A priority for any country is the desire to protect the health of its citizens. One area that the Government of Honduras (GOH) has made a priority over the last decade is women's health, particularly in reducing the maternal mortality rate. While there has been a decrease in maternal mortality over the last decade it is clear that much more needs to be done. The destruction caused by Hurricane Mitch in 1998 has hindered the GOH efforts in this area. Recent actions have been taken to revitalize the program and to carry out an extensive series of actions to bring concrete results in a short time. A National Plan for the Reduction of Maternal Mortality was developed in April 1999.

Five key program areas have been identified as the lynchpins for reaching the objective:

• pre-natal checkups;
• births;
• post-partum checkups;
• family planning; and
• cervical-cancer detection and prevention.

The Honduran Secretary of Health (SOH) has embarked on an ambitious program of upgrading the healthcare infrastructure, improving the logistics systems and upgrading the skills of its service personnel. The SOH identified the need for a woman's integrated health communication campaign as a strategy to achieve their goal of reducing maternal mortality. At the request of USAID, AED/PCS worked since June of 1999 with the SOH to develop and carry out a communication strategy to support efforts to reduce maternal mortality. Why a communication campaign? Data from the various studies carried out in the last five years indicate that audience knowledge levels are high and have positive attitudes towards the five health interventions that will be part of this campaign. However, there is a gap in the intention to practice certain behaviors and the actual practice of behaviors conducive to reducing maternal mortality. Research data also shows that the healthcare providers are unaware of the latest technical information about interventions as well as the handling, recording and referral of obstetric emergencies, and there is a need to enhance interpersonal communication (IPC) skills to improve quality of care.

Under the slogan "Help us save lives" "It's up to you": posters, buttons and press ads, TV and radio spots target health care providers and other influentials asking them to do their part to contribute to reduce maternal mortality in Honduras. Phase I of the campaign was launched on June 12, 2000 addressing the SOH personnel who provide services and information as its principal audience to improve level of technical information, interpersonal communication and quality service delivery . Secondary audiences include national, regional and local leaders and decision-makers to increase their commitment to reduce maternal mortality and support the SOH interventions.

Starting in October, Phase II of the campaign directed at rural and peri urban men and women will inform them about factors relating to maternal mortality, encouraging them to take community level actions to prevent maternal mortality and direct them to use the local health centers staffed with trained health providers.

The two phases of the campaign make individual appeals to decision makers, healthcare providers or clients to play an active role in reducing maternal mortality. For example, if pregnant, to attend pre natal checkups, to deliver in health care facilities and to attend attend post partum care. Health Care Providers to offer quality services and information during pre natal, post partum and other reproductive health care interactions, as well as encourage delivery at the hospital or clinic level. Influentials to creating a more supportive environment so community leaders, healthcare providers and men and women will make informed decisions and take appropriate actions towards reducing maternal mortality in Honduras. This communication plan gives equal priority to all of its target audiences identified for the key program areas.

CHANNELS

A coordinated multi media approach included mass media, community mobilization and interpersonal communication among family, family friends, community, social networks, service providers, decision makers and opinion leaders, will create a synergetic effect.

The campaign to reduce the maternal mortality rate in Honduras was launched on June 20 in Tegucigalpa under the slogan "Help us save lives" "It's up to you". The First Lady of Honduras, Mrs. Mary de Flores presided over the launching ceremony as a sign of support and endorsement to the Ministry of Health's effort to reduce maternal mortality in Honduras. There was extensive press coverage of the ceremony both in print and television. In July 2000, the campaign was launched in the three regions selected for Health Campaign. Materials prepared for influentials and health provider were distributed during the launching ceremony as well as during site visits to health centers in the different regions of the country.

Phase 2 of the campaign produced a Radio mini series featuring a young woman from the rural area and her extended family included information on pre natal care and safe delivery and post natal care and family planning messages. Many letters were received from listeners from the rural areas expressing their delight in following the story because it was "like their own story" and they could "do something good and save someone's life" when commenting on the benefits of pre natal care and family planning. Phase 2 also included printed materials for health providers to give to clients of the SOH services specifically importance of pre and post natal care and family planning.