Chipping away at the TB pandemic in Southern Africa

LiveMoya was commissioned by the World Bank to promote behavior change on TB among selected mining communities in Lesotho, Mozambique, South Africa and Swaziland. Mining communities are deemed to be miners, ex-miners, labor sending communities and communities situated around the mines. The key areas to address were:

• increasing TB awareness;
• improving case finding outcomes;
• improving treatment outcomes; and
• increasing compensation payments.

The four countries selected are among the hardest hit by the TB pandemic in the world. This is largely due to the large mining sector in South Africa, and the migratory nature of mining in Southern Africa. The response had to take into account the various languages and cultures between and within countries, the nature and extent of services available, and the vast distances to be covered to reach mining and labor-sending communities. Also, a number of historical challenges exist which have created confusion, mistrust and a lack of coordination.

It was therefore essential to implement a campaign that would speak with a single voice, reach across multiple languages and literacy barriers, build credibility, be spread through word of mouth, and importantly, create a new level of awareness of TB, new initiatives and services.

The face of this World Bank funded campaign was an animated character by the name of ‘Big Jim’. He took the figure of a typical mineworker who is a TB survivor. He is a trusted member of the mining community who helps current miners, ex-miners and the community at large understand the risks and dangers of TB and silicosis in the mining sector, and how to manage the disease. He also encourages those affected by TB to seek clinical and compensation services.

Big Jim provided campaign uniformity and was easily identifiable. He became a much loved character and appeared on all campaign literature and material. Social mobilisers were also dressed in Big Jim branded mining gear to create relatable personas. They conducted door-to-door mobilization and local dialogues to reach the affected communities. Additionally, selected spokespeople appeared on local radio stations to address questions on the campaign, TB and encourage community members to access services.

Communication materials distributed through the network of selected stakeholders included:

• an animated video (https://youtu.be/BcvWNYYXZAc ) with sub-titles in local languages;
• story cards for interpersonal engagement and dialogues;
• mobile messaging; and
• posters and pamphlets covering specific themes, and translated into local languages.

There was a high use of visuals in order to convey messaging irrespective of literacy levels. The visuals were largely taken from the animated video to ensure recognition and consistency of message.

In the implementation of the project LiveMoya collaborated with national institutions, non-governmental organizations, mining companies and public health bodies in each of the four countries. Each of these stakeholders has a footprint in the targeted communities and provided a departure point and form of credibility. Collaborations with the stakeholders involved partnering up during community events and sharing of information communication (IEC) materials for dissemination in the selected communities. LiveMoya also engaged with service providers (clinic, compensation etc.) to ensure there was a strong drive from interpersonal engagement to service uptake.

The project was successfully completed in December 2016 and while the impact of the campaign is yet to be de determined, LiveMoya was able to track the number of miners reached. This was done through tracking the number of people registered on the social mobilisation registers as well as people who attended events. The overall campaign results can be found in the tables below:

Table 1: Miners reached through interpersonal communication

During the implementation of the campaign LiveMoya learned the following:

• interpersonal communication (social mobilisation) is critical in addressing health issues and increasing service uptake;
• the use of IEC and promotional materials is effective as a secondary level of messaging support. They provide lasting reference points that can be shared numerous times amongst the target group;
• all communication and social mobilisation strategies utilised in communities should be contextualised to local needs and realities;
• close engagement with local partners provides an entry point into community structures and increases campaign credibility; and
• delivering on campaign promises is critical – particularly in an environment of low trust levels. Where delivery is impossible, open and timely communication with partners is important.