Rewarding behavior change in rural communities: Pathways for a sustained inclusive change for child health

Worldwide, pneumonia, diarrhea, and malaria remain leading causes of death for children under the age of five, even though these diseases are preventable and can be treated. In public health, complex behavioral change interventions are often used. These interventions employ multi-component strategies and work on domains, such as education, policy, and environmental change, to promote prevention, control, and management of childhood diseases. In Tando Muhammad Khan (TMK), the Community Mobilization and Community Incentivization (CoMIC) trial employed a complex, participatory community engagement strategy and included conditional community-based incentives and showed promising results by improving child health related behaviors. A study was conducted to explore the experiences and perceptions of community members regarding the implementation and engagement processes of the CoMIC trial. A total of 13 IDIs and 16 FGDs were conducted to understand the factors behind the community engagement and behavior change that led to the success of the CoMIC trial and its adaptability for wider scale-up. The study identified four key motives for driving community engagement: egoism, altruism, collectivism, and principlism. The community's close-knit social structure and shared sense of collective growth played a crucial role in encouraging participation and adapting to required behaviors. The trial focused on empowering the community by reinforcing health-seeking behaviors as a community responsibility, promoting cost-sharing to ensure long-term sustainability, and creating collective ownership through active community engagement and Conditional, Collective, Community-based Incentives (C3Is). By strengthening WASH and IYCF practices, increasing immunization uptake, promoting care-seeking behaviors, the intervention aimed to reduce the burden of childhood illnesses such as diarrhea, pneumonia, and malaria, ultimately improving child health outcomes.