Implementing and Innovating Upon Best Practices for Family Planning and Reproductive Health Results: Experiences from West Africa Breakthrough ACTION

"The community mobilization approach creates new, open lines of communication between community leaders and health agents, which paves the way for finding common ground and taking action."



This document, published by Breakthrough ACTION, shares promising, proven, or innovative social and behaviour change (SBC) approaches to increase modern family planning (FP) in West Africa. It offers a deep dive into three particular activities, which involve community dialogues and health facility walk-throughs, efforts to improve client-provider interaction, and radio public service announcements (PSAs). It is intended for SBC decision-makers and implementers to strengthen SBC for FP programme design in the West Africa region.



As explained in the report, the West Africa Breakthrough ACTION (WABA) project is a 5-year (2018-2023) field support buy-in to the Breakthrough ACTION cooperative agreement funded through the United States Agency for International Development (USAID) West Africa Regional Health Office. Its main objective is to leverage SBC approaches to increase modern FP access and informed, voluntary use in Burkina Faso, Côte d'Ivoire, Niger, and Togo. In each of these countries, WABA supports technical working groups of FP decision-makers and implementers to increase SBC capacity in FP, partners with district health and community structures to increase access to quality FP services, and implements multifaceted campaigns to overcome social and other barriers to FP information and methods.



For each of the three highlighted WABA activities, the report provides details on the activity's design on a general cross-country level and then shares country-specific examples to dive deeper into the activity. It explores some of the results of the project or approach and discusses challenges, key observations, and lessons learned. The three activities are as follows:


Community dialogues and facility site walkthroughs - This initiative used a multi-sectoral and community engagement approach to improve FP service quality via community-driven solutions. The community engagement approach comprises four iterative activities, which are discussed in detail:

• A community data review to identify areas of concern within a community such as low rates of antenatal care visits.
• Community dialogues that offer local community officials an opportunity to gain community input on FP service quality improvement. Participants include religious leaders, community group heads, women's associations, youth groups, and other prominent, interested groups, as well as primary health centre staff.
• Health facility site walkthroughs with a subset of the community dialogue participants, usually individuals influential in their respective community or religious networks. This experience allows them to ask questions directly to a health provider and to see first-hand what challenges exist to offer quality services.
• Action plan development - At the end of the site walkthrough, participants are involved in developing a community action plan based on the challenges identified. The results of the programme show how local action plans led to local resources being mobilised to improve facility infrastructure. Community-based contributions included, for example, in-kind labour, building materials, donations secured from external sources, and advocacy to the government for promised services such as health personnel and boreholes for accessing water.

FP provider behaviour change tools - This case study looks at how WABA sought to improve FP by focusing on the FP service delivery experiences in Togo, Côte d'Ivoire, Niger, and Burkina Faso - specifically, the client-provider interaction. It explains how Breakthrough ACTION as a first step organised intent workshops in each country to explore priority provider-based FP service use challenges. In Togo, it identified poor service organisation and client flow between services in health centres, in Côte d'Ivoire a lack of a standardised comprehensive counselling tool, in Niger a lack of provider motivation and need for a simplified segmentation counselling tool, and in Burkina Faso inconsistent provider motivation. Following the intent workshops, and based on each country's identified challenges, WABA inventoried dozens of PBC tools and approaches from all over the world to help participants imagine new ways to solve PBC challenges. The whole process used a human-centred design (HCD) approach based on the SBC Flow Chart, which was developed by Breakthrough ACTION to guide participants in developing solutions to identified challenges. The report does a deep dive into how the project in Burkina Faso sought to address the complex topic of provider motivation through a comprehensive approach based on three pillars: empathy, communication, and a satisfaction assessment. This process led to the development and implementation of a set of tools under the name "YASSOMA", which is discussed in some detail in the report.



The Confiance Totale (Total Confidence) radio campaign - This campaign sought to foster trust in FP services and methods during the COVID-19 pandemic. It consisted of a series of radio PSAs designed to increase knowledge about the benefits of FP methods and services and thereby to improve listeners' intention to use (and ultimately adopt a method of) modern contraception, according to their specific needs. The discussion, in particular, looks at the use of the Saturation+ Methodology (developed by Media International - DMI), which is based on the importance of three main principles for a successful behaviour change campaign:

• Saturation, meaning broadcast intensity, or the frequency of broadcasts;
• Science, or how many times you expect people to hear or be exposed to your message according to broadcast frequency; and
• Stories, referring to the way a message is crafted and delivered to ensure it is relevant, attractive, and memorable.

The report shares the results of an evaluation of Confiance Totale in Côte d'Ivoire and in Togo, which demonstrated the effectiveness of using the Saturation+ methodology. For example, among those who reported that they ever listened to the radio, 41.3% reported they had heard the Confiance Totale PSAs. Those who heard the PSAs more often were more likely to report intending to use FP and intending to visit a health facility.

Click here for the French version of this 21-page report in PDF format.