Planning Social Mobilization and Communication for Dengue Fever Prevention and Control: A Step-by-Step Guide

This 158-page resource explores the use of social mobilisation and communication to convince people to adopt or maintain behaviours in ways that will prevent Ae. aegypti, the mosquito vector for dengue, from breeding in and around their homes. Offered by the World Health Organization (WHO), the guide provides a "road map" of how to develop and implement community-based programmes designed to foster sustainable behavioural impact to prevent dengue fever (DF) and its more severe form, dengue haemorrhagic fever (DHF). As detailed here, an estimated 50 million dengue infections occur every year and at least 21,000 deaths from DHF occur every year, mostly among children. The disease is endemic in the Americas, the Eastern Mediterranean, South-East Asia, the Western Pacific, and tropical areas of Africa.

Specifically, the guide presents the basic steps and underlying principles of an approach to social mobilisation known as "COMBI": Communication-for-Behavioural-Impact. Developed and tested over several years, COMBI represents a coalescence of a variety of marketing, education, communication, promotion, advocacy, and mobilisation approaches that generally aim to have an impact on behaviour and to foster programme-community partnerships.

In introductory sections of the guide, the COMBI philosophy as applied to dengue fever is outlined, and examples are provided of the effectiveness of social mobilisation and communication strategies in specific contexts. For instance, in Johore State, Malaysia, an integrated social mobilisation and communication campaign motivated householders in Johor Bahru District to seek prompt diagnosis for any fevers, to destroy any larval breeding sites found around their premises, and to organise voluntary teams to inspect and control larval breeding sites in public spaces such as community halls, parks, and vacant lots. Dengue volunteer inspection teams (DeVIT) were formed in 48 localities. During the 3-month campaign period, DeVIT teams gave advice to 100,956 people, distributed 101,534 flyers, and inspected 1,440 vacant lots. The campaign resulted in a dramatic drop in the occurrence of dengue in the district; 3 months after the campaign, tracking surveys revealed that 70% householders were still checking their household premises. Two years later, 95% of DeVIT volunteers continue their work, and many of them have requested more responsibilities. The Government of the State of Johore has decreed that the campaign be implemented throughout the State.

Detailed guidance is offered on pursuing COMBI to address dengue; the steps outlined include:

1. Assemble a multidisciplinary planning team
2. State preliminary behavioural objectives
3. Plan and conduct formative research
4. Invite feedback on formative research
5. Analyse, prioritise, and finalise behavioural objectives
6. Segment "target groups"
7. Develop your strategy
8. Pre-test behaviours, messages, and materials
9. Establish a monitoring system
10. Strengthen staff skills
11. Set up systems to manage and share information
12. Structure your programme
13. Write a Strategic Implementation Plan
14. Determine your budget
15. Conduct a pilot test and revise your Strategic Implementation Plan

Specific toolkits offered in the subsequent sections of the resource focus on:

1. Useful books, reports, articles, and websites
2. Conducting formative research
3. Social mobilisation and communication strengths and weaknesses checklist
4. Analytical methods for setting behavioural objectives
5. Ten ideas for achieving the optimum budget for social mobilisation and communication

The guide is intended for health planners, dengue or vector control programme managers, and individuals, non-governmental organisations (NGOs) and other agencies with interests and/or expertise in developing biological, chemical, environmental, and communication interventions to prevent and control dengue fever. It has been used as a background resource for 2 WHO training programmes: a bi-regional (Western Pacific and South-East Asian regions) workshop held in the Lao People's Democratic Republic, in February 2003, and another held in Nicaragua for the Central American region for Pan American Health Organization (PAHO) in May 2003.

Concluding strategic notes in the resource: "Subscribing to the COMBI Planning framework outlined in this guide means that you must negotiate relevant and effective behaviours with all the various partners needed for the prevention and control of dengue fever. Every result you seek must be a sustainable behavioural result: someone has to do something - and continue doing it. It is not enough that they are aware, or are knowledgeable, or are even convinced....Understanding behaviour and behavioural environments requires research. Not just one-off studies but a continual 'dialogue' with your key partners....Better strategy development involves explicitly researching how to reinforce or modify specific behaviours from the outset and targeting a few behaviours that are simple and cheap to put into practice. But you will also need a dash of creativity to develop social mobilization and communication strategies that have real and long-lasting behavioural impact. 'Behavioural epidemics' are needed to combat dengue epidemics. But you can't start a behavioural epidemic unless you have really infectious ideas! And while many strategies can contribute to behavioural results....Someone has to communicate the right thing, in the right way, at the right time, to the right people, with the right effect..."