Gillian McKayBehaviour Change & Gender Officer

GOAL Ireland

Global Health Practitioners Meeting“Health Starts at the Community”

Silver Spring, Maryland May 5th -9th 2014

GOAL’s Work in Kutum, North Darfur, Sudan Integrated Programme

Primary Health Care

Community Health

Nutrition

Livelihoods

WASH

REFLECT (Regenerated Frerian Literacy Through Empowering Community Techniques)

GOAL & Gender GOAL is committed to gender equality throughout the

organization and in addressing the basic rights and needs of vulnerable populations throughout the developing world by focusing on gender issues across the full range of sectors within existing policies, development strategies and priorities.

Mainstreaming of Gender across organisation

Consideration of Women, Girls, Boys and Men

The DBC Framework The DBC Framework is an Evidence Based Behaviour

Change Planning Technique

Uses Barrier Analysis Formative Research to Discover the Barriers and Motivators of Behaviour Change

Helps Us to Choose Activities That Directly Address Those Barriers and Motivators

Can be Done Quickly, Cheaply and At Any Stage in the Project Life-Cycle

The DBC FrameworkBehaviour PriorityandInfluencingGroup

Description

SignificantDeterminants BridgestoActivities Activities

OutcomeIndicators:

ProcessIndicators:

The Problem Women in Kutum are not empowered to be involved in

decision making about themselves or their children to visit the health care facility in times of illness.

The Behaviour Women in REFLECT Circles in Kutum are

contributing to decision making concerning health seeking behaviour.

The Priority Group

Determinants of BehaviourDeterminant

Self – Efficacy / Access (transport, money)

Social Norms (Neighbours, Aunts/Uncles approve, Grandparents disapprove)

Action – Efficacy (high likelihood of negative effect, effect will be severe if do not contribute)

Bridges to ActivitiesDeterminant Bridges to Activities

Self – Efficacy/ Access (transport, money)

• Increase the perception that women can control household money

• Increase the ability of women to access health services

Social Norms (Neighbours, Aunts/ Uncles approve, Grandparents disapprove)

• Increase the perception that Neighbours and Aunts/Uncles approve of them contributing to decision making

• Increase the perception that Grandparents approve of contributing to decision making

Action – Efficacy (high likelihood of severe, negative effects)

• Increase the perception that not contributing to decision making can result in a high likelihood of serious effects on health

ActivitiesBridges to Activities Activities

Increase the perception that women can control household money

Village Savings and Loan Associations• “Social Funds” to access emergency care• Control of own money earned through IGADiscussion Fora• Role play how to discuss accessing the clinic• Invite key influencers to participate in

discussions

Increase the ability of women to access health services

ActivitiesBridges to Activities Activities

Increase the perception that Neighbours and Aunts/Uncles approve of contributing to decision making

• Follow up Focus Groups with these identified influencing groups to discover their true feelings on the behaviour

• Discussion fora with influencers and Priority Group members to create space to hear opinions and develop solutions

• Women supported to identify their “support person” who they can go to in the event they require support in contributing to decision making

• “Hands Up Approval” in Community Meetings• Training of Community Leaders

Increase the perception that Grandparents approve of contributing to decision making

ActivitiesBridges to Activities Activities

• Increase the perception that not contributing to decision making can result in a high likelihood of serious effects on the health of the children

• Sharing of Most Significant Change stories• Creation of Contrast Stories by the women in

the Circles for sharing• Discussion fora with local health extensionist• Training of REFLECT facilitators by health

extensionist on prompt care-seeking• REFLECT manual reviewed and additions

made by the Endemic Sickness Unit

Next Steps Identified activities to address barriers are being

integrated into a number of ongoing GOAL projects

REFLECT Circles

NIPPs Circles

We are planning to trial Care Groups in Kutum and will integrate DBC activities.

Framework is considered when we are developing new projects to show evidence-base of our selected activities

Early Results Increase from 30% to 50% of REFLECT circle women

who contribute to decision making

VSLA activities have improved the perception of women that they have the emergency funds to make the decision to access care.

Pre/Post Test increase from 5% to 75% of community leaders who report their approval of women contributing to decision making for care seeking following training

DBC’s Added Value No more assumptions!

Building the evidence base for how to increase access and control for women

Respecting the time of our target population

More emphasis on influencers

Lessons Learnt Challenging to come up with innovative activities to

address barriers

Support from Global Tech Team

Global Community of Practice

Integration of activities requires buy-in from all levels of in-country team

Acknowledgements

Questions?