SAVING LIVES WITH

KEY PRACTICES

Enoch Kalenga, 10, sleeps under a mosquito net at his

home, in Kalemies Filtisaf neighborhood.
UNICEF / Benoit Almeras-Martino, 2014.

Promoting key family

practices in the Tanganyika
District (Katanga)

UN ITED N ATIONS C HILDRE N S FUND Demo cratic Re publ i c of t he Congo

CONTEXT
Ac c ording to t he 2013
De mographic and Healt h Sur vey
c o n d ucted by t he C ongoles e
gove rnment, t he Tangany ika
di st rict shows s om e of t he worst
he a l th and child prot ect ion
i nd i c ators in t he w hole Dem ocra ti c
Re pu blic of th e C ongo.
In t his norther n dis t rict of t he
Ka ta nga province, only one in a
hu n d red birth ( 0. 9%) is proper ly
re g i stered in t he C iv il Regis t r y 1 .
F i ve women ou t of s ix ( 84%) gi ve
b i rt h outside h ealt h facilit ies 2 .
On l y one in eight children ( 13. 8 % )
i s a ppropriatel y vaccinat ed 3 .
D ue to religious beliefs or
l o c a l rumours, fam ilies ref us e
i mmunization, put t ing t he lives of
t he children a t r is k.
T he s e indicators t end to highlig h t
t he broken link bet ween s tat e
se rvi ces, espe cially healt h
fa c i l i ties, and t he local populat i o n .

vs. 25% at national level (DHS 2013)

DHS 2013.
3
immunization against BCG, DTCoq (3 doses), Polio (4 doses),
Measles.
1
2

Fa m i l i e s tu r n to o th e r tr u s te d
p l aye rs s u c h a s th e i r re l i g i o u s
l e a d e rs o r i n fl u e n t p e rs o n s i n
th e i r i m m e d i a te s u r ro u n d i n g s.
In o rd e r to e n c o u ra g e
ro u ti n e i m m u n i za ti o n a n d
to p ro m o te th e key fa m i l y
p ra c ti c e s, U N IC E F d eve l o p e d
C o m m u n i c a ti o n Fo r
D eve l o p m e n t
a c ti vi ti e s th a t
i n vo l ve th e
d i ffe re n t s tra ta
of th e ta rg e te d
c o m m u n i ti e s of
Ta n g a nyi ka .

Martha Nyota breastfeeds

her son Kabange (5
months) in her home in
Kalemie. Kabange was
vaccinated thanks to the
sensitization efforts of
the Community Health
Workers.

SAVING L IV ES WITH KE Y PRACTIC E S Pro mo tin g Key Family Pra c t i c e s i n Ta nga ny i ka Di s t r i c t

DESIGN:
HOW IT WORKS

HEALTH FACILITIES
PERSONNEL
routinely promote the
key family practices
with pregnant women
and young mothers
attending antenatal and
postnatal consultations.

Multiple stakeholders work with UNICEF to promote the key family practices
within the local communities.

SCHOOLS TEACHERS
promote the key family
practices with their
pupils, particularly
hand washing and the
use of a long-lasting
insecticide-treated net.

COMMUNITY HEALTH
WORKERS AND
COMMUNITY-BASED
ORGANIZATIONS
visit families to identify
issues and sensitize
them about the key
family practices

RELIGIOUS
ORGANIZATIONS
with a more intimate
link with families are
also engaged in the
key family practices
promotion. Preachers
(imams, pastors,
among others) often
hold educational talks
after the religious
gatherings.

MEDIA broadcast short

programs and phonein talk shows about
the promotion of the
key family practices.
These are broadcasted
during local prime time
(mostly before the
news broadcast).
Within villages or
neighborhoods,
LISTENING CLUBS have
been set up to facilitate
discussions about the
broadcasts.

These various stakeholders directly advocate the LOCAL, RELIGIOUS AND MORAL AUTHORITIES so they also
convince their followers in adopting the key family practices.

UN ITED N ATIONS C HILDRE N S FUND Demo cratic Re publ i c of t he Congo

C O N V I N C I N G M A R T H A : T H E I M P O R TA N C E O F P E R S O N A L I N F L U E N C E

Before, I did not like immunization: it was said that the

children were becoming sick, that they could have a fever,
they could have anemia...
Martha Nyota quietly recites the long list of rumors about
vaccination, while breastfeeding her baby boy against the wall
of her house.
She also believed these rumors. When she became pregnant
with twins, Kabange and Kyungu, she started receiving visits
form Leonard Mabingo, one of the Community Health Workers
of her neighborhood.
He visited me several times to give me advice says Martha
about exclusive breastfeeding, about sleeping under a
mosquito net, and also about immunization.
At first, I thought he was annoying. Yet he kept climbing
the steep path leading to my house. I got used to his visits.
He gave me vouchers to vaccinate my babies to the health
center.

I also listened to a radio programme saying that immunization

was necessary for children. Still I didnt want to go to the
health center. The person who eventually convinced me was
my mother.
Marthas mother, Elizabeth, is quietly sitting in the shade of
the living room. I told Martha that the Community Health
Worker came here too many times. No liar would make that
kind of effort.
I also think that my grandchildren have the right to be
immunized like every other child. When I was young, everyone
agreed to vaccinate their children.
Eventually, Martha decided to go to the health center. Kabange
and Kyungu got vaccinated, thanks to their grandmother
persuasion and Leonard perseverance. Martha did not regret
her decision.
Since then, I saw that the vaccines did not hurt my children
she says. Now I try to talk to my neighbors myself to
convince them that the rumors we hear are not true.

SAVING L IV ES WITH KE Y PRACTIC E S Pro mo tin g Key Family Pra c t i c e s i n Ta nga ny i ka Di s t r i c t

DELIVER: WHAT HAS BEEN ACHIEVED

In July 2014, an anthropological study was conducted in Tanganyika
district to identify the main resistances to vaccination 1.
3200 Community Health Workers and 144 nurses were trained on
the key family practices
1155 community workers from five different religious groups have
been trained on promoting the key family practices. Through their
activities, they reach more than 124,000 families.
UNICEF developed a partnership with 12 local radio stations. They
adapted their schedule to broadcast short programs about the
key family practices. Nearly 2,000 shows have been broadcasted
through theses channels. 29 listening clubs have been set up
to disseminate the content of the broadcasts. In the district of
1
Main resistances lie in (i) religious beliefs (56.7 %), (ii) fear of suspected secondary effects (39.3 %),
immunization being associated to poisoning (31%), fear that the vaccine can provoke anemia (28.6%),
lack of trust in the health facilities personnel (27.9%) and inadequate organization of the immunization
campaign (18.9%).

Tanganyika, one in three women and one in two men listen to the
radio at least once a week according to the Demographic and Health
Survey.
12 Child Reporters conduct advocacy with local authorities in
order to promote the key family practices and the Childrens Rights
throughout Tanganyika. They also participate in weekly radio and TV
broadcasts with UNICEF media partners.
8 Community-Based Organizations were trained on promoting the
key family practices in the district of Tanganyika.
The proportion of children who were not vaccinated due to the
refusal of their parents / guardians decreased from 11 to 6 per cent
in october 2013 2.

World Health Organization routine data.

INNOVATING WITH IMMUNIZATION VOUCHERS

Tanganyika Health District has developed
a voucher system to encourage families to
vaccinate their children.
Each Community Health Worker (CHW)
distributes immunization vouchers in his
neighborhood or village.
The voucher is given to the Health Center
when the child gets vaccinated.

Immunization vouchers used in April 2014 at Kalemies

Clinique Niche Health Center.

Thus the health centers can easily follow

respect of the immunization schedule of
every child.

Community Health Workers can also

focus on families who do not vaccinate
their children (since they didnt bring their
vouchers back).
If there are more than three different
families identified in the same street,
Community Health Worker can organize a
public information session.
Since December 2013, the coupons were
able to recover 10,257 children who had not
previously been vaccinated.

UN ITED N ATIONS C HILDRE N S FUND Demo cratic Re publ i c of t he Congo

DISCOVER: WHAT IS WORKING

MU LTI PLE SENSI TI Z ATI ON C HA N N E LS
Th e promotion of t he key fam ily p ra c ti c e s th ro u g h
a va riety of ch annels is w idely re g a rd e d a s o n e
of t h e factors facilitat ing t heir a d o p ti o n . As fo r
i mmunization, t he repet it ion of th e m e s s a g e s fro m
di f f e rent sourc es overcam e res i s ta n c e s.
TR UST ED SOURC ES O F I NF ORM AT IO N
Th e m ost effe ct ive com m unicat i o n c h a n n e l i s
t h e home visit, conduct ed by t r u s te d p e o p l e i n
t h e targeted neighbor hood or v i l l a g e, s u c h a s th e
C o mmunity Healt h Wor kers.
Sp o nsorship was als o develop e d to e n c o u ra g e
fa mi l ies to prom ot e t he key fam i l y p ra c ti c e s a m o n g
t h e i r neighbors ( s ee box on t he r i g h t) .
PERSON A L I N F LUENC E
An i nfluential pers on is als o nec e s s a r y i n o rd e r to
c o n vey and re inforce t he prom o ti o n of th e key fa m i l y
pra c tices. T his pers on can s erve a s a ro l e m o d e l fo r
t h e families.

NO L L A , N EIG H BO R A N D RO L E MO D EL
Community-based organisations
have developed a sponsorship
approach to promote the key
family practices.
In the Majengo area, the
Congolese Red Cross has
set up a Mothers Club to
facilitate the adoption of the
key family practices in families.
Noella Mokonta tells how she
incorporated this very open club.
I often saw the members of the Mothers Club in the neighborhood.
They came here to give us advice on how to have healthy children. I
wanted to be part of it to help my own neighbors.
I already knew the key practices - good hygiene, wash hands,
breastfeed in the first six months of life, sleep under a net, to
vaccinate, register the newborns at the Civil Registry... When I joined
the Mothers Club, I was trained; I learnt how to share my knowledge
with others.
Noellas house is like a model house: she uses it to educate her
neighbors. She shows them her hand washing station (made with a
single basin and a bucket), and the mosquito nets that cover all the
beds.
Noellas activities make her children proud. Joseph especially likes
how she helps the other families getting a better life. Bibiche, her
daughter, sees her mother as an example that will inspire me for the
years to come.

SAVING L IV ES WITH KE Y PRACTIC E S Pro mo tin g Key Family Pra c t i c e s i n Ta nga ny i ka Di s t r i c t

DREAM: VISION FOR THE FUTURE

EX TEN DI NG T HE P ROMOTI ON O F T H E K E Y FA M ILY
PRACT I CES
O ne of the main challenges is t h e a c c e s s to re m o te
a re a s due to t he lack of s ecur it y a n d re s o u rc e s. T h e
s c a rce number of s tat e s t r uct ure s c a l l s fo r m o b i l e
he a l th and civ il regis t r y s er v ice s.
In o rder to reduce t he num ber of m i s s e d fa m i l i e s,
NE W COMMUNI TY HEA LTH WORK E RS A RE N E E D E D
to t i ghten the coverage of neigh b o r h o o d s a n d
vi l l a ges.
IN C REA SED D I A LOG UE BETWEE N C O M M U N IT Y
STAKEH OLD ERS
In t e ractions bet ween com m unit y a c to rs a re n e e d e d
to re inforce th e coordinat ion of th e key fa m i l y
pra c tices prom ot ion m es s ages a n d th e u s e of h e a l th
fa c i l i ties.
MON ITORI N G O F THE FA MI LI ES C O M P L IA N C E TO
TH E KEY FA MI LY P RACTI C ES
Be t t er monitor ing is needed to p rove th e a d o p ti o n
of t h e key fam ily pract ices am o n g fa m i l i e s, w h i c h i s
hi n d ered by econom ic pover t y.

My dream is to see people

take ownership of our work, so
they know how to improve their
own health.
- Wasso Walonga, Community Health Worker
Kalenga Mission Village

What I like most is the trust that

the community showed me after I
gave them advice.
I became a member of the family
for many people
- Adnive Singini, member of a religious community-based
organization in Kalemie.

A 6-months old girl is getting vaccinated at Kalemies

Undugu Health Center.
UNICEF / Benoit Almeras-Martino, 2014.