Community leaders, champions for health

In Northern Nigeria, early marriage and entrenched gender norms restrict adolescent girls' access to modern contraceptives, resulting in critical gaps in care and elevated health risks. The Adolescents 360 (A360) program - Matasa Matan Arewa (MMA), reimagined social and behaviour change communication (SBCC) by engaging husbands and community leaders as allies in promoting contraceptive uptake. Through a human-centered design approach, MMA co-developed a key influencer strategy rooted in the socio-ecological model to build trust, improve couple communication, and support shared decision-making.
This relational strategy employed culturally resonant messaging and trusted community networks to shift social norms around adolescent sexual and reproductive health (ASRH). Activities included participatory community dialogues and male-focused discussion groups led by male interpersonal communication (IPC) agents and influential figures such as religious leaders.
A paired-entry and exit survey of 223 participants measured changes in knowledge, attitudes, and behaviours using descriptive statistics and McNemar tests (p<0.05). Results showed significant improvements: knowledge of contraceptive benefits rose from 52% to 71% (p<0.001), awareness of methods from 52% to 98%, and support for girls' autonomy from 63% to 99%. Joint decision-making increased from 5% to 62%, and willingness to support contraceptive use grew substantially.
Findings highlight the transformative power of connection in SBC. Co-created, influencer-driven strategies can reduce stigma, normalize contraceptive use, and promote equity in conservative settings. For sustained impact, successful approaches must be integrated into national systems and supported through long-term follow-up. This model offers scalable insights for relational SBCC programming.

Strong community connections and collaborative relationships between local leaders, health workers, and families are essential for the uptake of new health interventions. Seasonal malaria chemoprevention (SMC) was introduced in northern Mozambique in 2020, targeting children under five during peak malaria transmission. This qualitative study explored how caregivers, community leaders, and community distributors experienced and perceived collaboration in SMC campaigns. Data were collected in Nampula province through focus group discussions with caregivers, distributors, supervisors, and health workers, as well as key informant interviews with community leaders and stakeholders. Findings highlighted that community leaders were central to mobilising households, building trust, and legitimising the intervention, while distributors established personal connections with families through respectful communication and local language use. This relational approach helped to address fears, counter misinformation, and increase adherence to SMC. The study demonstrates that community-driven collaboration is not only an enabler but a cornerstone of successful public health campaigns. Embedding trusted relationships within programme design can enhance both uptake and sustainability of interventions in resource-limited settings.

This paper highlights the pivotal role of community leaders in promoting hygiene behaviour change under the Titukulane project in Mangochi District, Malawi. Titukulane, a five-year initiative implemented across 20 Traditional Authorities in Mangochi and Zomba, aimed to achieve equitable, sustainable, and resilient food and nutrition security for ultra-poor and chronically vulnerable households. Improving hygiene practices was central to enhancing nutritional outcomes for under-five children, adolescent girls, and women of reproductive age.
Hygiene component employed the Behaviour Centred Design (BCD) approach, following five steps-Assess, Build, Create, Deliver, and Evaluate-to design and implement interventions. The "Wali-Wali (Sparkling) Clean Campaign" used culturally resonant strategies such as role plays, hygiene competitions, and visual cues, reinforced by interpersonal communication through care groups, household visits, and community gatherings. Religious and traditional leaders were actively engaged to leverage cultural norms and faith-based values, fostering ownership and accountability. Quarterly review meetings and community by-laws further strengthened local governance and sustainability.
Data from 2024 Participant-Based Surveys revealed significant improvements: households with soap and water at handwashing stations increased from 7% to 75%; latrine ownership rose from 20% to 95%; and reported handwashing after latrine use improved from 69% to 95%. These gains were attributed to innovative materials, consistent follow-ups, and leadership-driven enforcement.
The findings underscore that community leaders, when recognized as hygiene champions, can catalyse lasting behaviour change. Integrating emotional engagement, cultural relevance, and strategic nudges within a structured BCD framework offers a scalable model for WASH interventions in similar contexts.

This initiative in Sujawal, Sindh, applied behavioural insights to strengthen Social and Behaviour Change (SBC) for improved health and nutrition outcomes in a socially stratified context. Implemented through public and private partnership, the programme integrated capacity building, participatory community engagement, strentheing existing village committees and formed integrated committees and recognition of frontline health workers especially Lady Health Workers (LHWS). Recognizing that caste dynamics and socio-economic disparities shape participation, advocacy efforts emphasized inclusive dialogue and equitable representation in decision-making. SBC staff of the public and private partners, Community Resource Persons (CRPs) and Change Champions were trained to engage respected community leaders and bridge divides through structured discussions on Health, nutrition, hygiene, and access to healthcare. Visual tools and scorecards were used to promote transparency and collective accountability.
Apart from the SBC staff around 60, a total of 157 CRPs trained 29,690 community members across three union councils, supported by 39 village-level Health and Nutrition Committees. Recognition events for 190 Government Lady health workers (LHWs) boosted morale and strengthened trust between communities and service providers. The initiative demonstrates how context-sensitive SBC, informed by behavioural insights, can address social barriers, promote inclusivity, and encourage a sense of shared responsibility for health outcomes.