Evaluation of Breakthrough ACTION-Nigeria's Social and Behavior Change Public Sector Capacity Strengthening Approach

Breakthrough RESEARCH/Population Council (Adetunji, Jani, Sripad); Population Council, Ghana, and University of Ghana School of Public Health (Abegunde, Ankomah); Kwame Nkrumah, University of Science and Technology (Addo)
"[I]t's mainly because of Breakthrough ACTION that I created a program = Health Living = on the radio....And because of them, we have decided to create more spaces or go into even more places....So, it's a big one." - media personnel, male, Ebonyi
Breakthrough ACTION-Nigeria, an 8-year project funded by the United States Agency for International Development (USAID), is implementing a complex integrated social and behaviour change (SBC) intervention with a component on public sector capacity strengthening (PSCS). On this approach, interventions address all three levels of the ecosystem (i.e., individual, organisational, and systems) to strengthen capacity and competencies, support effective SBC efforts, and positively affect health and social outcomes. This Breakthrough RESEARCH-Nigeria study evaluates the extent to which the SBC PSCS project, as implemented between 2017 and 2021, strengthened capacity at various levels of the state ministries of health (SMOHs) and related ministries, departments, and agencies (MDAs).
Breakthrough ACTION-Nigeria's SBC capacity strengthening approach is modelled on the SBCC [Social and Behavior Change Communication] Capacity EcosystemTM developed by USAID's Health Communication Capacity Collaborative (HC3) Project. This is a model that reflects the systematic assessment, design, and implementation of customised and strategic capacity strengthening for SBC. In brief:
- At the individual level, Breakthrough ACTION-Nigeria focuses on enhancing the SBC skills of both programme and government staff through a variety of on-the-job training, self-directed learning, and experiential learning approaches.
- At the organisational level, Breakthrough ACTION-Nigeria focuses on strengthening organisational and individual connections and coordination, as well as developing processes and systems to facilitate outcome-oriented coordination and improved advocacy for SBC promotion/communication.
- At the systems level, the emphasis is on re-invigorating existing SBCC technical working groups, advocacy, communication, and social mobilisation (ACSM) sub-committees, and SBC-advocacy core groups (SBC-ACG) to create a dynamic and active coordinating body.
Illustrative activities include: joint implementation of the integrated SBC approach (e.g., supporting roll-out of training on community information boards across all the 20 local government authorities (LGAs) of Bauchi State); technical assistance to improve SBC capacity (e.g., providing technical assistance in conducting a SWOT analysis on the functionality of the various state malaria ACSM core groups); local capacity development (e.g., training 648 community volunteers on community mobilisation approaches for malaria, effective interpersonal communication, and the use of monitoring and evaluation tools); and stakeholder participation and involvement (e.g., ensuring that the state malaria elimination programmes (SMEPs) and ACSM members were part of all the activities for the demand creation workstream for long-lasting insecticide-treated nets (LLINs) campaigns). The influence of key stakeholders is often leveraged to engage other stakeholders (e.g., religious leaders) in themselves sharing SBC messages.
A mix of data collection tools were designed to gather information for the evaluation of this work. First, a desk review of relevant project documents and engagements with Breakthrough ACTION-Nigeria and USAID Nigeria informed the choice of study design, which was the outcome harvesting approach. The review also helped identify the social actors (stakeholders and beneficiaries) of the SBC PSCS project. Data were obtained from 50 social actors across five Nigerian states - Nasarawa, Bauchi, Sokoto, Kebbi, and Ebonyi - through key informant interviews (n=30), most significant change (MSC) stories (n=15), and rapid capacity assessments (n=5).
Selected findings are outlined below:
- Through Breakthrough ACTION-Nigeria, USAID strategically focused investments on strengthening public sector systems for oversight of SBC activities at the national and sub-national levels.
- Findings revealed an increased value of SBC by Breakthrough ACTION-Nigeria's SBC PSCS social actors, sustained interest in applying new SBC techniques to health areas (e.g., malaria, yellow fever, Lassa Fever, COVID-19), and an increased commitment to cascade the knowledge and skills acquired so far from Breakthrough ACTION-Nigeria SBC training to the LGA and community levels to improve health and social outcomes.
- Social actors report participation in Breakthrough ACTION-Nigeria SBC PSCS project-related activities, such as training sessions, meetings, advocacy campaigns, health-related media discussions, and Breakthrough ACTION-Nigeria-supported special day celebrations. During the interviews, some of the social actors pointed out that the communication strategies Breakthrough ACTION-Nigeria used itself or advocated for use by state social actors have proven to be effective thus far. The use of radio jingles and live radio discussions on health topics (for example, the Albishirin Ku! radio programme) has helped to change people's behaviour by creating awareness.
- Social actors identified challenges they encountered in the post-training application of knowledge and skills, including perceived illiteracy of community members, resistance to change, financial and mobility issues, a lack of data collection tools, and conflicting work plans.
- Six study outcomes demonstrated coordination efforts by project beneficiaries, with all occurring at the organisational level and in Year 5 of programme activities. For example, in Kebbi: State Primary Health Care Development Agency/community mobilisation teams (SPHCDA/CMTs) began to coordinate and monitor SBC-ACG operations; SPHCDA/LGA CMTs were trained in the Community Action Cycle (CAC); and Community Health Action Resource Plan (CHARP) development began to design, execute, and coordinate SBC initiatives in Ebonyi State. Government authorities and media producers began to coordinate SBC operations in Sokoto State at the system level.
- The evaluation process - that is, gathering data on outcomes - served as a tool in and of itself to engage social actors and stakeholders in reflecting on what they had accomplished or what the SBC PSCS approach/project had enabled them to accomplish in terms of SBC capacity strengthening.
Recommendations are as follows:
- Sustain the high intensity of implementation as recorded in 2021.
- Address limiting factors that could lead to slow implementation of SBC PSCS activities in Kebbi state.
- Increase coordination efforts to ensure even greater synergy between different MDAs and long-term sustainability of SBC PSCS activities beyond the project's lifespan.
- Address limiting factors that affect social actors' application of skills gained, such as ignorance and insufficient awareness efforts.
In conclusion: "Breakthrough ACTION-Nigeria has so far laid the groundwork for additional opportunities to develop high-quality SBC in the public sector, particularly through training, technical assistance, and coordination with relevant MDAs. Breakthrough ACTION-Nigeria's efforts have markedly strengthened SBC capacity, as evidenced by the constellation of outcomes identified."
Population Council Knowledge Commons, August 9 2023. Image credit: Adetayo Adetunji
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