SBCC Capacity Strengthening in Action: HC3 Country Case Study Series
From the Health Communication Capacity Collaborative (HC3), this case study examines the Bangladesh Knowledge Management Initiative (BKMI) is part of a series describing HC3's social and behaviour change communication (SBCC) capacity strengthening efforts in Bangladesh, Ethiopia, and Nigeria. Further information about the BKMI is available under Related Summaries, below, but, in brief, the Bangladesh case study looks at how the project's second phase (2013-2016) focused its capacity strengthening work at 3 levels: improving the knowledge and skills of individuals who work in the 3 SBCC units of Ministry of Health and Family Welfare (MoHFW), developing tools and establishing processes within the units to strengthen organisational capacity, and working to optimise coordination of SBCC activities and integration of health, nutrition, and family planning topics at the system level.
As detailed here, BKMI's capacity strengthening work with the Bangladesh MoHFW can be described using the SBCC Capacity Strengthening Ecosystem™ Model. The Ecosystem: assesses capacity at the individual, organisation, and system levels; recognises that capacity strengthening is a dynamic, non-linear, and non-hierarchical process that involves many interacting agents; and speaks to the inherently complex, interconnected, and often unpredictable nature of capacity strengthening and the dynamic environments in which people often work. It also recognises that a single activity is almost never enough to make change.
To begin with, BKMI used a standardised capacity assessment tool to map the capacity of the 3 MoHFW units responsible for SBCC for health, nutrition, and family planning. Among other findings, this process revealed that a majority of the challenges were at the system level. So, BKMI worked with the MoHFW and the Behavior Change Communication (BCC) Working Group - a community of practice of SBCC practitioners in Bangladesh from government, non-government organisation (NGO), private and development partner, and other organisations - to develop an eToolkit for Field Workers. The case study describes the eToolkit in detail; in short, it is a digital library of print and audiovisual SBCC materials presented in a simple graphic format, organised by topics and sub-topics. Following a successful pilot in the Sylhet and Chittagong districts, BKMI began working with the MoHFW, NGOs, and private-sector organisations to support cadres of field workers to scale up the use of the eToolkit nationwide, making it available in 3 formats: online, offline (for those with access to a Windows™ desktop or laptop computer, but who do not have a reliable internet signal, and as a mobile app. Updated annually by a sub-group of the BCC Working Group, the eToolkit is an example of how capacity strengthening efforts for the MoHFW in Bangladesh spanned across all 3 levels in the SBCC Capacity Ecosystem: (i) At the individual level, the eToolkit enables field workers to enhance their knowledge and skills; (ii) at the organisational level, the 3 MoHFW units responsible for SBCC are involved in updating the eToolkit every year; and (iii) at the system level, the eToolkit facilitates coordination by compiling high-quality counseling tools for field workers in one place and is designed to be taken to scale in a country with a large cadre of both government and non-government field workers.
The case study has an evaluation lens, offering data from the eToolkit pilot process (May to August 2013), which found that using the eToolkit increased field worker credibility as the first point of contact for information on general health (from 18-59%), family planning (from 38-54%), and nutrition (from 29-50%). It includes qualitative data in the form of quotations from various personnel involved in the effort. For example, Rafiq Miah, Health Assistant, Goalabazar Union, Balagonj Upazila, Sylhet District, said: "The eToolkit provides important information in an entertaining way. This has caused people to be more accepting of me and my messages. This new technology in my hand has enhanced my importance within the community. Now people are more attentive. The eToolkit is my all-time companion now." Some of the reasons for the success of the eToolkit are outlined. For instance, the multi-level challenges - starting with the system, as revealed by the assessment - in capacity required creative thinking, which resulted in the development of the eToolkit. In 2014, the Directorate General of Health Services (DGHS) decided to invest in tablets for all of its field workers, which created an opportunity for scale-up that would not have been otherwise possible. To ensure sustainability and local ownership, the DGHS took over hosting the eToolkit on its server.
There are, however, some lessons learned:
- "Technology can also present some challenges: two years after DGHS' investment, many of the tablets were not in service. As a result, BKMI had to prioritize working with known existing ICT infrastructure, such as the laptops in more than 13,000 Community Clinics and the computers in the 240 Family Welfare Centers.
- Investing in ICT infrastructure was beyond the scope of BKMI. Rather, BKMI had to rely on existing computers and mobile devices within MoHFW and advocate for the further investment in mobile devices, including field-based technical support, supervision and training on using both the devices and software.
- To address challenges in ICT infrastructure, BKMI made the eToolkit available in three formats so field workers could access it with or without an internet connection, using a desktop or laptop computer or mobile device. However, the trade-off is that it is not possible to accurately monitor the dissemination and use of the offline and app versions.
- To achieve true sustainability, MoHFW will need to take over promotion and dissemination of the eToolkit, field-worker training, trouble shooting and tech support, and annual content updates, which can be accomplished in four to five months with the support of the BCC Working Group.
- Taking the eToolkit - or any technology - to scale takes time and may not follow a linear process....Compromises in quality sometimes need to be made to achieve scale, or compromises in scale need to be made to retain quality."
Having identified some next steps for protecting the MoHFW's investment and improving effectiveness of these tools, the case study concludes that "[l]ong-term investments in building systems can result in sustainable impact when done in a collaborative manner, with a focus on impact and supporting local objectives and priorities. By changing the lens through which capacity strengthening is viewed and drawing upon innovative ways to assess and validate capacity strengthening outcomes, the MoHFW, partners and stakeholders were able to be innovative and bring technology to their aid."
"Three New Case Studies Show SBCC Capacity Strengthening in Action in Bangladesh, Ethiopia and Nigeria", by Kim Martin, January 4 2017.