Measuring Social and Behaviour Change Communication Capacity in Malawi

"A disproportionately high burden of communicable diseases and high child and maternal mortality require high-quality health promotion interventions."

In Malawi, this evaluation aimed to obtain a baseline measurement of current social and behaviour change communication (SBCC) competencies, and to inform skills building for SBCC in a 5-year Health Communication for Life (HC4L) begun in 2016.

As stated here, "C4D competencies include facilitating dialogue and community participation, while health communication competencies and skills include the development, dissemination and evaluation of health information to and from audiences." Measuring human resources in Malawi by assessing requisite skill sets, as well as their baseline measurement at different levels, through capacity assessments using the HC4L capacity assessment tool was the project of the Health Education Section (HES) within the Ministry of Health (MoH), at both the national and district levels, as a baseline and to inform skills-building for SBCC. "This paper presents the process of designing the tools and the findings of the baseline SBCC capacity assessments. Finally, the paper draws lessons from the assessment, and highlights implications for SBCC capacity-strengthening effort."

Between January and March 2017, 38 health promotion officers (DHPOs) attended the assessment, done through two standardised participatory tools developed to capture SBCC competencies. Four domains of competency of competency included: (i) institutional systems; (ii) planning and designing; (iii) implementation and monitoring; and (iv) evaluating, scaling and sustaining (described in Table 1, page 70, and below.)

• "Institutional systems - Institutional systems within the Ministry of Health that are essential to lead, co-ordinate and harmonise SBCC. Improved SBCC involves more than strengthening individual SBCC competencies, but must also have strong institutions to conduct SBCC programming. Systems that directly influence communication intervention planning were considered, namely: internal communication mechanisms; human resource systems (recruiting, supervising and supporting personnel and volunteers); and management information and reporting systems.
• Plan and design - SBCC competencies needed to effectively plan and design SBCC programmes. This includes conducting a situation analysis to guide/build a programme around evidence, setting priorities designing an appropriate communication approach to address the identified health or other social barriers to change.
• Implement and monitor - Best practices for implementing and monitoring SBCC programmes, including the development and use of programme implementation and monitoring plans, co-ordinating implementation with other SBCC programmes, supervision and mentoring and SBCC development plans.
• Evaluate, scale and sustain - SBCC competencies needed to evaluate SBCC programmes and to scale and sustain SBCC programme progress, including evaluating programmes, documenting and disseminating results and adapting and adjusting programming based on data for sustainability to scale up."

The individual result were scored on a scale of 1 - 4 and analysed at the national level and the district level. Results showed low national level scores with organisational capacity to evaluate, scale, and sustain being the lowest overall and in all sub-domains, while implementing and monitoring, and planning and design scored close to 2 each. Scores reflected a lack of research capacity, the absence of a training budget, lack of a strategic and a monitoring and evaluation plan, and a lack of organisational planning within the HES. At the district level, institutional priority scored the best while ‘evaluate, scale and sustain' scored poorly." A large proportion of districts had very little capacity in terms of developing a communication strategy and commissioning and conducting outcome evaluations. At this level, staffing, retention management was weak, despite institutional system capacity being relatively strong."

The article concludes that the HC4L capacity assessment tool established a baseline of HES capacity in SBCC by articulating and measuring the skill set required for SBCC at different levels, opening the way for establishing policies and interventions for SBCC health promotion.