implementation partners. Strategic Programmatic goals The programme goals of national contingency plan of various South East Asian nations for Avian Influenza are articulated in two key documents: Contingency Plan for Avian Influenza (April 2005), Ministry of Agriculture and Rural Affairs (MARA). Goal: Maintain disease response preparedness, and implement rapid control measures in the event of suspicion or an outbreak of disease, to contain virus transmission. Pandemic Influenza National Action Plan (Oct 2005), Ministry of Health Goal: To ensure that all persons, facilities and institutions are prepared to recognize and manage influenza pandemic, and plans are in place to reduce the transmission of the pandemic virus strain; decrease cases, hospitalizations and deaths; maintain essential services; reduce the economic social impact of a pandemic. The documents are the cornerstone of the national preparedness and response plans for the prevention and rapid containment of outbreaks (animal-to-animal, animal-to-human, human-to-human transmission). The communication interventions envisage the dissemination of key message to the public through the mass media and frontline workers, to promote hygiene and prevention behaviors, across the various epidemic phases. Communication Goals and Objectives The overarching goals for 2006 of the communication strategy are: All services provide use the knowledge, recommend healthy practices and reach at least 80% of the population with adequate and accurate information and knowledge. Policy-makers and community leaders use the knowledge and information to prevent and contain avian/pandemic flu, to ensure full systemic and institutional preparedness for rapid roll-out of appropriate interventions to control localized outbreaks, or the emergence of a pandemic. Specific Communication Objectives Through the implementation of a comprehensive and coordinated public education, behavior change and policy advocacy campaign, the following will be achieved by end of 2006: At least 80% of the population correctly recall the negative health effects of Avian/Pandemic Influenza; know the correct methods of AI prevention. At least 80% of those who keep backyard poultry, or are involved in commercial winged animal farming and trading, know how to use safe practices and AI prevention behaviors. At least 80% of community leaders such as teachers, imams and muhtars have a comprehensive knowledge of AI prevention measures and actively disseminate and knowledge. Domains for Strategic Communication Interventions The communication strategy will be implemented to simultaneously influence the following three domains: Social/Political Domain: The primary objective in this domain is to use advocacy methods and tools for the establishment of a supportive and enabling socio-political environment for avian influenza prevention/containment.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Strategic coordination mechanisms and advocacy activities are planed to place AI prevention high on the political, social and development agenda;   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   and to foster political will, and increase financial and other resources to   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   ensure full ‘preparedness’.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Policy advocacy activities will include strategic use of data and approaches to advocate to the parliamentarians, provincial governors and administrators about the impact of the issue at the national level. At the local level, advocacy will be used to convince opinion and community leaders about the need for local action and preparedness. Media advocacy will be conducted to improve quality of reporting, and to ensure that the public receives information of relevance and society remain strongly committed to implementing national AI prevention and containment policies. Target audiences and communication ways include: inclusion of avian flu issues in parliamentary debates and other political events; press conferences; news coverage; technical conferences and symposia; celebrity spokesperson; and meeting between various government agencies and civil society organizations, community and religious organizations, municipalities, service providers, association of physicians, and the private sector. AI service delivery Domain: The objective in this domain is to bring together all feasible and practical inter-social allies, and increase their communication capacities to raise people’s knowledge and awareness, and influence their attitudes and practices, for prevention and containment of avian flu. Allies include; frontline development workers, community leaders, non-government Organizations, municipalities and local media. An appropriate mix of interpersonal, group and mass-media channels, including participatory methods will be used in the implementation of these activities. The range of activities include group and community meetings, school-based activities, traditional media, road shows, leaflets, posters, pamphlets, videos, and home visits. The focus will be on communicating a series of messages about AI transmission and prevention and informing the public about what services are available and where and encouraging reporting of dead/sick bird/poultry. Community and individual Domains: The objective in this domain is t establish community norms and safe practices related to poultry-keeping, for the prevention of avian-flu. Community mobilization techniques can help create an environment through which communities particularly affected and ‘at-risk’ communities, can discuss, organize, build consensus and communicate their own perspectives on AI. Primary audiences including women and children, families involved in backyard poultry-keeping, small-scale commercial poultry farmers and dealers, transporters of poultry products, community leaders. Summary Implementation of a coordinated and comprehensive country-wide Public Education and BCC campaign, directed at stimulating greater public dialogue on Avian/Pandemic Influenza within wider society, and adoption of ‘safe practices’ by ‘at-risk’ population to reduce risk of virus transmission. Implementation and monitoring of policy and media advocacy interventions that facilitate the creation of robust policy implementation mechanisms and a proactive media environment. Increasing of communication capacities and competencies of key partners to implement, manage and monitor prevention/containment strategies, at national and sub national levels. The Campaign will use an evidence-based mix of mass media and ground-level inter-personal communication interventions to achieve the strategic goals and objectives elaborated earlier. Management and Coordination Mechanisms for Implementation The strategy will be implemented, both, at national and sub-national levels, by a range of institutions and partners including the ministry of Ministry of Health, the Ministry of agriculture, Ministry of National Education, Ministry of Interior, UN and international organizations, the provincial Governorates, the Media, non-governmental and community-based organizations , and the private sector. To coordinate and effectively manage the implementation of the communication interventions, the following is envisioned: Establishment of a formal, inter-sectoral Strategic Communication Working Group (SCWG) on AI Prevention/Containment, which will provide overall technical guidance and oversight in the planning and implementation of the interventions The SCGW will be comprised of communication and technical specialists, drawn from among the various partners. Drawn from among the various partners. The Provincial governorates, in collaboration with national counterparts, will provide leadership in coordinating and managing the implementation of activities at the provincial level including the preparation of micro-plans and training of key front-line workers like teachers, health workers, youth groups, and local NGO.