SOCIAL MOBILIZATION

PLAN
For

Enrollment in Mal-Ed and To Avoid Possible Future

Dropouts & Refusals during the Study
AGHA KHAN UNIVERSITY, KARACHI
Department of Pediatrics and Child Health

Social Mobilization Plan, MAL-ED, NAUSHAHRO FEROZE | 2

Table of Contents

Abbreviations & Acronyms.....................................................................................................3

Background............................................................................................................................4

(1) Introduction.......................................................................................................................5

(2) Aims & Objectives.............................................................................................................6

(3) What is Social Mobilization................................................................................................6

(4) Why Mobilize the Community ……………….…………………… …………………....……..6

(5) Mobilizing the Community……………………………………………………….…………… 7

(5.1) Assessment of the Target Area…………………..…………….………………….. 7

(5.2) Develop Teams …………………………………………………….…………..…… 8

(5.3) Action Step………………………………………………………..……………..….. 9

(6) Overcoming the Possible Challenges / Barriers………………………………..…………... 12

(7) Monitoring & Evaluation……………………………………………………………. ………... 13

(8) Expected Outcome ……………………………………………………………………………..

………………..……………… 14

Social Mobilization Plan, MAL-ED, NAUSHAHRO FEROZE | 3

ABBREVIATIONS & ACRONYMS

BBCM: Broad Base Community Meeting

CW: Community Worker

CBM: Confidence Building Measures

CM: Community Meeting

COMAA: Communication and Advocacy

DC: Data Collector

IPM: Inter-Personal Meeting

LHW: Lady Health Worker

MAL-ED: Malnutrition & Enteric Disease

PW: Pregnant Women

R.M.O: Research Medical Officer

R.O: Research Officer

RA: Research Assistant

S.M: Social Mobilization

T.A: Target Area

T.G: Target Group

U.C: Union Council

UNICEF: United Nations International Children Emergency Fund

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BACKGROUND

The Enteric Diseases and Malnutrition are considered to be the most prevalent risk factors
for morbidity and mortality and responsible for half of the child deaths worldwide and pose a
great threat to the child health and development at very early age1.

To investigate the associations between malnutrition, enteric infections and risk factors, a
study is being initiated in the eight sites of developing countries including district Naushahro
Feroze, Sindh, Pakistan. It is a longitudinal epidemiological study that is designed to obtain a
comprehensive understanding of the risk factors for malnutrition, enteric diseases and
associated health consequences in children.

We will follow a cohort of 300 children in the selected area (UC Molhan district Naushahro
Feroze) for the period of two years from birth to 24 months age of child.

The accomplishment of aims and objectives greatly depends on the collaboration of the local
community & the participation of target groups (pregnant women & their husbands & head of
the household). Hence, target groups must be mobilized for achieving our target sample size
and subsequently the aims and objectives of the respective project and a specific plan of
activities needs to be formulated that guides the implementation of social mobilization
process at target area during the course of study.

1
MAL-ED project proposal, p-p 4-5
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 1 INTRODUCTION

“Together we can eliminate malnutrition & enteric diseases in children and

strive for a future without this health hazard” (S.A.M)

Social mobilization is a proven development strategy that has helped people around the
world to identify and address important health issues. Social mobilization not only helps
people improve their health and living conditions, but strengthens and enhances the ability of
the community to work collectively towards a common goal2.

Through mobilization, communities can be made aware of the adverse effects of malnutrition
& enteric diseases on their child health and members of the community can develop efforts
to reach out at-risk populations. It can increase awareness within a community regarding the
importance of eliminating and preventing this health hazard. Moreover, the sustainable
support and participation of community, for MAL-ED project, can be achieved through the
process of social mobilization.

This proposed plan is designed to explain in detail that strategic implementation of social
mobilization process step by step at targetarea in lieu with the design of the project. Further,
it describes the procedures and methods of executing the processes involved in social
mobilization during the entire period of the study. In addition, this plan will provide a base for
community support and participation for the respective project.

2
How to mobilize communities for health & social change, pp-2,

http://www.jhuccp.org/training/scope/nepal/comm/concepts.pdf
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 2 AIMS AND OBJECTIVES:
The aims and objectives of the plan are to:

1. Aware and sensitize the participants about consequences of malnutrition & enteric
diseases in their children under 2 years of age.

2. Inform the participants about the procedures to be carried during the entire study
and to get consent (verbal/ written) from them

3. Overcome the refusals and dropouts of the target groups through CBM (Confidence
Building Measures).

4. Improve interaction and cooperation between target groups and project staff.

5. Motivate target groups and key persons to collaborate and participate in project
activities.

3 WHAT IS SOCIAL MOBILIZATION

Social Mobilization, as defined by UNICEF, is a broad scale movement to engage people's

participation in achieving a specific development goal through self-reliant efforts. It takes into
account the felt needs of the people, embraces the critical principle of community
involvement, and seeks to empower individuals and groups for action3.

Moreover, Social mobilization is the process of bringing together all practical inter-sectoral
allies to raise awareness for a particular program, to strengthen community participation for
sustainability and self-reliance. It capitalizes on people’s energies and commitments that can
help move a group of people to achieve a common goal and understand why it matters to
them.

4 WHY MOBILIZE THE COMMUNITY?

It is very important to mobilize the community before the implementation of a community

based projects in which the community participation and collaboration is needed because
mobilization can infuse new energy among target groups for a health issue, it can expand
the base of community support for an issue, it can enhance the participation level of target
groups for MAL-ED and also it can diminish the problem of potential refusals and dropouts of
target groups and also it can encourage cooperation between individuals and organization4.

3
www.tulane.edu/~icec/socmob.htm -
4
Community mobilization guide, Centers for Disease Control and Prevention (CDC),
United states, pp 9, www.cdc.gov/std/see.
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 5 MOBILIZING THE COMMUNITY:

(5.1a) First step: Assessment of the Community (Target Area & Groups)

Before the beginning of mobilization process at the target area, the first step will be the
assessment of the target community in order to have a comprehensive understanding of
target groups, which will help in the formation of activities according to its observed
variables.

Following questions will enable us in the basic assessment of the target area & groups and
the answers will help us in the designing of the mobilization strategy according to it:

• Who is affected most by this disease?

• What are their race, ethnicities, and gender?
• What are their socio-economic levels?
• Where do they live?
• What other information do you have on this population?
• What is the impact of this disease in the community?
• What kind of social mobilization strategy will be most suitable for mobilizing the target
subjects?
(5.1b) Assessment of the Target Area

After assessing the target area, following are the findings & suggested strategies:

Target Area: UC Molhan, District Naushahro Feroze

The MAL-ED field teams have already conducted the identification process of Pregnant
Women (PW) & Women of Reproductive Age (WRA) at the target area in which 300 PW &
4175 WRA have been identified.

The target area is comprised of 38 villages with a population of 17895 & 2354 households
(as per census by SNL [Saving newborn lives] project).

It is divided into four dehs including Machur, Ladho Rano, Molhan Reti and Molhan Jageer.
Deh Machur is comprised of 21 villages, Deh Molhan Reti 6 villages, Deh Molhan Jagir 4
villages and Deh Ladho Rano 7 villages.

Target groups: 300 pregnant women & their husbands and head of the households

and key persons of the community

If we want to mobilize the community, we must know it first. – S.A.M

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(5.1c) Proposed Strategy for mobilizing:

Considering the findings of the assessment of the target area & groups, the proposed
strategy will be COMAA 5(Communication and Advocacy) for mobilizing the subjects and will
be based on following tools and approaches:

• House to House / Door to Door Approach

• Inter-personal meetings/ CM (Corner Meetings)

• Counseling/ Motivation

• Advocacy:

• BBCM (Broad Base Community Meeting), it will be only employed at

the time of strong refusals/ disagreement of respective subjects at
the beginning or during the study

(5.2) Second step: Develop teams

After assessment, the second step is to develop teams which will implement the process of
social mobilization and carry out all the activities and also will monitor & evaluate the social
mobilization processes.

Team Composition:

There will be three teams:

1. Two Field Teams (for Mobilization)

2. One Monitoring & Evaluation (M&E) Team

• Field teams will mobilize the target groups at the beginning of the screening
process (by MAL-ED field teams) till the end of the project from time to time.

• M&E team will monitor & evaluate the ongoing activities of social mobilization
process fruitful

Each field team will be comprised of three members:

• One Male community mobilizer

• One Female Community mobilizer

• One Research Assistant (Female)

5
COMAA (Communication and Advocacy) is a proposed strategy based on combined
approach of communication and advocacy. It will be a productive strategy for mobilizing
the target groups. (S.A.M)
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The M&E team will be comprised of:

• Field Supervisor/ Project Supervisor

• Male/ Female RMO (Research Medical officer)

• Two Data Collectors

(5.3) Third Step: Action Step

Once teams are developed, the training sessions will be conducted for field teams by project
and field supervisors, where teams will be acquainted with MAL-ED project and social
mobilization: its strategy, process and aims and objectives of this plan and also they will be
imparted necessary skills (communication skills, advocacy, motivation etc) to mobilize the
target groups.

After training, the process of mobilization will be started in lieu with project design and
requirement, in a following procedure:

(5.3a) Approaching the key persons (Field Teams):

• Meeting with the key persons (immams/ teachers/ head of village/local zamindars/
nazims/ councilors etc) of the community to aware and sensitize them regarding the
MAL-ED project

• The Field teams (Male members only) along with project supervisor/ field supervisor
will arrange a BBCM with the key persons of respective villages (one by one) in order
to aware the key persons about MAL-ED project and procedures to be carried on
during the study before the start of enrollment process.

• During the BBCM the mobilizer will give project orientation to the key persons of the
respective village(s) in order to facilitate the project activities in that village and to
avoid possible issues during the study.

(5.3b) Approaching the Target Groups (Field Teams):

• The field teams will obtain consent (verbal/ written) and ensure the participation of
the target groups.

• The field teams will visit the respective households before the screening process (of
Child & Mother) in order to get consent.

• Community Mobilizers will arrange Inter-personal meeting with the parents of

respective child (mother & father) separately and will aware them from the aims &
objectives of MAL-ED project and procedures to be conducted in a detailed, pleasant
and polite manner and in local language.

• Community Mobilizers will use motivation/ Counseling as a mobilization tool to

pursue the parent to participate in the study by addressing the adverse effects of
Malnutrition & enteric disease and by telling that how this study is beneficial for them.

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 • During the Inter-personal meeting mobilizers must be humble, polite in their behavior
& tone and demonstrate a positive attitude in order to get consent of the parents for
recruiting their child in the study.

• The Female Research Assistant (RA) will support and assist the mobilizers in
mobilization process and will help to identify the household of the respective child.

• The field teams will maintain the documentation of social mobilization process &
activities respectively and will submit monthly reports to M&E team.

(5.3c) Approaching the strong refusals (Field Teams):

• The field teams will make a separate list of the strong refusals

• The field teams will visit the household of that child whose family strongly refused /
disagreed to continue the participation in the study during the project.

• The field team (Male member only) will arrange the Interpersonal Meeting/ Corner
meeting with the head of the respective family and will motivate him to participate in
the study in conducive environment.

• In the meeting, the team will identify the reasons for strong refusal and will convince
the head of the household in order to continue their participation in the study.

• In the meeting, the team can take help of the field supervisors and community key
persons (Immams, village heads, Teachers, local zamindars etc) to encourage the
respective head of the house to take the active part in the study.

• The field team (Female members only) will meet the mother of the respective child or
grandmother of the child and will provoke her about the importance of their child
health and will aware them about the consequences of not participating in the study.

• The field team (Female members only) can take help of the Local Lady Health worker
/ Female teacher for motivating the mother/ grand mother of the respective child.

The mobilizers are suggested to adopt following way of mobilization step by step (during the
IP/BBCM meetings) in order to give comprehensive and same information about MAL-ED
project to the target groups and key persons of community:

o Introduce yourself and your organization and purpose of your visit in very
humble manner considering best ethical practices.

o Describe briefly the consequences of malnutrition and enteric diseases:

 Malnutrition is considered to be the most prevalent risk factor for

morbidity and mortality

 Malnutrition and enteric diseases caused 50% deaths in chidren in

developing countries

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 o Give brief introduction of MAL-ED project: its aims and objectives in detailed,
polite and friendly manner:

 MAL-ED project is a epidemiological longitudinal study

 The aim of project is to test the associations between enteropathogen

infections and malnutrition and to discover that which micro-organisms
or mixed infections are responsible for growth faltering and poor
development and at what age in early life do specific infections cause
the most disruption to growth and development

o Explain the procedures to be conducted in greater detail (one by one):

o Written consent, screening process and enrollment

o Twice weekly surveillance (for diet and illness of child) and diarrheal
sample collection (if child experienced diarrhea) for cause of diarrhea

o Anthropometry (monthly 0-24 months) for physical growth

o Stool sample collection (monthly 0-24 months) to identify pathogens

o Urine sample collection (at 3,6,9 and 15 months) to see the nutritional
status and gut integrity of child through lactulose and mannitol test

o Blood sample collection (at 7 and 15 months) to assess the child

immune response and level of micronutrients i.e. vitamin A

o Different forms will be filled from time to time to get subsequent

information about mother and child health.

o Describe the advantages of MAL-ED project and benefits of participating in

project study and motivate them to participate in the study.

o Aware them from the importance of child health and development

Note: Mobilizers will use local language (sindhi) of the community in mobilization process
and will use motivation and counseling as mobilizing tools for mobilizing the target groups
and key persons of the community

Mobilizers should: Mobilizers should not:

• Know as much as possible about
respective subject
• Keep record of mobilized
subjects.
He/ She should have patience,
listening skills, skills to ask
question and politeness
• not get discouraged.
It is possible that a family would
need more than 5 visits.
Share such information of the
family, If the family shares with
you something which should not
spread to others, keep strictly with
you
• not give wrong or half
information
• be aggressive in her/ his tone
.

For community mobilization to succeed, energy and momentum is needed

otherwise people's morale will decline as time goes on. (S.A.M)
6 OVERCOMING THE POSSIBLE CHALLENGES & BARRIERS
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Mobilizing the community is not an easy task; there will be possible Barriers/ challenges in
the implementation of social mobilization process at the target area during the project study.
Thus, it is important to highlight some of the potential challenges and find solutions
accordingly.

Possible Barrier: Strong Refusals

Strong Refusals of the parent of the child during the study due to twice weekly visits and
blood, urine & diarrheal sample collection because twice weekly visits may irritate the target
groups and the varied collection of samples may distress them.

Proposed Solution:

The field teams will arrange the Broad-Base community meeting in the village of the
respective subjects with help of key persons/ religious person/ community workers/teachers
in which the father or head of that family will be invited.

In the meeting, male mobilizer will demonstrate the benefits of MAL-ED project and along
with that other key person may have an informal speech to pursue the targeted subject to
continue the participation.

To overcome this potential issue, the mobilizers are suggested to inform all the procedures
to be conducted during the project in greater detail before the filling consent form.

The field teams can take help of field supervisor (if it is required) in the BBCM to mobilize the
refused participant.

If the father/ head of the family still refuse to participate then the child of the respective
family will be excluded from the study.

Possible Challenge: Reliability of Data

Reliability of Data / Documentation (Mobilization)

Proposed Solution:

All the concerned documents/ data will be checked by M&E team for its reliability through
weekly random visits to the respective family(s).

M&E team will do (10%) validation of the mobilization activities (by mobilization teams) and
the documentation will be thoroughly checked by the supervisors of MAL-ED project.

Possible Challenge: Sustained Participation

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Achieving the sustained participation of the target groups throughout the study

Solution:

The mobilizers will make quarterly visits (in a year) to the particular households and will
motivate the target groups throughout the study and will give small gift packages to their
children like toys, picture books etc.

This act of the mobilizers will create a sense of support and care among the target groups
that will increase the active participation in the study

Possible Challenge: Harsh Attitude

Harsh attitude of target family towards project staff in case of death of target child during the
course of study because it is possible that during our study a child may die and his/her
family may associate the death with project activities (blood sample & urine sample) and
may blame project staff.

Solution:

The mobilizers (Male) along with project supervisor/ field supervisor will arrange a BBCM
with the key persons of respective villages (one by one) in order to aware the key persons
about MAL-ED project and procedures to be carried on during the study before the start of
enrollment process.

This action will greatly help us to overcome this potential challenge because in case of death
of target child, the key persons will support us and will help to gratify the target family.

7 MONITORING & EVALUATION OF MOBILIZATION PROCESSES

The monitoring & evaluation is an important element of a plan to analyze collected

information & impacts of strategic targets systematically as the project progresses. It is
aimed at improving the efficiency and effectiveness of a project and to keep the project
activities on track.

Therefore, it is necessary to monitor & evaluate social mobilization processes and activities
throughout the project in order to increase the effectiveness and efficiency of the
mobilization process.

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Monitoring & Evaluating: (M&E Team)

The M&E team will be responsible for validating, monitoring & evaluating the social
mobilization activities and processes throughout the study.

• M&E team will weekly monitor the activities of core teams through visiting & meeting
the concerned target family randomly

• M&E Team will monitor the efficiency of the activities of core teams through the
monthly performance of core teams and can modify the changes in mobilization
processes accordingly.

• The M&E will monitor the monthly progress of mobilization activities:

 Number of visits were made?

 Number of IP/CM/BBCM meetings were arranged?

 Behavior/attitude of mobilizers during the meetings?

 Number of consents were obtained?

 Number of refusals were reported?

 Reasons for refusals?

 Number of refusals were made agree and how?

• The M&E team will make weekly surprise visits to the respective village(s) to ensure
the quality assurance of the mobilization activities in the target area.

• The M&E team can set their own guidelines of monitoring & evaluating (as
appropriate to requirement) within a specific time period to further enhance the
efficiency and effectiveness of mobilization activities

• The M&E team will validate 10% of the total data of mobilization processes.

8 EXPECTED OUTCOME OF MOBILIZATION PROCESSES

Most likely, the target families will be made aware of the adverse effects of enteric diseases
and malnutrition, written consent of target groups will be obtained, the participation of target
groups will be ensured & sustained and a base for community support & collaboration(for
MAL-ED project) will be created.

The target families in general will be educated about the importance of child health and
development through this social mobilization process that may lead to future cooperation
and support of community for other health-related project.

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