designing for behavior change to increase access to health services in madagascar prepared by mr....
TRANSCRIPT
Designing for Behavior Change to Increase Access to Health Services in
Madagascar
Prepared by Mr. Elysée Ramamonjisoa and Ms. Linda Morales
Presented by Sabrina Eagan
Community-Based Integrated Health Program (CBIHP/MAHEFA)
4 November 2013
Context • Community-Based Integrated Health Program, also
known as MAHEFA, is a 5-year USAID-funded program in Madagascar
• Implemented by JSI Research & Training Institute, Inc and two international partners: The Manoff Group and Transaid and 19 Malagasy NGO partners
• North and west of the island (6 regions, 24 districts and 280 communes)
• MNCH/FP and water/sanitation• Roughly 20-25% of the Malagasy population or
about 3.5 million people2
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Context Context
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Context
• What are the most powerful barriers and motivators to behavior change in each region?
• Who are the key influencing groups per behavior?• What are the feasible actions for specific behaviors?• What materials already exist and are they appropriate for
our regions?• What channels exist and which are most effective in
reaching priority groups?
Behavior-Centered Programming: Key Questions
Data collection method: face-to-face qualitative and quantitative surveys (3000 individual interviews conducted)
The study universe: individuals named priority groups with specific characteristics relating to behavior15 behaviors studied (MNCH, WASH)Two regions covered: Menabe and Sofia
Results: Identification of major barriers and important motivators for each behavior
Steps for Behavior-Centered Programming:Formative research
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• Right/adequate formulation of the behavior to be promoted
• Priority group’s position on the BC scale (awareness, attempt) and identification of their groups of influence (e.g., spouse, MIL)
• Main barriers and key motivators
• Act on perceptions to minimize barriers and promote motivators
Research results Decisions based on research results
Behavior
Descriptio
n of priority
group and groups of influence
Determinants
Key factors guiding
activities
Activities for target priority group
Steps in Designing for Behavior Change:DBC Matrix
• Address and offer solutions to problems/ difficulties experienced by the priority group in practicing the behavior
• Help maintain beneficial health behaviors already practiced by the priority group
• Are high visibility to mobilize the community• Favor the promotion of community dialogue to find local
solutions to local problems8
Steps in Designing for Behavior Change:DBC Matrix
Behavior
Description of priority group and groups of influence
Determinants
Key factors guiding
activities
Activities for target priority group
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Behavior
Description of priority group and
groups of influence
Determinants
Key factors guiding
activities
Activities for target priority
group
Research results Decisions based on research results
Mothers of children under five treat their water every day, year round, and in all relevant locations
Mothers with children under five living in rural areas Low literacy level Poor families, needy Participate in women’s group meetings Want improved living conditions Positive influence group is husbands
Perceived self-efficacy barrier: lack of firewood
Improve the perception of mothers of children under 5 that the lack of firewood can be solved by using other methods of treatment (SODIS, Sûr'Eau)
CHW collaborates with the women’s group to organize a water treatment demonstration session where both SODIS and Sûr'Eau methods are shown
DBC Matrix
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Lessons Learned: Locally tailored approaches
• Implementation steps for locally tailored approaches are in the Guide & Solutions manual for CHWs
• Examples: • Care group: a family that has correctly adopted a
healthy behavior then help other families in the community to practice the behavior
• Carnival: high visibility activity to mobilize the community for important health events (campaigns, international health days
• Demonstration: an approach to demystify unfamiliar practices for healthy behaviors, e.g., treating water with Sûr’Eau
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Lessons Learned: Channels of Communication: CHWs
CHWs are trained on message transfer techniques and Behavior Change Empowerment approaches for interpersonal communication and group discussions
Lessons Learned:Tools to promote BC
Maternal and childhealth flip chartsdeveloped by previousprojects were updatedand adapted accordingto research findings,and disseminated tocommunity healthworkers.
Tool based on research results, with:- 17 approaches to reaching priority groups- Gender scenarios Approaches & scenarios are informed by:- Description of the main barriers to
practicing certain behaviors - Description of the motivators perceived by
those who practice the healthy behavior - How to direct the priority group on the
choice of actions to take - Proposed solutions for the priority group to
overcome barriers
Lessons Learned: Tools to promote BC CHW Guide and Solutions
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Lessons Learned: Channels of Communication: Radio
Mass communication through radio broadcasts and Village Listening Groups - Local radio stations broadcast
messages on health, WASH and gender
- Members of Listening Groups listen to the broadcasts and discuss issues raised, such as emergency transport or protection of water sources, to try to find solutions together
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This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of JSI Research &Training Institute, Inc. and do not necessarily reflect the views of USAID or the United States Government.
Thank you for your attention !
For more information, please contact [email protected]@[email protected]