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Ten Lessons From Breakthrough ACTION’s Social and Behavior Change for Family Planning and Reproductive Health Programs

Over the last four years, Breakthrough ACTION has completed a wide array of activities utilizing social and behavior change (SBC)* approaches to improve family planning and reproductive health (FP/RH) outcomes, including both global and regional advocacy, technical assistance, and capacity strengthening, as well as country-level implementation of SBC campaigns and solutions.

To uncover and synthesize lessons learned and best practices from four years of Breakthrough ACTION programming related to SBC for FP/RH, we conducted several activities, including a desk review and several insight generation workshops. We validated our findings with Breakthrough ACTION core and country teams, then captured them in an overview brief and three technical briefs that detail project examples, key lessons learned, and considerations and recommendations for implementing partners, governments, and funders looking to improve their SBC for FP/RH programming.

We categorized the 10 key learnings into three themes:

  1. Going Beyond Engagement: Community-Centered Social and Behavior Change for Family Planning and Reproductive Health Programming (also in French)
  2. Strengthening Social and Behavior Change for Service Delivery: Tailoring Interventions for Different Stakeholders in Family Planning and Reproductive Health (also in French)
  3. Ensuring Effective Partnerships and Coordination for Social and Behavior Change for Family Planning and Reproductive Health (also in French)

Going Beyond Engagement: Community-Centered Social and Behavior Change for Family Planning and Reproductive Health Programming

Breakthrough ACTION’s key learnings in this area demonstrate that community involvement in the co-design process is crucial to success. Simple solutions that are co-designed with communities and that build upon existing assets and concepts create the environment for sustained behavior change. Through iteration and tailoring to specific audiences, SBC for FP/RH solutions can better meet communities where they are and ensure continued, sustained behavior change. Key learnings include:

1. Community involvement in the co-design process uncovers more nuanced insights and creates locally-owned, effective SBC for FP/RH solutions. Breakthrough ACTION’s approach to developing sustainable, community-informed SBC for FP/RH programming goes beyond engagement by centering the community in the co-design process and program implementation through various approaches, including human-centered design (HCD).

2. Co-designing and co-developing simple SBC for FP/RH solutions that build on existing community assets, concepts, or points of reference create an enabling environment for sustained behavior change. SBC for FP/RH programming does not have to be time consuming, multi-layered, or complex to be effective or worthy of investment. Simple innovations that are co-designed and developed with, by, and for community members and build upon existing structures, values, or practices create the enabling environment required for increasing demand and uptake of FP/RH services.

3. Effective SBC for FP/RH solutions strike the ideal balance between simplicity and complexity through iteration and tailoring to specific audiences. While multi-faceted, multi-user solutions that capture the myriad of interrelationships and social and gender norms provide a comprehensive approach to SBC, it is important to use iterative design to ensure that specific tools or approaches are simple, clear, and straightforward. As a result, Breakthrough ACTION programming often meets complexFP/RH behavioral barriers with similarly intricate SBC solutions that communities desire.

Strengthening Social and Behavior Change for Service Delivery: Tailoring Interventions for Different Stakeholders in Family Planning and Reproductive Health

“SBC for service delivery” refers to using SBC processes and techniques to motivate and increase uptake and maintenance of health service-related behaviors, including modern contraceptive use. Implementers must tailor interventions to address the specific barriers faced by not only different existing and potential FP clients, including youth, couples, and men, but also to those delivering services, such as facility-based providers and community health workers (CHWs). Programs can apply SBC across the service delivery continuum to improve both access to and use of FP/RH services. Key learnings include:

4. Building empathetic and compassionate care for youth is crucial for increasing their health-seeking behaviors, especially those related to family planning. Youth need to experience—not only perceive—that providers are empathetic and will uphold confidentiality about their interest in and use of FP/RH services. Making that perception a reality means delivering compassionate care, rooted in mutual empathy. Empathy is the attitude, method, and practice of assuming the point of view of another person to better understand their needs when designing meaningfully impactful services, products, or experiences.

5. Leveraging the circumstances under which men seek health care and intentionally engaging them in FP/RH discussions can improve couple communication and joint decision-making about FP. Across most countries, men often do not seek services at health facilities for a variety of reasons. Physically meeting men where they are can create opportunities for critical dialogue, especially when lack of time is a barrier to care-seeking. In addition, positioning the health facility as a place specifically for men’s health and wellness can increase their health-seeking behavior, especially if the facility is open on the weekend or with extended hours. Finally, integrating FP/RH more broadly into health and wellness can help overcome the perception of FP/RH as a women’s issue and normalize discussions about FP use.

6. Facilitating provider-client dialogues within communities can spark empathy, generosity, and joint problem-solving. Bringing the conversation from health facilities into communities can shift the nature of the provider-client interaction from transactional to even more relational and cooperative, allowing clients and providers to become more empathetic and trusting of one another. As compassion for and understanding of each other’s challenges increase, each stakeholder group discovers their role in helping solve problems. This can spark action to address barriers to FP/RH service uptake.

7. Strengthening CHWs’ capacity through SBC tools builds their self-efficacy and confidence in performing their jobs and improves completed referrals from the community. CHWs are integral in connecting communities to health facilities for FP/RH services. However, they are not always comfortable speaking with women and couples about FP/RH, often lacking the skills to do so. As a result, investing in CHWs’ utilization of SBC for FP/RH tools is highly motivating: It not only increases their confidence, but also helps them better meet the needs of their community members. By sharing this newfound knowledge about FP, they can better identify and connect potential FP clients with the health system.

Ensuring Effective Partnerships and Coordination for Social and Behavior Change for Family Planning and Reproductive Health

The Sustainable Development Goals, FP2030, and Ouagadougou Partnership goals all uphold the desire to ensure universal access to FP/RH information and services. SBC practitioners can play a greater role in ensuring that everyone has the same access to health information, services, and products. To make this a reality, effective partnerships are necessary to coordinate the scale-up of SBC for FP/RH programming. Key learnings include:

8. A shared vision rooted in an understanding of partners’ priorities and needs can lead to more effective partnerships. Project partners—from implementers to governments and funders—require a deep understanding of each other’s priorities, needs, and constraints related to their organization’s SBC for FP/RH efforts. To create a truly effective partnership that drives universal access to FP/RH information and services, everyone needs to work within a shared vision to motivate them to strive beyond their individual project’s or organization’s goals. Although each partner needs to know and work within clear roles and responsibilities, they also need implementers with well-developed soft skills who can convene the most appropriate people for a given situation and appeal to their needs, strengths, knowledge, and interests.

9. Using SBC to position FP/RH as part of healthy living can appeal to more multi-sectoral partners and can reach more potential FP clients. Treating FP/RH as part of healthy living, or even linking it to non-health sectors, is often not only more palatable to potential clients, but also to potential partners. Different sectors may be interested in supporting integrated SBC interventions that impact FP outcomes, as long as they improve other development outcomes as well. Tailored SBC advocacy messages that appeal to different sectors—such as education; the environment; democracy, rights, and governance; and food security and livelihoods—are key. This broader positioning of FP/RH as part of healthy living can lead to multi-sectoral partnerships, which increase efficiency and reduce the risk of disrupting and overburdening the health system with stand-alone interventions.

10. Just as designing and testing SBC interventions is incremental and iterative, so is determining results and impact. Although the lack of robust impact evidence can threaten scale-up, Breakthrough ACTION has taken this as an opportunity to reimagine how best to use monitoring data to effectively make the case for an intervention’s potential impact. In addition, our engagement with a wide range of stakeholders and potential partners at all stages of the project cycle helps to ensure broad ownership of the solutions developed and increases the likelihood of adaptation and replication.

Want to learn more? Please visit the complementary thematic technical briefs.

Have questions or comments? Contact Sarah Kennedy at sarah.kennedy@jhu.edu.

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Sarah Kennedy

Family Planning Program Officer, Johns Hopkins Center for Communication Programs

Sarah Kennedy is a Family Planning Program Officer at the Johns Hopkins Center for Communication Programs (CCP), providing core programmatic and knowledge management support across various projects. Sarah has experience in global health project management and administration, research, communications, and knowledge management and is passionate about making the world a more just and humane place and learning from others. Sarah holds a BA in Global Studies from the University of North Carolina at Chapel Hill and an MPH with a certificate in Humanitarian Health from the Johns Hopkins Bloomberg School of Public Health.

Lisa Mwaikambo

Knowledge Management Team Lead, Johns Hopkins Center for Communication Programs

Lisa Mwaikambo (née Basalla) has worked for the Johns Hopkins Center for Communication Programs since 2007. During that time, she has served as the IBP Knowledge Gateway global administrator, program officer on an HIV prevention strategic behavior change communications project in Malawi, and manager of the USAID Global Health eLearning (GHeL) Center. As the Director of KM Integration, she led the K4Health Zika portfolio and now serves as the KM Lead for The Challenge Initiative (TCI), leading the dynamic TCI University platform, and also supports Breakthrough ACTION. Her experience spans knowledge management (KM), instructional design, capacity building/training and facilitation – both online and in-person, program design, implementation, and management, and research and evaluation. Lisa has extensive experience in family planning, gender, and HIV programming. She is a certified Knowledge Manager and has a Master of Public Health from Case Western Reserve University and a BA from the College of Wooster.

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