Health Communication Capacity Collaborative,Johns Hopkins Center for Communication Programs. 111 Market Place Suite 310,Baltimore MD 21202 USA,Telephone 1 410 659 6300. Fax 1 410 659 6266,www healthcommcapacity org, Cover photo credit A health worker immunizes a child at Khuwi maternity clinic in Malawi 2014 Donna. Murray Courtesy of Photoshare, This implementation kit was made possible by the support of the American People through the United. States Agency for International Development USAID HC3 is supported by USAID s Office of Population and. Reproductive Health Bureau for Global Health under Cooperative Agreement AID OAA A 12 00058. 2017 Johns Hopkins University All rights reserved,Integrated SBCC Programs I Kit i. TABLE OF CONTENTS,INTRODUCTION 1,What is Integrated SBCC 1. About this I Kit 3,PART 1 THE DECISION TO INTEGRATE SBCC 5. Advantages 5,Disadvantages 6,PART 2 LAYING THE FOUNDATION 8. Mapping the Landscape for Integrated SBCC 8,Engaging Support 11. Preparing for Design and Implementation 17, PART 3 STRATEGIC DESIGN OF INTEGRATED SBCC PROGRAMS 22. Considerations for the Strategic Design Process 22. Formative Research 23,Components of an Integrated SBCC Strategy 25. From Strategy to Creative Concepts and Materials 34. Designing Linkages between SBCC and Service Delivery 36. Engaging and Preparing Providers 37,Capacity 37,PART 4 INTEGRATED SBCC STRATEGY IMPLEMENTATION 39. Coordination 39,Activity Planning 39,Implementation Models 40. Integrated SBCC Platforms 42,Media Buying 43,Materials Production and Distribution 43. Capacity Strengthening 44,Monitoring 45,ii Integrated SBCC Programs I Kit. PART 5 RESEARCH MONITORING AND EVALUATION 46,Coordinate 46. Creating an Integrated SBCC RM E Plan 47,Measurement and Data Collection 49. Process Evaluation 52,Impact Evaluation 53,Evaluation Design 54. Re Planning 60,CASE STUDIES 61, Lessons from the Integrated Life Cycle Based Health Communication Campaign in Uganda 61. Using an Umbrella Approach to Link SBCC Campaigns in Ghana 66. Using Unique Identifier Codes to Monitor an Integrated SBCC Program 72. Setting Up a Strong Coordination System to Support an Integrated SBCC Program in Egypt 75. ANNEXES 79,Annex A Socio Ecological Model 79,Annex B Pathways Model 80. Annex C Health Competence Model 81,Annex D Bounded Normative Influence 82. Annex E Social Learning Theory 83,Annex F Communication for Social Change 84. Annex G Theory of Planned Behavior 85,Annex H Diffusion of Innovations 86. Annex I Customized 87,Annex J Worksheet 1 Stakeholder Identification 88. Annex K Worksheet 2 Stakeholder Interview Guide 90. Annex L Worksheet 3A Stakeholder Capacity Matrix 92. Annex M Worksheet 3B Implementing Stakeholder Matrix 93. Annex N Worksheet 3C Stakeholder Analysis Overlap Synergies and Gaps 94. Annex O Worksheet 4 Environmental Analysis 95,GLOSSARY 97. REFERENCES 98,Integrated SBCC Programs I Kit iii,ACKNOWLEDGEMENTS. This I Kit draws from the rich discussions at a two day Expert Consultation on Integrated SBCC Programs held. in Baltimore MD in April 2016 and sponsored by the Health Communication Capacity Collaborative HC3. and the United Nations Commission on Life Saving Commodities Approximately 46 individuals representing. 15 organizations attended and provided their insights ideas and experience on best practices in integrated. SBCC programs Those organizations listed in alphabetical order were Abt Associates Aga Khan University. Karachi Pakistan Bill and Melinda Gates Foundation FHI360 Gent University Belgium Jhpiego Johns. Hopkins Center for Communication Programs CCP John Snow Inc JSI National Institute of Hygiene and. Epidemiology Hanoi Vietnam Population Services International PSI Save the Children The Manoff Group. UNICEF University of Queensland Australia and USAID. We would particularly like to thank the following individuals who gave their time and provided critical. feedback and content in the development of this I Kit Amos Zikusooka FHI360 Angela Brasington USAID. Antje Becker Benton Save the Children Carol Hooks Independent Consultant Chelsea Cooper Jhpiego. Cheryl Lettenmaier CCP Joanna Skinner CCP Doug Storey CCP Heather Chotvacs PSI Hope Hempstone. USAID Ian Tweedie CCP Ketan Chitnis UNICEF Lydia Clemmons The Manoff Group Ron Hess. CCP Rupali Limaye CCP and Stephanie Levy USAID, Special thanks to Jen Orkis Heather Hancock Katherine Holmsen Sanjanthi Velu and TrishAnn Davis of CCP. for their extensive contribution and assistance in finalizing the I Kit and to the communication team at HC3. including Marla Shaivitz Anna Ellis Missy Eusebio and Brandon Desiderio for their support in proofreading. formatting and getting the I Kit online, Finally we would like to express our thanks to the HC3 USAID management team for their enthusiasm. support and intellectual contributions to this project. The participant list of individuals and their organizational affiliation can be found here. iv Integrated SBCC Programs I Kit,ANC Antenatal Care. AOR Agreement Officer s Representative,ARV Antiretroviral. BCS Behavior Change Support,BNI Bounded Normative Influence. C4SC Communication for Social Change, CCP Johns Hopkins Center for Communication Programs. CHC Communication for Healthy Communities,CHL Communication for Healthy Living. CHW Community Health Worker,COP Chief of Party,DOI Diffusion of Innovations. EHP Essential Healthcare Package,FGD Focus Group Discussion. GOE Government of Egypt,HCC Health Communication Component. HC3 Health Communication Capacity Collaborative,HEU Health Education Unit. HEP Health Extension Program,HIV Human Immunodeficiency Virus. IBP Individual Birth Plan,ICT Information Communication Technology. IDI In depth Interview,I Kit Implementation Kit,IMCI Integrated Management of Childhood Illnesses. INGO International Non governmental Organization,IPC Interpersonal Communication. IPTp Intermittent Preventive Treatment in Pregnancy. ITN Insecticide Treated Bed,LMIS Logistics Management and Information System. MAG Management Advisory Group,MCH Maternal and child health. MCSP Maternal and Child Survival Project,M E Monitoring and Evaluation. NGO Non governmental Organization, NURHI Nigeria Urban Reproductive Health Initiative. PHC Primary Health Care unit,PHE Population Health and Environment. PMTCT Prevention of Mother to child Transmission,PASMO Pan American Social Marketing Organization. PDA Positive Deviance Approach,RFA Request for Applications. RFP Request for Proposals,RM E Research Monitoring and Evaluation. SBCC Social and Behavior Change Communication,SDG Sustainable Development Goal. SP Sulfadoxine pyrimethamine,SSD I Support for Service Delivery Integration. STI Sexually Transmitted Infection,SNA Social Network Analysis. STRADCOM Strategic Radio Communication,TB Tuberculosis. Integrated SBCC Programs I Kit v,TOR Terms of Reference. TCCP Tanzania Capacity and Communication Project,TTHV Tchova Tchova Historias de Vida. UNFPA United Nations Population Fund,WHO World Health Organization. WHIP Western Highlands Integrated Program,vi Integrated SBCC Programs I Kit. INTRODUCTION, Recent years have witnessed a shift from development programs that focus on a single health or development. topic to initiatives that encompass multiple topics within a single program This shift is reflected in. the Sustainable Development Goals SDGs indicating that integrated programming is a priority across. the range of global development areas In global health specifically the shift to an integrated approach is. a key focus of movements concerned with universal health coverage primary health care health systems. strengthening and client centered care Corresponding to this larger trend toward integrated development. interest in integrated social and behavior change communication SBCC programming SBCC that addresses. multiple health topics and behaviors under the same program has also been increasing as a critical strategy. to improve health and development outcomes,WHAT IS INTEGRATED SBCC. Integrated SBCC refers to SBCC programming designed to cohesively address more than one health or. development issue within the same program Typically this involves developing a logical and unified SBCC. strategy that addresses multiple topics and or behaviors and considers how they relate or interact with one. another Examples include programs that address, Human Immunodeficiency Virus HIV and Tuberculosis TB. Population health and environment PHE,Handwashing and improved child feeding practices. Family planning and HIV prevention, Reproductive maternal newborn and child health RMNCH. Antenatal care ANC prevention of mother to child transmission of HIV PMTCT and prevention of. malaria in pregnancy,Integrated management of childhood illnesses IMCI. Agriculture and nutrition,Immunization and family planning. What Are the Models for an Integrated SBCC Program. Integrated SBCC programs can follow one of four different models. Add on A new program integrates additional health topics into an existing vertical SBCC program. Phased Implementation A program phases in health topics and or behaviors gradually over a period of. time presenting information in progressively manageable pieces. Overarching Umbrella Brand A program develops and promotes an overarching brand encompassing. all the included health topics, Combination A program chooses a mix of the above integrated programming models. More detailed information on these models can be found in the Implementation section. SBCC programs may integrate to varying degrees among several dimensions such as co location. coordination collaboration or cross training FHI360 2016 While these dimensions may indeed and. perhaps should be part of any integrated SBCC initiative taken separately they do not constitute complete. integration This I Kit seeks to guide SBCC programs looking to achieve complete integration that is when. multiple health sectors e g family planning HIV and RMNCH jointly plan and implement activities and. comprehensively address all relevant audiences A completely integrated SBCC program is able to deliver. cohesive and logically packaged SBCC interventions that unite divergent health areas. An integrated SBCC program addresses the interplay among multiple topics In contrast a vertical SBCC. program addresses an issue in relative isolation For example a vertical program may develop an SBCC. strategy only for malaria control or only for increasing demand for family planning but not address RMNCH. HIV or other health topics in the same strategy,Integrated SBCC Programs I Kit 1. Vertical SBCC Programs Integrated SBCC Programs, Address an issue in relative isolation Address the interplay among multiple health topics. 2 Integrated SBCC Programs I Kit,ABOUT THIS I KIT,What Is the Purpose of this I Kit. This I Kit provides guidance to programs seeking to develop an integrated SBCC strategy It offers insights. recommendations examples tools and links to useful resources It focuses on the aspects of SBCC unique. to integrated programming and avoids basic SBCC content that would be applicable to any SBCC program. For information on general SBCC strategy development visit HC3 SBCC Implementation Kits and SBCC. How To Guides The emphasis of this I Kit is health but the concepts and tools may be applied to a range of. development issues,Who Is the Audience for This I Kit. The intended users of this I Kit are project managers who are considering developing an integrated SBCC. strategy regardless of whether or not service delivery is integrated This I Kit assumes the user has prior. experience designing and implementing SBCC strategies and wants guidance specific to SBCC for integrated. programs Staff who are not directly implementing programs but who provide oversight or funding for. integrated SBCC programs such as those working for a government ministry or donor agency and who want. to develop a general familiarity with SBCC integration will also benefit from this I Kit. What Does This I Kit Contain, A synthesis of promising practices for integrated SBCC as currently understood. Guidance and considerations for developing implementing and evaluating integrated SBCC programs. Case studies of integrated SBCC programs, Sample tools to assist in the development of integrated SBCC programs e g landscape mapping. analysis templates and, Links to additional resources such as how to guides for a number of different aspects of SBCC. How Should This I Kit Be Used, Managers may use this I Kit as a guide to help develop implement and evaluate an integrated SBCC program. that covers multiple health and development topics Please carefully consider which recommendations may. apply to your program and which may need to be modified. This I Kit is organized into five sections each containing a variety of resources. 1 Start by deciding whether or not to use integrated SBCC What are the pros and cons of integrated. SBCC and what evidence exists to demonstrate its value. 2 Next lay the foundation for integrated SBCC by mapping the landscape engaging support and. preparing for implementation, 3 Then strategically design or adapt the integrated SBCC program Learn what to take into consideration. when designing integrated versus vertical programs how formative research differs in integrated. programs and what elements of a communication strategy and concept and materials development and. testing are unique to integrated SBCC programs, 4 Finally learn about the implementation considerations specific to integrated SBCC programs and. 5 Consider how to monitor and evaluate integrated SBCC with an emphasis on how to assess the extent. and impact of integration, Case studies and other resources provide examples to support I Kit users efforts to develop implement and. assess integrated SBCC programs,Integrated SBCC Programs I Kit 3. How Was the I Kit Developed, This I Kit is a collaboration of the United Nations Commission on Life Saving Commodities and the Health. Communication Capacity Collaborative HC3 Based on an initial systematic literature review it was clear. that SBCC professionals are still in the process of exploring what does or does not work in integrated SBCC. programs and how programs can be improved This I Kit reflects the findings of that review as well as a two. day expert consultation that convened over 40 experts from around the world to develop recommendations. and guidance on the design implementation and evaluation of integrated SBCC programs Other source. materials include literature reviews articles and program documents listed in the Resources section of this. I Kit as well as interviews with SBCC professionals who have designed and implemented integrated SBCC. 4 Integrated SBCC Programs I Kit,PART 1 THE DECISION TO INTEGRATE SBCC. SBCC integration is a decision Sometimes the funding agency may require integration in its Request for. Applications Request for Proposals Other times the implementing partners may drive the decision during the. proposal or project design phase At the very least implementing partners should understand to what extent. the project they have accepted is amenable to integration. Integration advances the concept of holistic and client centered care and has the potential to significantly. improve health and development outcomes It can also potentially lower costs by reducing the redundancy. inherent in implementing several vertical SBCC programs see Making the Case for SBCC to learn more about. the evidence for integration, However the decision to integrate SBCC should not be automatic Programs should consider the environment. for SBCC integration the pros and cons of integration in their particular context and most importantly if and. how integration will benefit the target audience then decide whether it is both feasible and worth the effort. ADVANTAGES, SBCC integration has many potential advantages Programs may choose to integrate SBCC in order to. Approach audiences more holistically by organizing programs in a way that reflects the audience s. reality i e audience s lives are not divided by health topic. Avoid message fatigue by linking similar messages together. Reduce missed opportunities for the audience and the program by addressing behaviors that happen. together or are linked to one another e g HIV and substance abuse or offering FP counseling when. new parents bring children for immunization services. Increase the reach of SBCC interventions either by serving a larger number of people or reaching new. or underserved populations such as women or youth, Help build a brand or take advantage of a successful brand e g expanding a well regarded family. health brand to include and promote modern family planning. Give more visibility to topics whose SBCC efforts have historically been under funded. Leverage resources and improve effectiveness by sharing costs and resources and reducing. duplication of efforts,Support integrated service delivery. Help realize national goals related to harmonization. coordination collaboration and integration DEFINITION. Strengthen the capacity of staff and the local community The World Health Organization WHO. or government to better manage programs across topics defines integrated service delivery as the. or sectors management and delivery of health services. Enhance the sustainability of interventions by so that clients receive a continuum of. establishing and institutionalizing their interdependence preventive and curative services according. to their needs over time and across different,levels of the health system WHO 2008. Improve the satisfaction of providers or clients e g. beneficiaries being able to receive all relevant services at Please refer to the Glossary for other terms. one time in one place,Integrated SBCC Programs I Kit 5. In the Guidance for Evaluating Integrated Development Programs FHI360 categorizes the potential advantages of. integration into operational benefits and improved outcomes While this framework is not related to SBCC. specifically it is useful for thinking through the possible reasons for integration. PROGRAM EXPERIENCE TARGET AUDIENCE, At the start of the Nuru integrated poverty reduction program. in Kenya the agriculture program targeted farmers the. financial inclusion program targeted entrepreneurs and the. WASH healthcare and education programs targeted the. entire community This caused Nuru to question how this. assortment of programs focused in the same community. was getting at people of extreme poverty faster cheaper and. more effectively than any one of the interventions alone As. a result they changed their unit of impact to the farmer and. their household with all outcomes focused at aggregated up. to that level Changala 2014,DISADVANTAGES, Programs may also have reasons not to integrate SBCC Consider the following potential disadvantages and. challenges to SBCC integration, It might overload the audience or the delivery channel e g community health workers. It can be more complicated than focusing on a single issue from both a programmatic and audience. point of view, It often requires more coordination and longer timelines than single issue SBCC programs. Bringing together donors or partners might require more time or money than the programs can afford. given their deliverables timelines and budgets, It can require an up front investment in partnership building that might not otherwise be needed. A lack of cooperation among or buy in within the divisions of a donor agency involved in the integrated. program might lower the program s chances of success. 6 Integrated SBCC Programs I Kit, Competition among donors or potential partners might make integration more difficult than the. results would merit It can be difficult to garner the political will and understanding needed for effective. integration, Measurement is difficult measuring multiple outcomes as well as measuring the effect of integration. can be very challenging,KEY QUESTIONS, Any program considering SBCC integration will likely identify additional advantages and disadvantages. specific to their context Remember that there are varying degrees of integration and many decisions to be. made regarding how many and which technical areas to include and the weight to give to each Weigh all. of the competing factors and make the best decision for the target audiences and the program If you are. an implementing partner and the decision has already been made by the donor find ways to maximize the. advantages of integrated SBCC and to reduce the risks including ensuring there is adequate funding for. building and maintaining effective partnerships, Key questions to consider before deciding to integrate different health topics. What are the pros and cons for SBCC integration in the program s context. What existing SBCC platforms and policies are already in place Are they supportive of integration. Whose buy in is needed, Is there enough time in the project s lifespan to design implement monitor and evaluate an integrated. Is there enough evidence to make an effective case for integration. Is enough funding available to support both the strategy and the required coordination. Can the staff volunteers and communication channels handle the implicit complexity of integration. How many and which topics behaviors should the integrated strategy include given the resources. available i e human financial time etc and the coordination effort required. ADDITIONAL RESOURCES,Implementation Kits, Social and Behavior Change Communication in Integrated Health Programs A Scoping and Rapid. SBCC How To Guides,Integrated SBCC Programs I Kit 7. PART 2 LAYING THE FOUNDATION, Before designing an integrated SBCC program it is critical to understand the enabling environment for. the program How might support for the project be strengthened What actions can be taken to lay the. foundation for an ultimately successful integrated program While some actions may be implemented. prior to the actual program design and implementation reinforcing the supportive environment will be an. on going activity throughout the life of the program This section reviews how to map the landscape for. SBCC integration how to engage the necessary support for an integrated program and how to prepare for. implementation,MAPPING THE LANDSCAPE FOR INTEGRATED SBCC. To gain an in depth understanding of the landscape start with. stakeholder and environmental analyses This section provides TIP. guidelines for conducting those analyses The Mapping the. Landscape for SBCC Integration Analysis Toolkit also provides a Keep in mind that the complexity of. series of analysis templates to assist in this process the landscape for an integrated SBCC. program increases with the number, Stakeholder Analysis of topics and or behaviors that are. included the number of sectors, Integrated programs are likely to involve a significant number of involved e g health agriculture. stakeholders from a wide variety of sectors Such sectors may and education and the extent of. include health education agriculture technology communication decentralization in those sectors e g. or others Start by identifying all stakeholders and then spend time operating at national regional district. exploring each of them to gain a deeper understanding of their and or village levels. mission approaches and needs,Stakeholder Identification. Your first task is to identify the stakeholders for each health topic and behavior Cast the net widely to be. sure you capture all of the current and potential players in the field both big and small These may include. government Ministries e g the MOH and the Ministry of Education different divisions within a given Ministry. e g the Reproductive and Child Health Section the National AIDS Control Program or the Health Promotion. Unit within the MOH donors multi sectoral bodies civil society organizations faith based organizations. NGOs service delivery partners SBCC partners social marketing organizations systems strengthening. partners universities or media organizations Program beneficiaries are also key stakeholders. Understanding Stakeholders, Once you have identified your stakeholders learn about the goals and objectives of each potential. stakeholder how each stakeholder might benefit from integrated SBCC and what each stakeholder can. bring to the SBCC integration effort Be sure to understand any concerns competing demands or agendas. Investigate what each stakeholder understands about the. integration Some may think integration means concurrent. programs under one funding mechanism rather than cohesive RESOURCES. and logically packaged interventions that unite divergent health Worksheet 1 Stakeholder Identification. areas for Integrated SBCC Programs provides,a template to guide your stakeholder. Collecting Information identification process, Collect the following information on the donors local See Worksheet 2 Integrated SBCC. government and partners to help you identify gaps challenges Program Stakeholder Interview Guide for. and opportunities for effective and efficient SBCC integration a sample stakeholder interview guide for. integrated SBCC programs,8 Integrated SBCC Programs I Kit.
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