This technical brief from the Health Communication Capacity Collaborative (HC3) describes the components of an effective social and behaviour change communication (SBCC) system and then provides spotlights on HC3's work in five countries to illustrate selected components in action. It forms part of the "HC3 in Action" series, which seeks document and synthesise the HC3 project's experiences and lessons learned on topics that cut across the project's diverse portfolio of activities.
As HC3 explains, while a focus on individual and organisation levels is critical to supporting sustainable SBCC, a significant proportion of SBCC capacity strengthening efforts concentrate on the system level. For more information on the multiple levels of SBCC, see SBCC Capacity Ecosystem™, a model developed by HC3 that reflects the systematic assessment, design and implementation of customised and strategic capacity strengthening for SBCC at each of these levels (see Figure 2 in the brief). An effective SBCC system coordinates, harmonises, and provides opportunities for exchange and advancement of high-quality SBCC programming. The nine components of an effective SBCC system include:
- Coordination: Coordinates the activities of various actors at the different levels. Has sustainable coordinating structures and processes.
- Strategic direction: Provides strategic direction to partner organizations through well-articulated and disseminated policies, strategies, and frameworks.
- Message harmonisation: Provides institutionalied guidance and an effective process for ensuring harmonied messaging.
- Breadth of competencies: Ensures that competencies in all critical aspects of SBCC are present across its network of implementing and coordinating organisations.
- Recognised profession: Institutionalises the SBCC profession and roles. Recognizes SBCC as a critical element in the health system.
- Sustained professional development: Sustains SBCC pre-service training programmes and ongoing professional development required to produce a critical mass of high-competency health communication professionals.
- Knowledge management: Documents, catalogues, and broadly disseminates strategies, media, and materials.
- Funding: Ensures adequate resources to implement high-impact and sustainable SBCC programmes.
- Networking: Provides both virtual and face-to-face networking opportunities for knowledge exchange and professional development among SBCC practitioners.
The five country spotlights illustrate specific components of SBCC system strengthening, and how HC3 addressed SBCC system challenges. In brief:
Role of coordination in Nigeria: The United States Agency for International Development (USAID) HC3 Nigeria Malaria Project 2014-2018 funded by the President's Malaria Initiative (PMI) works with the National and State Malaria Elimination Programs (NMEP/SMEP) to implement evidence-based, high-quality SBCC interventions at scale to increase the demand for and use of malaria prevention and control products and services. Hand-in-hand with implementing comprehensive SBCC interventions, HC3 also works to increase the capacity of the NMEP's Advocacy, Communication and Social Mobilization (ACSM) branch to improve coordination and leadership of malaria ACSM activities at the national and state levels.
To address ACSM's undeveloped capacity and limited experience in effective coordination, HC3 helped facilitatd a process to update the National Strategic Framework for Advocacy, Communication and Social Mobilization to align it with the new National Malaria Strategic Plan for 2014-2020. The guidelines are divided into four main sections, including: conceptual framework and background, strategy development, implementation, and monitoring and evaluation (M&E). Using coloured tabs to separate the sections created a modular format, transforming what had originally been a cumbersome document that the user had to search through into a highly functional resource. The guidelines also include useful technical content - e.g., practical steps for designing quality strategic communication materials and M&E indicators for each malaria technical area. In terms of coordination, the guidelines outline a logical and efficient process for message and material harmonisation among partners working in Malaria SBCC and the ACSM's role in that process.
Role of strategic direction in Sierra Leone: The USAID HC3 Sierra Leone Project (2015-2017), in collaboration with the Ministry of Health and Sanitation (MOHS) and other partners, implemented a SBCC programme to rebuild trust in the country's health system and encourage uptake of reproductive, maternal, newborn and child (RMNCH) services as part of Ebola recovery efforts. One activity included working with the MOHS to develop a national tool that would provide strategic direction on how to improve operation, management, coordination, and integration of health promotion across multiple health areas. In early 2016, HC3 began work to revitalise the strategy development process at the request of the MOHS. The final National Health Promotion Strategy of Sierra Leone (2017-2021) was launched in February 2017. It outlines a plan for strengthening the capacity of the MOHS Health Education Division (HED) and change agents at all levels, addressing, among other things, how to: strengthen health promotion structures, including the role of community health workers (CHWs); improve human resources and capacity strengthening for health promotion through pre-service training; and improve M&E systems.
Role of recognising the SBCC profession in Egypt: A key challenge concerning Egypt's health educators, that currently number approximately 5,500, is that health education is not a recognised profession. HC3, working with the Ministry of Health and Population (MOHP), identified the need to create a formalised professional track in the Technical Health Institute (THI) for health educators, leading to a two-year certificate degree. HC3 is working with local experts to develop a curriculum that will cover the core concepts of strategic communication and behaviour change theory, as well as practicum experience. HC3 is also piloting an in-service training with 1,000 current health educators and developing a reference manual for health educators on a range of health topics.
Role of knowledge management in Bangladesh: The Bangladesh Knowledge Management Initiative (BKMI) from 2013 to 2016 strengthened the capacity of the Government of Bangladesh, USAID implementing partners, and other stakeholders to develop strong, consistent and effective SBCC campaigns and interventions to improve the health and well-being of the people of Bangladesh. (See Related Summaries, below.) BKMI worked closely with the Ministry of Health and Family Welfare (MoHFW) to create a series of complementary knowledge management solutions. A Community of Practice, the BCC Working Group, was formed to facilitate coordination, networking, and sharing among government and non-government stakeholders. Among other activities, the BCC Working Group hosted an annual share fair to recognise and celebrate best practices for health, family planning and nutrition SBCC in Bangladesh. BKMI also led the development of eLearning courses and an eToolkit for field workers. The eToolkit strengthens the system by consolidating the best SBCC counseling tools in one digital publicly available location, enabling all field workers throughout Bangladesh to have access to a common, integrated package of high-quality SBCC counseling tools.
Role of networking in Nigeria: The Uganda Ministry of Health, under the auspices of the Health Promotion and Education Department (HPED), started the Behavior Change Communication Working Group (BCC WG) in 2007 as an umbrella platform for coordinating health communication interventions in the country. Springboard for Health Communication Professionals, a community-building initiative started by HC3, offered a strategic partnership to help advance the mandate and objectives of the BCC WG. Springboard has strengthened networking and knowledge sharing among the Ugandan SBCC community and helped improve learning and collaboration among members both online and in face to face meetings. This has led to a growing evidence of application of SBCC principles during the design and implementation at national and district levels.
HC3 website, October 11 2017. Image credit: © 2007 Peter Roberts, Courtesy of Photoshare