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Communication for Behavioral Impact (COMBI)
Communication for Behavioral Impact (COMBI) COMBI, is an effective method directed at enacting behavior change to benefit health and social development. COMBI blends multiple communication strategies from both the private and public sector with market research to better encourage precise behavioral outcomes (COMBI Institute website). It's a 10-step strategic communication planning method for designing communication programs to engage individuals, families, communities, nations to consider and take action on specific recommended behaviors which could make a difference in the quality of their lives (Hosein, Parks, & Schiavo, 2009; World Health Organization [WHO], 2012).

COMBI begins with a precise focus on the behavioral result(s) expected in relation to people’s needs, wants, or desires (1st Attachment, Page 2). It recognizes that in health the ultimate goal is behavioural impact: someone doing something (3RD Attachment, Page 1).

It initially focused on behavioral outcomes in health as part of the social mobilization work of the World Health Organization back in 2000. But over the years, the methodology has been effectively used with regard to an extensive array of non–health related behavioral expectations. Much of this non-health work has been with UNICEF and UNDP but also UNWOMEN and UNFPA, and one anticipates further expansion of COMBI utilization in other dimensions of social development (page 109, attch 1).

History
Note to self: Add text from chapters sent.

Background
One dilemma in public health globally is the fact that people know what to do to improve their health status, but do not take the necessary action. The fundamental challenge confronting the prevention and control of diseases is having individuals (within the context of families and communities) adopt and maintain healthy behaviors.

The public health communication and education response has been to keep improving people’s knowledge of diseases and preventive behaviors. But increased awareness and education about healthy behaviors have been notoriously insufficient bases for individual or family action, although they are essential steps in the process toward healthy behavior practice. The cliché is appropriate: It is one thing to know, another to do (page 2, attch 1).

Founder
Dr. Everold Hosein, is the founder of the strategic communication planning methodology called COMBI – Communication for Behavioural Impact, initiated at New York University in 1994 and adopted and refined at WHO since 2000, and more recently combined with UNICEF’s Communication for Development (C4D) work.

Dr. Hosein, Senior Communication Advisor-Consultant, World Health Organization (WHO), and UNICEF Communication Consultant, is an international communication specialist (born in Trinidad and Tobago) with over 45 years of experience in strategic communication, integrated marketing communication, advocacy and public relations, communication for development (C4D), health education, and IEC (information-education-communication), related to social development issues and behavioural impact/behaviour change.

His communication work has focused on the following fields: nutrition, early childhood education, children‘s welfare and girls education, children and violence, water and sanitation, communicable diseases prevention and control, influenza, environmental education, non-communicable diseases, pandemics, general public health, reproductive health (including maternal/child health, family planning and HIV/AIDS/STD prevention), pharmaceutical policies, gender equality, health promotion, university education, agricultural and rural development, population and development, and banking/monetary policies. He has completed over 300 consulting assignments around the world, from Africa and Asia to the Caribbean, Latin America, Europe, and North America.

Dr. Hosein’s expertise includes integrated marketing communication, public relations, advertising, social mobilisation, health education, public education, public information campaign strategy planning, audience/market research, communication programme reviews/evaluation and new programme development, communication training, audio-visual and print materials production, radio-television-video-print media production and dissemination, media relations, and promotional special events. He has worked with, among others, various United Nations agencies including WHO, UNICEF, UNFPA, UNDP, FAO, UNIDO, UNESCO, the World Bank, Inter-American Development Bank, Rockefeller Foundation, Emirates Foundation, Asia Development Bank, USAID, the German Government, Ministry of Health/France, Ministry of the Environment/Singapore, national and international non-governmental organizations, and numerous governments in developing countries.

COMBI Plan
COMBI planning applies a 10-step process in designing a strategic health communication plan and two principal mantras.

The 10-step process:
1. Set Out the Overall Goal 2. Set Out Preliminary, Tentative, Specific Behavioral Objectives 3. Carry Out a Situational Market Analysis 4. Present the Communication Strategy 5. Present the COMBI Plan of Action 6. Manage and Implement the COMBI Plan 7. Monitor Implementation 8. Assess Behavioral Impact 9. Develop Calendar/Timeline/Implementation Plan 10. Prepare the Budget

COMBI's Planning Mantras:
1. “Do nothing—produce no T-shirts, no posters, no pamphlets, no videos...until one has set out precise, specific behavioral objectives” (SBOs). 2. “Do nothing—produce no T-shirts, no posters, no pamphlets, no videos...until one has carried out a situational market analysis in relation to the desired behavioral results, until one has listened to the ‘“consumer’” with regard to the offered recommended behavior.”

COMBI In Action
Since 2000, the World Health Organization (WHO) and its partners have been applying COMBI in planning, initiating, and implementing strategic communications and social mobilization interventions in more than fifty countries in a variety of settings and disease areas that span from contributing to controlling and preventing outbreaks of infectious diseases (for example, by increasing public compliance to prevention measures for lymphatic filariasis or modifying behaviors to respond to early signs of dengue fever) to the reduction of maternal and infant mortality; HIV/AIDS programs; decreasing the incidence of household violence; and more recently promoting changes in diet and lifestyle. (page 536, attch 2)

To date, COMBI programs have reached a minimum of 100 million people worldwide and affected the health and/or social behavior of an average 60 percent of those individuals who have been reached by and engaged in COMBI interventions (Everold Hosein, personal data files, 2008).

Summary
Applied in more than fifty countries, Communication - for- Behavioral Impact provides a strategic framework that has established efficacy in health promotion. The ten - step planning model used in COMBI has been carefully developed and its utility is well established. COMBI has been applied across a wide range of cultures, thereby demonstrating its adaptive capacity. The approach is based on prevailing theories in health promotion and is firmly grounded in the principles of community engagement. COMBI spans a wide range of intervention points, thereby optimizing its potential to create meaningful and lasting behavior change. The integration of five mobilization and communication action areas into the COMBI approach is vital to its success. Emphasis on social engagement and mobilization is a hallmark of COMBI, thereby making the method quite compatible with current thinking in public health practice (page 549, attch 2).