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1.0 Background
The Reproductive Health Directorate in conjunction with Health Education Unit (HEU) in partnership with
Save the Children, Saving Newborn Lives (SNL) project, with funding from the Bill & Melinda Gates
Foundation (BMGF) piloted a Social and Behavior Change Communication (SBCC) campaign,
the Khanda ndi Mphatso Campaign, in Machinga and Thyolo. The campaign aimed to improve newborn
health by shifting norms around the value for newborns, and to promote Kangaroo Mother Care (KMC) for
preterm and low birth weight (LBW) babies.
The Khanda ndi Mphatso campaign was piloted in two districts (Thyolo and Machinga) under the
governments Moyo ndi Mpamba (Life is Precious) umbrella campaign, which is a national health
promotion campaign that encompasses six health areas, including maternal newborn health. The Khanda
ndi Mphatso campaign was designed to build upon the investment and success (brand equity) of the
Moyo ndi Mpamba campaign and tap into its implementing partners and structures.
1.1 Contextual Background
In Malawi, three conditionscomplications of preterm birth, severe infection, and intrapartum-related
(birth asphyxia)account for 89% of all newborn mortality. Complications from preterm birth alone claim
roughly a third of all newborn deaths. A myriad of factors contribute to the high rate of preterm deaths,
including: low socio-economic status, low literacy levels, limited decision-making power among women,
lack of knowledge of the danger signs in pregnancy, delays in care-seeking for delivery, harmful cultural
beliefs and norms, poor infection prevention practices and poor quality of care.
While several interventions have been implemented with the aim of promoting maternal child health in
Malawi, most have focused on improving child survival by targeting immunization, hygiene and prevention
and treatment of common childhood illnesses (malaria, pneumonia, diarrhea). Despite multiple SBCC
efforts to reach women of reproductive age, pregnant women, and caregivers, including the Moyo ndi
Mpamba campaign, none have focused specifically on pregnant women at risk for preterm birth or women
who have given birth to premature infants. Moreover, there have been limited efforts to increase the value
of newborn life and address misperceptions and stigma against preterm birth or small/LBW newborns. To
address these gaps, the MOH and SNL developed and piloted an SBCC campaign focused on pregnant
women and mothers of preterm/LBW babies, which has been branded Khanda ndi Mphatso (A Baby is
a Gift), with the tag line Lipatseni Mwayi (Give it a Chance).
1.2 The Khanda ndi Mphatso Campaign
The campaign brand Khanda ndi Mphatso builds on the everyday positive perceptions of a baby as a
gift, with the aim of increasing value for newborn life. The tag line, which is also a call to action- Lipatseni
Mwayi (Give the baby a chance) aims to inspire Malawians to provision the necessary care to newborns,
which in the long run will result in the improvement of newborn health.
1.2.1 Campaign goal and SBCC objectives
Goal: To increase the value of newborn life and community-wide/familial engagement in saving newborn
lives, with a focus on low birth weight babies
Specific SBCC objectives:
To increase by 20% knowledge of LBW babies and KMC among pregnant women
To increase by 20% proportion of mothers with low birth weight babies who strongly agree that
KMC is an effective way to save LBW
To increase by 20% the number of mothers of LBW babies who agree that their husband/partner
supported them to practice KMC
To increase by 20% the number of mothers with LBW babies who report receiving comprehensive
counselling to support KMC (continuous skin-to-skin, breastfeeding, infection prevention/hygiene, danger
signs and care-seeking)
To increase by 20% the proportion of mothers of LBW babies who report that their community is
supportive of KMC
FAMILY
Husbands
Mother-in-Laws
Other family members of the primary audience
messengers, radio listening groups, and road shows. At the same time, they heard campaign messages
on local radio and when they visited the clinic or entered the KMC ward, they engaged in interpersonal
communication (IPC) with providers who provided more detailed information for skill-building. Community
health workers (Health Surveillance Assistants HSAs) were also expected to follow up with mothers
discharged from KMC units to support community KMC efforts.
babies and their partners will lead to increased acceptance of KMC as effective way to save PTB/LBW
babies.
o
Increased access to information and dialogue about PTB/LBW and KMC among pregnant
women will lead to increased uptake of services and KMC maintenance
Increased community sensitization will lead to increased social support for pregnant
women to be aware of KMC options and for parents of PTB/LBW babies to seek appropriate health care
(through a pathway of changes)
Increased social support for pregnant women and women with PTBL/LWB babies will improve
their care seeking for ANC, labor & delivery, and postnatal care for the needs of their PTB/LBW infants
and themselves.
1.2.2 Khanda ndi Mphatso implementation
The Khanda ndi Mphatso campaign was piloted in two districts Machinga and Thyolo. These districts
were selected based on criteria outlined at a stakeholder workshop convened in February 2015 by the
Ministry of Health (Health Education Unit and Reproductive Health Directorate) and Save the Children
Saving Newborn Lives project. Criteria included: 1) high birth volume; 2) well-established KMC services
to ensure that there is quality supply to meet increased demand; 3) ongoing community-based maternal
newborn health interventions implementation; 4) at least one district with SSDI interventions and other
partner support for KMC services[1].
Machinga and Thyolo are located in the Southern region of Malawi (see map). SNL was implementing
concurrent efforts to strengthen the quality of facility-based care for small and sick babies in both districts.
Machinga was an SSDI-Communication District where the "Life is Precious" SBCC campaign has had a
media and community-based presence. Both have district hospitals with well-established KMC units.
There are distinct differences between the two districts in terms of religion and cultures. The Yao tribe, a
large proportion of whom belong to the Muslim religion, dominates Machinga. In contrast, Thyolo is
dominated by the Lomwe tribe, the majority of whom belong to the Christian religion. Polygamy is more
common in Machinga than Thyolo.
Within each district, three traditional authorities (TAs) were selected for implementation with inputs from
district leaders. Meetings were then held with the Area Development Committee (ADC) for the selected
TAs to identify one Group Village Headman (GVH)[2], a cluster of approximately 10 villages, for
implementation of the community and facility based activities. Mass media activities (radio and TV spots,
etc) were implemented district wide and nationally. Annex 2 provides an overview of the target
population, community groups and health facilities in the targeted communities.
Baseline: In April 2015 a mixed methods (qualitative and quantitative) assessment was conducted to
assess baseline levels of predictors of newborn health with regard to preterm birth and KMC (including
knowledge, attitudes, self-efficacy, risk perceptions, normative perceptions and practices). This was a
descriptive cross-sectional survey conducted among a sample of community members, pregnant women,
women who delivered a LBW/PTB baby, husbands of women who delivered a LBW baby, and nurse
midwives in the two pilot districts where SBCC activities are being implemented. The full baseline report
is available and a summary of the results against the main communication objectives is provided
in Annex 3.
Phasing: The Khanda ndi Mphatso campaign was designed to communicate on two separate, but
simultaneous levels, through:
An umbrella IMAGE phase: This component is aimed at shifting norms, increasing the value of
newborn lives (regardless of size), and mobilizing pregnant women, male partners, family members, and
providers. Activities and materials for image phase include: radio spots, campaign theme song, branded
messenger badges, roll up banners for health facilities; branded chitenjes and t-shirts; posters and
billboards
A TACTICAL phase: This is a component that promotes specific health behaviors, with a focus on
increasing demand for the early initiation of KMC that continues after discharge from the KMC Unit and
into the community (community KMC). Activities and materials for the tactical phase include: radio spots;
radio dramas; digital stories (included in messenger toolkit); repackaged radio dramas from Life is
precious; KMC flip chart; KMC take home calendar; Messenger toolkit and toolkit guide; road shows;
community discussions; religious sermons; facility discussions; SMS messages to pregnant women and
women in KMC.
A detailed overview of Khanda ndi Mphatso main activities and materials according to phase (image,
tactical of both) is provided in Annex 4. A summary of the main campaign activities and the timeframe in
which they were implemented is shown in the table below.
2015
Activity
2016
No
Ma
Au
No
Dec Jan FebMarApr
Jun Jul
Sep Oct
Dec
v
y
g
v
Campaign launch
(Nov 24-26th)
TV music video
SMS broadcasting to
SC-support ended in
July but song still
playing on TV due
to its popularity
Messenger training
Community activities
(community dialogues,
discussion, household
visits)
Facility-based
activities (ANC
counselling, KMC
counselling)
Road Shows
Data were also to be collected on number of campaign messengers trained, participation during activities,
and actions taken after community discussions.
Community level activities were monitored periodically by SNL staff and reports prepared by GVHs were
reviewed and summarized to track types of activities, messenger involvement, and numbers reached.
Data is still being collected and the completed template will be shared with the evaluators in January.
In addition, one day community reflection meetings were held in each district in August 2016 bringing
together GVH leaders, religious leaders, HSAs, KMC veteran mothers and health facility staff to facilitate
cross learning, sharing of experiences and implementation and consolidation of findings thereof, with the
aim of enhancing impact and generating evidence for progress reporting. A mini mid-term assessment of
the campaign was conducted in end of September 2016. The min report reveals that community members
testify to have heard campaign information from church, community messengers and health facilities. It
was however known that people cant recall detailed campaign information heard from various fora.
1.3 Rationale for an evaluation
The Khanda ndi Mphatso campaign pilot phase will be completed by December 2016. The Ministry of
Health and other stakeholders require information about the extent to which the Khanda ndi
Mphatso campaign is achieving its objectives and if successful, what would be needed to scale up the
program beyond the pilot districts. Findings from this evaluation will be used by SNL to determine a way
forward and will be shared with stakeholders and partners.
2.0 Objectives of the evaluation
The overall objectives of the evaluation are to:
1. Determine if Khanda ndi Mphatso SBCC objectives and intended outcomes are met and assess
the processes of implementation
2. Assess the quality of the Khanda ndi Mphatso campaign in terms of appropriateness of channels
used for the local context, scheduling, reach and recall
3. Identify constraints and areas for improvements and provide recommendations
Did knowledge improve regarding PTB/LBW babies among the primary target audience of the
campaign (pregnant women and mothers of LBW/PTB)?
Has the belief in KMC as an effective way to save PTB/LBW babies among the primary (and
secondary audiences) increased?
Did the level of community support and male involvement in KMC improve in the pilot
communities?
Did targeted health facilities provide effective counselling on KMC to pregnant women and
mothers of PTB/LBW babies?
Did the perceived value of newborn life, and in particular the life of small/preterm babies, improve
in the target communities?
1. Assess the quality of the Khanda ndi Mphatso campaign in term of appropriateness of channels
used for the campaign content in the local context, scheduling, reach and recall
What was the reach and recall of Khanda ndi Mphatso campaign content among the primary and
secondary audiences (disaggregated by content, channels and mode of delivery (message, dialogue or
other)?
How were the messengers (CAGs, KMC veterans) prepared/trained and were the support
materials (toolkits, job-aids, etc) useful/relevant to support their actions?
Did the campaign activities generate meaningful debate and discussions among communities and
families? Did the discussions/campaign activities lead to supportive actions at community level?
1. Identify constraints and areas for improvements and provide recommendations
What were the main challenges to implementation of the Khanda ndi Mphatso campaign?
What are the target audiences suggestions for improving the Khanda ndi Mphatso campaign?
Baseline content
o Maternal
Pregnant Baseline: 60 women
women recruited from
district hospitals (30
from Thyolo DH and
30 from Machinga
DH) among women
attending ANC and
maternity waiting
homes.
Endline options:
background
characteristics
o
Knowledge of LBW
(ever heard of, ever
given birth to LBW,
source of info)
o
Knowledge of
KMC (ever heard
of, benefits of
KMC, source of
info)
o Rating of
(1) Min of 60
women recruited
from ANC/waiting
sources of
homes at target
information on
facilities (including
MNH (very useful
lower level facilities)
Additional endline
content
o Maternal
Mothers Baseline: 60 women
of LBW/ recruited by
PTB
randomly sampling
women discharged
from KMC ward at
district hospitals (30
from Thyolo DH and
30 from Machinga
DH).
Endline options:
background
characteristics
o KMC
practices postdischarge (still
practicing, reasons
why not, length of
time in STS,
whether go out of
house with baby in
STS, challenges)
o Support
follow-up care
(facility,
community)
o Perceived
benefits of KMC
A small sample of pregnant women and mothers of PTB who registered for SMS messages
(randomly selected from the list of those registered) can be contacted and administered a very brief
survey about their exposure to the messages, what they recall, whether they found the messages
relevant/helpful, would they recommend another woman to register, etc.
Sample of campaign messengers at community level could be sampled directly from the list of
messengers and surveyed in person - would request come to central location on specific day and time to
minimize costs and time; would be administered a very brief questionnaire
4.2.2. Qualitative data
Qualitative data for the evaluation will be collected through focus group discussions and individual indepth interviews and will aim to solicit feedback from the primary and secondary target audiences
regarding how they have received and perceived communication materials and interventions, assess the
self-reported impact of the intervention on the target audience, and identify recommendations for
improvement. The evaluation will involve conducting focus group discussions (FGDs) with pregnant
women, women who have given birth to LBW babies, their spouses and families, as well as health care
workers, religious leaders and other campaign messengers who will be trained in IPC.
The minimum number of FGD and IDIs are given in the table below, based on the baseline data
collection. Convenient and purposive sampling will be used to recruit pregnant women and health care
workers, community leaders, religious leaders and other campaign messengers to the discussions.
Pregnant women will be recruited from health facilities in the target GVH communities with the help of the
facility in-charge, and community members will be recruited from their households with the help of the
community leaders (village headman) and community based campaign messengers/CAGs. Snowball
sampling strategy will be used to recruit participants, especially husbands of women who have delivered a
preterm baby to the discussions.
Maching Thyolo
a
Total
Interviews
Conducted
Pregnant women
KMC mothers
FGDs
Total FGDs
12
HSAs
Nurse midwives
Community Leaders
Religious Leaders
Husbands
10
20
IDIs
Final SBCC baseline reports, data collection tools and datasets (quantitative and qualitative)
Monitoring data
In addition, SNL Malawi will also provide the following supportive functions for the evaluation team:
provide inputs to the development of data collection tools and sampling approaches
organize consultative meetings with stakeholder at the district and national level to solicit input on
the evaluation preliminary findings from key stakeholders
conduct inception meeting with stakeholders, particularly with DHO and HEU and RHD
develop and finalize quantitative and qualitative data collection tools (within inputs as described
above)
identify key informants and provide additional information and reports as needed
provide inputs to the survey tools and support sampling (particularly for the comparison areas)
2016
2017
Activity
Nov Dec Jan Feb Mar Apr
7.0 DELIVERABLES
The selected evaluation team will be responsible for the following deliverables:
Deliverable
Description
Preliminary
Preliminary report and summary 2 weeks after data
evaluation report presentation covering the
collection ends
and presentation following sections: background
and objectives; evaluation design,
sampling and sample size, data
collection, analysis, findings,
discussion, conclusions and
recommendations
Final clean
Quantitative data: dataset in Stata 1 week after
datasets and
(preferred) or excel; any analysis feedback received
analysis files for files (Stata preferred)
(same time as final
quantitative and
qualitative data
evaluation report)
8.0 BUDGET
The budget should cover the costs of professional fees and data collection, entry and analysis costs.
SNL will cover the costs of evaluation planning and dissemination meetings as such these costs should
not be included in the evaluation agency budget. Overhead charges are limited to 10%. Unallowable
costs include purchasing of hardware (tablets, computers, voice recorders, phones, etc.) and analysis
software. Note that while new purchase of hardware is not allowed, budgets can include use fees for
tablets and voice recorders owned by evaluation agencies that will be used for data collection purposes.
All quantitative data will need to be collected using tablets while qualitative data will need to be collected
using voice recorders/phones.
Interested agencies must use the budget template provided, which outlines expected line items.
Description of budget line items is required to justify the budget (e.g. contribution of key personnel listed,
travels details, etc.)
Experience with mixed methods evaluation required; qualitative and quantitative research
methods.
Experience evaluating SBCC campaigns required; experience with maternal and newborn health
programs preferred.
Documented experience collecting and analyzing qualitative data required, including focus group
discussions and in-depth interviews required; experience using Nvivo software preferred
Documented experience collecting and analyzing quantitative survey data required; experience
using CS Pro for data entry and Stata for data analysis preferred
Experience collecting quantitative data using tablets/phones highly preferred, as this can improve
data quality and reduce time between collection and analysis
The proposal must be submitted in hardcopy as outlined in the request for proposal or 11.0 below. Ecopies of submitted hardcopy proposals will be requested from those that will submit their proposals. The
e-copies will be used to aid in the evaluation process hence the need to maintain similar content as
presented in the hardcopies. Submissions must follow the proposal outline (see below) and budget
template provided.
Proposal outline (max number of pages given in parentheses):
Cover page with project title, agency name, contact person, contact details, and date of
submission (1 page)
Methodology covering: design, sample size and sampling, data collection plan, analysis approach
and milestones with timelines (5 pages)
HR/staffing plan with brief bios and relevant qualifications of key qualitative and quantitative staff
(2 pages)
Budget
Preference will be given to evaluation teams demonstrating experience with mixed methods (quantitative
and qualitative expertise), evaluations of SBCC programs, and competitive budgets.
11.0 Mode of Submission
The technical and financial proposal should be in separate sealed envelopes and put into one envelope
clearly marked Proposal to conduct final evaluation of Malawis Khanda ndi Mphatso SBCC
Campaign and submitted not later than Friday, 25th November, 2016 at or before 13:30 hours local
time at Save the Children Country Office in Lilongwe addressed to:-
Email submissions will not be accepted. Electronic copies of the proposals will be
requested after the deadline and opening of proposals to aid the evaluation process.
Save the Children reserves the right to accept the lowest, highest or no proposal
Save the Children maintains a 'Zero Tolerance' policy towards fraudulent, dishonest,
corruption and bribery practices. If you are approached by Save the Children staff or
representative demanding or asking for any kick-back or willing to provide any privileged
information in exchange of business favours, please call a toll free line on 52121. Corrective
measures shall be taken according to the organisations policy and the supplier shall never be
penalized or disadvantaged in any way.