Strengthening Social and Behavior Change Monitoring and Evaluation for Family Planning in Francophone West Africa

"SBC-related indicators: measure SBC processes and techniques to motivate and increase uptake and/or maintenance of health service-related behaviors among intended audiences."



Evidence suggests that social and behaviour change (SBC) interventions can directly increase contraceptive uptake and use through pathways that address intermediate indicators such as attitudes and communication around family planning (FP). However, SBC measurement tools and indicators measuring these domains are not systematically applied to monitor and evaluate FP/reproductive health (RH) programme performance. West Africa Breakthrough ACTION (WABA) is a regional United States Agency for International Development (USAID)-funded initiative aiming to increase coordination and effectiveness of SBC interventions in Burkina Faso, Côte d'Ivoire, Niger, and Togo. Breakthrough RESEARCH conducted a mapping of FP investments, technical approaches, and indicators in these 4 countries. This report summarises findings from the mapping, identifies indicator gaps, and makes recommendations to improve measurement of SBC activities within the broader FP programmatic landscape.

The researchers suggest that availability of SBC-related data, including standardised indicators, would provide several advantages:

• SBC data are needed for programme design, and to continuously monitor programme quality and efficiency.
• SBC data can be used to show that programmes have their intended short- and long-term effects, which can be used to advocate for further investment. This is particularly true in the Ouagadougou Partnership (West African) countries, where many countries still have a high mean ideal number of children and low contraceptive prevalence rates.
• Standardised SBC indicators at the country level can facilitate collection and aggregation of information at the national level, while regional standardisation provides countries with the opportunity to benchmark their progress against other countries.
• Routine monitoring systems using standardised SBC data could be used to design and evaluate programmes without the need for one-off data collection activities, which could generate cost savings.

Structured key informant interviews with FP stakeholders (primarily project/country directors and monitoring and evaluation (M&E) officers) in each country were conducted November-December 2019. The purpose of the interviews was to obtain information on FP investments and relevant documents on FP indicators. Table 2 in the report illustrates the master indicator matrix. Counts of indicators by type (output, programmatic reach, intermediate, and outcome) and socio-ecological level (individual, community, facility, project, national, regional) were summarised in heat maps to visually explore prevalence of specific types of indicators as well as gaps.



The researchers collected 1,508 indicators from 55 stakeholder/projects operating in the 4 countries over the last 5 years. Overall, they found a broad range of indicators reported across type and level. Summary of insights:

• The predominant number of indicators collected in each country were at the output level (occurring as a result (direct product) of a programme's activities). Output-level indicators were captured across socio-ecological levels but with fewer at the individual level.
• There are few measures related to reach or exposure of beneficiaries to interventions. Burkina Faso registered the greatest number of reach indicators, mostly consisting of more general measures of exposure to FP information, messages, and interventions by type of channel (e.g., mass media, toll-free numbers, community events, interpersonal communication, etc.).
• Intermediate indicators measuring ideational factors such as attitudes, self-efficacy, risk perceptions, and social norms were not widely represented. Among the ideational factors measured, most focus on awareness, knowledge, and partner communication. The lack of intermediate indicators at the community level indicates that there may be a need to focus on capturing more normative measures of behaviour change, as awareness of methods without favourable attitudes and enabling social norms is insufficient for behaviour change.
• Although most programmes typically seek to reach all reproductive age women, there are some indicators that focus on key audiences such as adolescents or women who are postpartum or receiving post-abortion care. However, there are few indicators that address audiences such as older women or high-parity women.
• Nationally representative household surveys lack SBC-relevant measures beyond knowledge, such as programme exposure and behavioural determinants, which limits their use for SBC programme design and evaluation.
• There were few indicators relevant to SBC programming at the provider level, such as attitudes, beliefs, and communication practices.
• The limited number of policy indicators, particularly at the outcome level, may reflect measurement challenges.
• There were very few indicators that measured costs.

In addition, the researchers leveraged the 72 indicators in the SBC indicator bank for FP and service delivery, developed by Breakthrough ACTION. Table 8 in the report provides an illustration of the extent to which indicators available in the SBC indicator bank are represented by the indicators collected in the indicator matrix. The researchers found that stakeholders across the 4 countries used, to varying degrees, 48% of the indicators included in the indicator bank. Approximately 21% of the indicators in the indicator bank were similar to the indicators found in the matrix; 31% did not match. Examples of overlap between intermediate indicators collected through the interviews and in the indicator bank include knowledge of FP methods, intention to adopt FP, and talking to others (friend, relative, community, provider) about FP. On the other hand, one example of an SBC indicator bank output indicators not captured in the matrix: percent of long-acting or permanent method counseling sessions that were deemed high quality and comprehensive. Table 9 presents a list of indicators in the SBC indicator bank that are not currently being used by stakeholders but that might be incorporated into SBC monitoring systems.



Based on the findings from this indicator mapping exercise, the report offers recommendations to inform SBC investments and SBC M&E:

• Recommendations for research and measurement partners - Participate in the development of a regional M&E framework that is inclusive of SBC programmatic investments; incorporate measures for programmatic reach (particularly for large campaigns), as well as intermediate indicators beyond awareness of FP methods; and capture better data on men, FP/RH-related intermediate indicators, and how these are changing over time.
• Recommendations for governments - Track key SBC indicators using standardised SBC measures, such as those in the FP indicator bank; invest in data quality assessments and explore innovative methods to improve data quality; and leverage the data for decision making, and promote their use across all levels of the health system.
• Recommendations for implementers - For example: Programmes should identify through a theory of change development process at the design stage and identify behavioural drivers to be addressed by programming to assess progress in achieving longer-term programme outcomes and impact.
• Recommendations for donors - For example: Donors may consider further investing in knowledge management and research utilisation projects to help stakeholders make the most of available data sources for programme and policy decision making.
• Recommendations for the SBC indicator bank - For example: It may be useful to include indicators such as number of government leaders who feel they are able to speak out in favour of FP to better understand the policy context related to SBC.