Population-Level Social and Behaviour Change Evidence Review for Child Survival in Africa

In January 2013, two meetings, a consultation on population-level social and behaviour change  (SBC) evidence review and "African Leadership for Child Survival: A Promise Renewed", led to a consensus to "accelerate child survival efforts. This decision was endorsed by more than 120 delegations from Ministries of Health across the continent…" and responded to the goal set in 2012 to reduce child mortality to 20 per 1,000 live births. The meetings were organised by the United States Agency for International Development (USAID) and the United Nations Children’s Fund (UNICEF) in Addis Ababa, Ethiopia.

The aim of the meeting was to discuss the Africa evidence review commissioned by USAID, as well as to prepare for the "SBC Advocacy Engagement at the High Level" meeting of African health ministers. Advocacy engagement included presenting three case studies on SBC and child survival from Niger, Tanzania, and Ethiopia.

The meeting, focused on eight effective SBC interventions and discussions, led to the identification of gaps and limitations in each approach, including:

1. Interpersonal/Individual/Family Approach
2. Community Level Approach and Advocacy
3. Mass Media and Infomation and Communication Technology
4. Holistic/Integrated Approach
5. Addressing Inequalities
6. SBC Partnerships
7. Delivering at-Scale
8. Structural/Systems Approach (Enabling Environment)

Participants provided new evidences and evidence briefs to researchers on successful SBC interventions which detailed the six most effective SBC approaches for child survival in Africa (Interpersonal/Individual/Family Approach; Community Level Approach; Holistic/Integrated Approach; Partnerships, Social Marketing, and Scaling Up with Mass Media and ICT. )

Participants then developed sets of strategies and recommendations on effective SBC interventions to present to attendees at the high-level "African Leadership for Child Survival - A Promise Renewed" meeting that coincided with the review.

According to Mario Bravo of USAID, "[t]he Evidence Summit focuses on the challenge of achieving the needed social and behaviour changes to end preventable child deaths. Given the consensus on the important role of communication, the next challenge is how to put the evidences into action."  He stated that there is empirical and anecdotal evidence that social and behaviour change communication (SBCC) works, but a more systematic approach needs to be identified for approaches that are working in order to determine their characteristics and explore at-scale implementation. Participants made several recommendations which are sampled below.

Strengthening Research, Monitoring, and Evaluation in SBC:

• Plan evaluations of SBC as ongoing, long-term processes;
• Broaden focus of SBC indicators and evaluation designs to include those that will measure antecedents on the pathway to behaviour change (e.g., changes in perceptions, intentions, attitudes; shift in social norms, power relationships; and individual and collective self efficacy);
• Facilitate partnerships on research, monitoring and evaluation for SBC amongst national health research boards, local universities, regional centres of excellence, and global health partnerships.

Strengthening Systems Approach for SBCC:

• Incorporate SBCC components in all health sector policies, strategies, plans, and budgets at national and district level;
• Establish or strengthen national/district level coordination mechanism for SBC;
• Work towards integrated SBCC interventions that include a mix of communication approaches (i.e., interpersonal, community-based, mass media, and technology) and multiple linkages (i.e., across various health issues, societal levels, sectors, and the lifecycle).

The next stops for SBC in Africa to advance the goal of child survival include: disseminating the outputs from the evidence review meetings and supporting sustained advocacy on SBC; developing a package of tools to strengthen the systems approach for SBC; establishing SBC technical assistance fund/facility; identifying and recommending key, affordable impact indicators; and promoting the role of regional university/practitioner networks in supporting dissemination, advocacy, and integration of evidence in SBC.