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)

Building Blocks for Great Nutrition SBCC

Taxonomy of Behaviors

Stages of Change Model

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

Brainstorming Key Design Elements

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

Thank you!For more information on SPRING, visit:

www.spring-nutrition.org