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Investing in Social and Behavior Change: Understanding Costing

These days costing is top of mind for many working in family planning. To increase voluntary contraceptive use and reduce unmet need, how might you influence behaviors in a cost-effective manner, and what are the best ways to reach your target audiences? Breakthrough RESEARCH (BR), through work led by Avenir Health, is gathering, analyzing, and sharing evidence on the costs and impact of social and behavior change (SBC) interventions. The goal is to make the case that investing in SBC is crucial for improving health and advancing development, including for family planning.

Defining Terms

  • Social and behavior change interventions seek to change behaviors by addressing factors such as knowledge, attitudes, and norms.
  • Costing is the process of data collection and analysis for estimating the cost of a health intervention.

Nicole Bellows, Senior Associate, Avenir Health, explains, “Our hope is that costing will become an essential component in monitoring and evaluation (M&E). SBC is complex and this makes costing more challenging because it is a little bit harder to draw the parameters around what is SBC. But costing SBC is not that hard once you break down the interventions into the main cost components.”

Lori Bollinger, Vice President, Avenir Health, is one of the leading voices in cost-effectiveness modeling for SBC and says, “We have always asked which interventions can help people change their behavior. But not many asked how much it costs. For cost-effectiveness, you look at the cost divided by impacts. In SBC one of the issues is defining the audience that is being reached, and how that changes based on the intervention. Another issue is that there is often donated time and in-kind contributions—which are important and add to impact but are difficult to value.”

SBC Costing Resources and Tools

The primary objectives of Breakthrough RESEARCH’s costing work are to build evidence on SBC cost-effectiveness and to enable others to conduct quality SBC costing. Most people who design and offer family planning services are not economists or experts at modeling. That is why Breakthrough RESEARCH has developed a suite of products and tools to make it easier for those interested in SBC to do the costing work. The suite includes:

Detail from cover of Breakthrough RESEARCH SBC costing technical report
Detail from cover of Breakthrough RESEARCH SBC costing technical report

Bellows says that costing can be used in several ways: for budget and planning, for evaluating cost effectiveness and efficiency, and for determining the best way to use limited resources. “Most people set up a program that includes M&E from the start, but these frameworks often do not include metrics for costing. We find it useful to look at costs early on as well,” she says. “Our hope is that costing will be part of SBC intervention planning. But there is some discomfort at looking at costs because people aren’t sure how to do it.”

Breakthrough RESEARCH and Breakthrough ACTION are hoping to change that. The two are sister projects: Breakthrough ACTION works in partnerships within countries to implement SBC activities, and Breakthrough RESEARCH focuses on conducting research to generate evidence on what approaches are most effective and cost-effective.  Both are funded through USAID.  The programs collaborate on some activities but are independent.

The more family planning implementers, donors, and governments integrate costing into M&E frameworks, the larger the resulting evidence base will become. And, says Bellows, “If we can find the most cost-effective SBC approaches, it can increase confidence that SBC is worth investing in.”

BR modeled the cost-effectiveness of family planning SBC investment scenarios in Guinea, Niger, Togo, and Zambia. The modeling asked two major questions: What exactly are you doing, and what are your unit costs to reach someone through SBC?

For example, in Zambia, Breakthrough ACTION worked with partners to make the case to the National Family Planning Technical Working Group (TWG) to include strategic and specific SBC approaches in the next Costed Implementation Plan (CIP), 2020-2026. The TWG was keen to meet the country’s FP2020 goals but was not on track to do so. The results of the Breakthrough RESEARCH modeling exercise for Zambia were used to make the case for increased family planning SBC investments on the basis that it was found to be highly cost-effective.

Looking forward, Breakthrough RESEARCH aims to increase cost data collection and improve the modeling of SBC costing. “We work with the financing people to see exactly what does this program cost and what is driving those costs,” explains Bellows.

Pathways to Impact for Family Planning

The family planning community has been receptive to the idea of costing, says Bellows. This is likely because the literature demonstrates that SBC delivery works and is cost effective. Bellows says many within the family planning community have agreed to look at BR’s framework to learn more about pathways to impact.

Bollinger encourages everyone to spend some time on costing: “In the same way that you plan for an impact assessment, you have to plan for the costing. You have three different aspects. You have a budget which is what you expect to spend. You have expenditures which is what you are actually spending. You have costs which is what you should be spending. Ideally those should all be the same but often they are not.” While costing can be challenging, “You don’t need to be a PhD economist to do this,” says Bellows.

In order to help actors involved with family planning learn more about costing for SBC, Breakthrough RESEARCH is offering a costing skills-building webinar (click here to register) on Thursday, June 10 at 9am Eastern (1pm UTC).

Tamar Abrams

Contributing Writer

Tamar Abrams has worked on women’s reproductive health issues since 1986, both domestically and globally. She recently retired as communications director of FP2020 and is now finding a healthy balance between retirement and consulting.