COMMUNICATION FOR BEHAVIOURAL IMPACT COMBI PLAN

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COMMUNICATION FOR BEHAVIOURAL IMPACT (COMBI)
PLAN FOR DENGUE FEVER PREVENTION AND CONTROL IN
MALDIVES Ministry of Health, Maldives WHO
Maldives UNICEF Maldives UNDP Maldives March
2006 (Draft 1)
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Prepared by

• Department of Public Health
• Mr. Hassan Samir, VBDCU
• Ms. Zakiyya Hassan, DPH
• Ms. Mariyam Waseela HEU
• Mr. Ali Shareef, VBDCU
• Ms. Fathimath Sheeza DPH
• Ministry of Construction and Public
  Infrastructure
• Col (rt) Shoukath Ibrahim
• Indira Ghandi Memorial Hosp
• Dr. Abdulla Afeef
• Male Municipality
• Mr. Moosa Abdul Gadhir

• Ministry of Education
• Ms. Thohira Abdulla, EDC
• Ms. Angeela Naseer,
• Thaajuddeen School
• Ministry of Tourism and Civil Aviation
• Ms. Aishath Nahula
• World Health Organization
• Dr. Linda Lloyd

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Why do we need COMBI?

• Case data
• a significant increase in of dengue cases from
  Oct. 2005 Feb. 2006
• increased of DHF cases, 3 deaths
• Entomological data
• Indices have stayed at levels usually seen during
  heavy rains season

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• Most important breeding site (70 of positive
  containers) is difficult to control
• Miscellaneous water-holding containers
• diversity of types and sizes of containers
• many are not trash items
• people store them on the roof and forget them
• people use them then forget
• to turn them over or empty them
• for several days

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• Second most important breeding site (17 of
  positive containers) is challenging because
  people like them

• Water plants
• are generally inside the house
• are generally in small
• pots
• larvae may be difficult to see

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• Special setting
• Construction sites
• large number of construction sites in city
• open wells used during construction
• cement slabs are covered with water as part of
  cement curing process
• large plastic containers are common to
  construction work

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Households (1)

• Twice a week behaviours
• The female head will make sure the premises are
  checked twice a week and that all cooking pots
  and kitchen utensils are turned over so they do
  not collect water.
• The female head will make sure that water plants
  do not breed mosquitoes by adopting one of the
  following three behaviours (1) making sure the
  water in the water plant is changed once in every
  five days, (2) using either marbles or small
  pebbles to fill the vase or jar and adding water
  to cover 1/3 to 1/2 of the marbles or small
  pebbles, or (3) using rooting jell instead of
  water.

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Households (2)

• Twice a year behaviours (April/May Sept/Oct)
• Householders will check their premises to make
  sure that rain gutters are cleared of debris,
  check the roof to make sure things stored on it
  are turned over and weighted down so they cant
  be blown over, and check water tanks to make sure
  the tank is properly closed (put a cloth over the
  water tank opening, cover and weight down the
  cover if it is plastic) and that there is a cloth
  tied around the overflow pipe.
• The male head will punch holes so water can run
  out of tires that are used as weights for the
  roof or will cover the open area of the tire with
  a flat piece of wood or stiff card board and then
  cover with plastic sheeting, tucking the plastic
  under the tire.

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Construction sites

• Every construction company will keep an oil
  film/layer on any water surface, such as open
  wells, water covering cement slabs or water
  sitting in the foundation.
• Day laborers will turn over buckets and other
  containers that can hold water at the end of each
  work day.
• Day laborers will cover any container holding
  water at the end of each work day.

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COMBI Strategy

• Community mobilization
• Dengue Week/Clean-up Day annual partnership in
  April/May between DPH, HEU VBDCU and the Male
  Municipality
• Smaller mass mobilization in Sept/Oct
• Weekly inspections of school grounds by school
  children

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• Interpersonal communication/counseling/ personal
  selling
• Intensified COMBI house visits in 50 of Male
  households to reinforce weekly activities in
  afternoons when female head is home
• Intensified COMBI visits to construction sites
  with visual information due to language
  differences
• Field officers need training on communication
  and interpersonal skills

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• Publicity
• Radio TV spots during mobilization activities
  and for five months of monsoon
• Newspaper ads during mobilization activities
• Point-of-service promotion
• Invite plant shops and pet shops to serve as
  mosquito prevention resources for customers
  purchasing water plants
• Invite garages, spare parts shops to serve as
  mosquito prevention resources for old tires

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Long-term strategy for construction sites

• Create vector control regulations as part of
  Public Health regulations for inclusion in the
  National Building Code.

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Budget

• External funding Counterpart Sponsors
• 35,000 52,534 21,960
• Total Project MRF 1,471,075 USD 109,139

Requested from Donors is 35,000. Budget is
actually 39,431, but this will be less once more
accurate printing costs are obtained.
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Who will implement the COMBI Plan?
A multisectorial team that brings different
skills and responsibilities to the programme.