Eight Principles for Strengthening Public Sector Social and Behavior Change Capacity

"Capacity strengthening is a dynamic, non-linear process that requires time, patience, flexibility, and strong relationships with many actors."

From Breakthrough ACTION, this brief highlights key principles, strategies, considerations, and operational research questions for personnel who are leading or supporting social and behaviour change (SBC) capacity-strengthening efforts in the public sector (e.g., the health promotion and/or health education units of a country's Ministry of Health).

Experiences highlighted throughout the brief were collected and synthesised from various stakeholders from current or past United States Agency for International Development (USAID)-funded projects, including Bangladesh Knowledge Management Initiative (BKMI), Breakthrough ACTION, Communicate for Health (C4H), Communication for Change (C-Change), Communications Support for Health (CSH), and the Health Communication Capacity Collaborative (HC3) project, as well as Population Services International (PSI) Cambodia and the Ministry of Health and Family Welfare Bangladesh.

Core concepts:

• SBC can encompass a wide array of approaches, such as community mobilisation to strengthen communities' capacity to promote collective action, to address harmful social and gender norms underpinning behaviours, and to tackle structural barriers to change. SBC programmes may also utilise human-centred design and behavioural science, to name but a few elements.
• Capacity strengthening includes trainings, mentoring, or coaching - conducted both in-person and/or virtually - as well as efforts to strengthen policies and processes, and to institutionalise SBC into routine health planning and strategy. "Instead of one-off, one-size-fits-all trainings, successful capacity strengthening initiatives provide opportunities for not just SBC technical knowledge but also applied learning and skills transfer based on in-depth understanding of the beneficiaries, including their needs and goals."
• The SBC ecosystem model reflects the systematic assessment, design, and implementation of customised and strategic capacity strengthening for SBC. It highlights inherently interconnected relationships at three levels - individual, organisation, and system - with different strengthening goals at each level. The public sector operates in all three domains of the SBC ecosystem.

The 8 key principles, which are illustrated with examples throughout the document, include:

1. Nurture relationships with key stakeholders in the public sector, by:
   • Communicating frequently, openly, and honestly with senior leaders, directors, and SBC specialists through routine meetings, emails, WhatsApp groups, and other platforms;
   • Participating in actively contributing to SBC technical meetings, and jointly presenting at internal and external meetings;
   • Serving as a consistent resource;
   • Recognising the strengths of the public sector;
   • Working together as a team;
   • Setting clear and feasible expectations in line with the pace at which the public sector functions, including agreed-upon roles, responsibilities, and timelines for transition of technical and financial responsibilities; and
   • Demonstrating confidence and building trust in SBC specialists through transparency, co-creation, mentorship, patience, persistence.
2. Align capacity strengthening efforts with public sector goals, structures, and processes, by:
   • Linking SBC efforts to existing public sector objectives and interests such as demonstrating positive impacts on health outcomes;
   • Advocating for SBC public sector funding;
   • Supporting health promotion units in advocating to the Ministry of Health for continued SBC efforts;
   • Creating an understanding of both what SBC indicators are and how they can contribute to programme indicators, as well as advocating for and support the inclusion of SBC indicators into national monitoring systems;
   • Beginning capacity-strengthening efforts by asking how implementers can support public sector goals;
   • Conducting visioning activities and needs assessments to gauge interest, capacity, and competencies (knowledge, skills, and values) to inform and tailor the design of the capacity-strengthening approach; and
   • Building public sector ownership of SBC activities by creating demand for competitive capacity-strengthening opportunities that allow participants the time and ability to both apply what they have learned and seek funding to implement SBC initiatives.
3. Maximise the strengths and comparative advantage of public sector processes, by:
   • Advocating for the health promotion unit and providing support to institutionalise and integrate SBC into national programmes;
   • Focusing capacity-strengthening efforts on the ability of the public sector to establish and maintain quality SBC initiatives and programmes; and
   • Highlighting the role of the public sector as the national convener and expert by supporting them to fully leverage their national and sub-national networks to strengthen collaboration and scale up successful interventions.
4. Elevate the status of public-sector SBC specialists, by:
   • Involving public-sector SBC specialists, such as by inviting them to present at and lead meetings and giving them ownership and credit for their contributions;
   • Creating clear job descriptions outlining the essential role of SBC professionals and their connection to health promotion;
   • Developing and institutionalising academic and certificate programmes for pre-service and in-service training on health promotion and SBC;
   • Ensuring opportunities for SBC professionals right out of school;
   • Connecting SBC professionals to one another through routine knowledge exchange events and forums;
   • Nurturing and strengthening advocacy, research, and evaluation skills to support the public sector in advocating for district-level health promotion funding and demonstrating the impact of SBC interventions;
   • Developing and provide facilitator guides for trainings; and
   • Providing support and mentorship for trainings implemented by the public sector.
5. Focus public-sector capacity-strengthening efforts on management, coordination, and collaboration, by:
   • Ensuring public sector staff are able to coordinate processes and create linkages among programmes, partners, and the private sector to develop materials and implement activities;
   • Strengthening the capacity of the public sector to manage contracts and partnerships with ad agencies and production houses and to understand how and when to outsource support;
   • Providing tools to support contracting; and
   • Advocating for the public sector to have the autonomy to manage government funding.
6. Support technical and organisational capacity simultaneously, by:
   • Focusing initial efforts on readiness, including fostering workforce development and ensuring SBC specialists have the necessary computer software and file management systems;
   • Introducing and support the institutionalisation of processes and tools to facilitate high-quality technical and organisation capacity in SBC - e.g., establishing an archive of SBC materials and standardising SBC practices;
   • Determining how to work with the public sector - whether through co-locating in the same office, seconding a staff member to the project, or providing remote support - and creating and implementing specific scopes of work, roles, responsibilities, and timelines to meet the contextual needs of the programme; and
   • Supporting the public sector in creating and implementing a resource mobilisation strategy for financial sustainability.
7. Strengthen and support SBC systems in which the public sector plays a role, by:
   • Implementing technical working groups, websites, knowledge exchange events, or formal and informal communication channels, such as email and WhatsApp, to support information exchange at various levels;
   • Collaborating with the public sector to develop clear coordination structures and practices, including the creation of technical working groups, content design teams, message harmonisation processes, and monitoring systems;
   • Creating and maintaining a database of private-sector partners such as agencies, production houses, and creative consultants; and
   • Connecting the public sector with private-sector partners able to produce high-quality SBC materials.
8. Build in sustainability structures, by:
   • Positioning public-sector SBC specialists in integral roles throughout the lifespan of SBC initiatives, so they have the knowledge, confidence, and capacity to coordinate activities going forward;
   • Ensuring and advocating for sufficient budget for the public sector to procure services to carry projects or specific activities forward;
   • Using key documents, developed collaboratively, such as an SBC strategy and action plan, as roadmaps for transition;
   • Documenting processes and progress to enable successors to continue in the same direction by creating "how-to" guides and succession plans;
   • Conducting a skills review so activities are handed over to the right person in the right division, who ideally has been involved since the onset;
   • Including SBC activities and associated tasks in formal job descriptions to create accountability; and
   • Ensuring the public sector has partnerships in place with other non-governmental organisations (NGOs) and the private sector, to provide sustained support.

In conclusion: "Despite the challenges, strengthening public sector SBC capacity can improve the health and well-being of communities. Therefore, implementers should document and publish their experiences and additional principles for success, which will aid the continuation of efforts to strengthen global SBC capacity."