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This presentation was made possible by the American people through the U.S. Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031,
the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project.
Building blocks of great nutrition SBCC: innovating while getting the basics right
Ashley Aakesson, The Manoff GroupLauren Bailey, JSISascha Lamstein, JSIMichael Manske, USAID
“Behavior matters—particularly in nutrition. We know what works. We have to work together across uncommon allies . . . 45% of under-five mortalities are related to nutrition. If we do the right things for survival, then we do the right things for health. We can’t do these things without behavioral change.”
—Katie Taylor, Deputy Child and Maternal Survival Coordinator, USAID
Why Social and Behavior Change?
Why Social and Behavior Change?
The 2010 Global Burden of Disease report indicates that 5 of the top 20 health risk factors are predominantly behavioral, and the other 5 are highly influenced by behavior. (Lim et al., 2013)
USAID in its Multi-Sectoral Nutrition Strategy considers SBCC strategies and approaches to be “essential for increasing optimal nutrition practices, demand for services and commodities, and ultimately, increasing utilization of services.” (USAID 2014)
Behavior permeates global nutrition efforts (across sectors and whether preventive or curative).
Thinking Beyond the Individual
1. Freestanding, personal or lifestyle behaviors
2. Care-seeking behavior or demand3. Client adherence and collaboration4. Provider behavior5. Pro-social and anti-social behavior6. Policy and priority settingSource: Shelton 2013. Global Health Science and Practice
Strengthen global and country efforts to scale up high impact nutrition practicesPrevent stunting and anemia in the first 1,000 daysLink agriculture and nutrition under Feed the Future
About SPRING
Who we are What We Do
Enhance evidence for promising SBCC delivery strategies
Apply, document, share
promising strategies
Implement SBCC activities in the Sahel
Build evidence and develop guidancefor systems thinking approachesto nutrition Build capacity for systems thinking for nutritionprogramming at scale
Engage with countries tostrengthen anemia programming
Build evidence on implementation and effective scale-up of existing interventions for anemia
Partner with the global community to inform anemia prevention and control programs
Build evidence (operations research, technical guidance documents, tools)
Deliver technical assistance scale Share, learn, and build an active community of practitioners
Strengthening Systems for Nutrition
Linking Agriculture & Nutrition
Preventing Anemia
Catalyzing Social and Behavior Change
Our Work
Evidence for SBCC: Why SBCC?
“SBCC is fundamental to improving nutrition. . . . We need to de-mystify SBCC, and get lessons learned about success out there. We must push people to take risks, and learn from it. We need to inspire people and be creative.”
—Ellen Piwoz, Senior Program Officer, Bill and
Melinda Gates Foundation
SBCC is Crucial for Nutrition; Nutrition is
Crucial for Development Nutrition has gained importance for the development agenda, in large part due to the Lancet Nutrition Series 2008 and 2013 which documented the scope of malnutrition and the evidence base for effective interventions.
Scaling Up Nutrition has estimated that malnutrition costs some countries up to 3% of their GDP per year.
Recent evidence has supported the crucial role of SBCC as a fundamental strategy for most nutrition-specific and nutrition-sensitive interventions.
WHO, Maternal and Child Nutrition Study Group, 2013Alive &Thrive special issue of the Food and Nutrition Bulletin, 2013Journal of Health Communication, 2014
Core Elements of SBCC
Social Change to achieve shifts in the definition of an issue, people’s participation and engagement, policies, and gender norms and relations
Behavior Change through efforts to make specific health actions easier, feasible, and closer to an ideal that will protect or improve health outcomes
Communication using channels and themes that fit a target audience’s needs and preferences
Adapted from: The Manoff Group. See: http://manoffgroup.com/documents/DefiningSBCC.pdf
Evidence for Nutrition SBCC
Evidence of the effectiveness of SBCC approaches in improving breastfeeding practices is strong and broad and supports the claim that SBCC approaches can and do succeed in improving uptake of the behaviors promoted.
There is extensive evidence for positive impact of SBCC on improving infant feeding practices.
There is little experience or evidence regarding the priority nutrition practices for adolescent girls and other WRA and how to effectively promote them.
Evidence for Nutrition SBCC (cont.)
There is evidence of effectiveness for a wide variety of delivery strategies including: interpersonal communication, community mobilization, social marketing; and to a lesser extent, mass-media campaigns, and environmental nudges.
One-on-one or small group communication is the approach most consistently and effectively used, with the most published evidence supporting it.
There is emerging evidence that mass media can be cost effective in creating individual behavior change.
Evidence for Nutrition SBCC (cont.)
Mutually reinforcing interventions through multiple delivery strategies, channels, and points of contact improves effectiveness of SBCC.
The CORE Group and TOPS Project analyzed project data and found that projects using any SBCC approach had better outcomes than those not using SBCC.
Continued recognition of the importance of social and structural/environmental change to support individual behavior change. Mass media and advocacy for enabling policies and structural investments play a role in bringing about those changes.
What We Need…
Evidence of the optimal combinations of approaches, channels, and target audiences
More complete and comparable documentation of “the black box of design”
Indicators which are standardized, endorsed by WHO, and widely used, to measure nutrition-related behaviors and SBCC processes
Best approaches and tools for bringing about and measuring social change
Maternal, infant, and young child nutrition care practices
Initiate BF early
Introduce CF at 6 months
BF on demand
Feed with appropriate frequency
Eat a diverse diet
Eat adequate quantity of food
Continue BFfor 2 years
Exclusive BF
for 6 months
Sleep under
treated bednet
Take de-worming
medication
Take iron / IFA supplement
Eat Vitamin A supplement /
fortified foods
Use alatrine
Wash hands at critical
moments
Properly store/treat
water
Feed a diverse
diet
Takeprotein/energy supplements
Feedactively / responsiv
ely Feed appropriately during/after
sickness
Improved nutritional status during the first 1000 days
Dietary practices
during pregnancy and
lactation
Complementary
feeding (CF)
Control and prevention of
anemiaWASH
Breastfeeding (BF)
practices
Use multiple micronutrient
powder
Take malaria
prophylaxis
Properlydispose of
feces
Eat iron-rich/ fortified foods
Properly store/prepar
e food
www.spring-nutrition.org/publications/briefs/sbcc-pathways-improved-maternal-infant-and-young-child-nutrition-practiceswww.spring-nutrition.org/publications/series/evidence-effective-approaches-social-and-behavior-change-communication
Improved nutritional status
Government, business, NGO, and
faith leaders
Community leaders and service providers
Families, partners, and peers
Individuals / caregivers
Community / social
mobilization (campaigns,
community events)
Advocacy(raising resources and political/social
leadership commitment)
Behavior change
communication
(IPC, small media, and mass media)
Non-Communication
Strategies (policy change, systems
strengthening)
Diet during pregnancy
and lactation
Complementary feeding
Control and prevention of
anemiaWASHBreastfeeding
Deliv
ery
st
rate
gie
sTa
rget
popu
lati
on
sD
ete
rmin
an
ts
of
care
pra
ctic
es
Imm
edia
teca
use
s
Demand Environment Supply
Ability to act
(skills and efficacy,
agency, and control
of resources)
Enabling systems
and policies
Awareness,knowledge,
and understandin
g
Availabilityof health services
and food
Qualityof health services
and food
Social norms
and role models
Motivation, attitudes,
convictions, perception, and beliefs
Und
erl
yin
gca
use
sC
ate
gori
es
of
care
pra
ctic
es
Food security Access to quality
health services and environment
Care Practices
Dietary intake
Health status (disease)
Drivers of BehaviorDrivers of behavior can be conscious or unconscious, internal or external, physical or social, and at multiple systemic levelsThe World Bank’s recent Mind, Society, and Behavior report highlights cognitive drivers
Humans think automaticallyHumans think sociallyHumans use mental models
Good design makes the optimal behavior easy and desirable, and sometime the default
Choice architecture and cues for action approaches
Choice Architecture
Great design makes it easy and fun to do the optimal behavior. "Flies" in urinals improve, well, aim. When Amsterdam's Schiphol Airport was faced with the not uncommon issue of dirty urinals, they chose a unique solution: by painting "flies" in the (center of) commodes, men obligingly aimed at the insects, reducing spillage by 80 percent.
Source: Slideshare presentation by Lola Sanchez
Strategic Agenda for Great Nutrition SBCC
Promote SCALE-FOCUSED nutrition SBCC
Drive EXCELLENCE in design and implementation
Engage WORLD-CLASS people and partners
Build on the EXISTING EVIDENCE BASE for SBCC’s impact on nutrition
Persuade decision-makers that SBCC IS CRITICAL for tackling malnutrition
Innovation at SPRING(round tables)
Community generated, human mediated digital media
Applying SBC basics to nutrition-sensitive agriculture design
Avoiding “faith-based scaling” through evaluation
Resources• Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A
comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260.
• USAID.2014. Multi-Sectoral Nutrition Strategy 2014-2025. Washington D.C. http://www.usaid.gov/sites/default/files/documents/1867/USAID_Nutrition_Strategy_5-09_508.pdf
• Shelton JD. The 6 domains of behavior change: the missing health system building block. Glob Health Science and Practice 2013;1(2):137-140. http://dx.doi.org/10.9745/GHSP-D-13-00083.
• http://www.thelancet.com/series/maternal-and-child-undernutrition
• http://www.thelancet.com/series/maternal-and-child-nutrition
• http://scalingupnutrition.org/about/why-nutrition
• Alive &Thrive special issue of the Food and Nutrition Bulletin, Food & Nutrition Bulletin, 34:3 (Supplement), 2013
• Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries: a Review of the Evidence. Journal of Health Communication 19:1, 2014.
• World Bank. 2015. World Development Report 2015: Mind, Society, and Behavior. Washington, DC. http://www.worldbank.org/en/publication/wdr2015
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