SBC: Social and behavior change

IMA World Health leads the five-year, USAID-funded MOMENTUM Integrated Health Resilience program, which is part of a suite of innovative MOMENTUM awards designed to holistically strengthen quality voluntary family planning, reproductive health, and maternal, newborn, and child health in host countries around the world. Working alongside local organizations, governments, and humanitarian and development partners in fragile settings, the project helps accelerate reductions in maternal, newborn, and child illness and death by increasing the capacity of host country institutions—at the national and subnational levels—to strengthen health systems, adapt evidence-based polices, guidelines and practices to their specific contexts, collect and utilize data to inform interventions, and increase partnerships between various public and private stakeholders to disseminate learning, leverage resources and scale efforts to achieve better outcomes. IMA's SBC approach is interwoven throughout the activities with the team producing a roadmap based on their experience and learnings for how to utilize SBC to improve demand for and use of quality health services in fragile settings. 

Through the FCDO-funded ASTUTE program, IMA strengthened the capacity of local government authorities to address child stunting, achieving between 7-12% stunting reduction across five regions of the Lake Zone: Kagera, Kigoma, Mwanza, Geita and Shinyanga. The project trained nearly 7,800 district health workers and non-health sector service providers and reached 17.6 million nationally through mass media campaign. Additionally, 6.4 million mothers, caregivers and decision-makers benefited with improved child-feeding information through home visits conducted by 6,000 community health workers. As part of the project, IMA created a toolkit to provide government and local organizations with programming recommendations and tools to help implement successful multisectoral SBC interventions aimed at preventing and reducing stunting.

As a part of the Corus International family of organizations, IMA assisted our fellow Corus organization Lutheran World Relief with SBC activities for their USDA Food for Progress SESAME Project during the COVID-19 pandemic. The goal of the overall project was to increase the quality and volume of sesame exports through climate-smart agriculture and market systems strengthening in the regions of Boucle du Mouhoun, Est, Cascade and Hauts Bassins in Burkina Faso. Through the project’s existing agricultural extension online platform, IMA and LWR provided up-to-date information about pandemic-related impacts on agriculture and provided more than 5,000 farmers with information to protect their health and livelihoods. The platform not only provided standard COVID information but gave farmers specific information such as locations and times in their districts or regions where they could sell produce or purchase inputs while limiting exposure to COVID. 

Funded by USAID, the C-GBV project (known in Swahili as "Tushinde Ujeuri") supported communities in eastern DRC to prevent and respond to GBV with the goal of reducing violence, combatting stigma and improving holistic care for survivors. Building on the highly successful USAID-funded Ushindi program implemented by IMA (2010-2017), the C-GBV project provided urgent medical care, psychosocial counseling, legal support, and socioeconomic support (access to village savings and loan associations, literacy circles, and women’s empowerment groups) to help survivors gain financial independence and social support. To create change at the community level, the project’s SBC strategy used a peer group approach and engaged local leaders, working largely through schools. IMA helped establish 194 youth clubs to educate adolescents (ages 10-19) on gender equality, positive masculinity, children’s rights, and sexual and reproductive health, Using an evidence-based curriculum tailored to the DRC context, the clubs reinforced awareness and offered specific information to increase protection for women and girls. These youth clubs covered topics such as the impact of GBV on families and the community and the risks of early marriage. Similarly, in Ushindi, IMA supported the formation of over 400 “noyaux communautaires,” or Community Core Groups, involving 20-30 voluntary local leaders, faith leaders, and village chiefs in educating their communities and promoting discussions on gender and positive masculinity.

Afya Jijini, which translates to “health in the city,” was a three-year USAID contract (with two option years) with the strategic goal of improving Nairobi City County’s (NCC) institutional and management capacity to deliver health services. The program improved access to and use of maternal, neonatal and child health services; family planning and reproductive health services; water, sanitation and hygiene (WASH); and nutrition services. The program also helped the government roll out newly revised Integrated Management of Childhood Illness (IMCI) guidelines and improve the coverage and reporting on childhood immunization in Nairobi County. When the COVID-19 pandemic hit Kenya, the project provided technical assistance to the Nairobi Metropolitan Services (NMS) to develop its RCCE strategy and interventions. The project tapped a cohort of 500 previously trained and trusted Community Health Volunteers (CHVs) to serve as the frontline for COVID-19 SBC messaging and contact tracing efforts. These volunteers, who had been engaged previously for MNCH, FP, and HIV messaging, pivoted to provide evidence-based messaging on COVID-19 prevention at the individual, household, and community level; how to cope with the pandemic and lockdowns; and allaying common fears, such as the widespread belief that patients often contracted COVID-19 by visiting health facilities. CHVs were also trained to conduct contact tracing and support home-based isolation and care for clients who could safely be managed at home rather than in isolation centers. Project coaching focused on improving rapport with clients to help identify infected patients who may be afraid to share their information as well as helping households understand when patients may require facility-based care. 

During eight years of implementation, ASSP and its follow-on project ASSR improved the health of women, adolescents and children through support for disease prevention, delivery of health care and health systems strengthening. With funding from the UK’s Foreign, Commonwealth & Development Office (FCDO), the projects supported an estimated 9.7 million people across 52 health zones in five provinces, strengthening the health system by focusing on priority interventions such as the treatment of malaria, pneumonia and diarrhea; nutrition; obstetric and neonatal care; family planning; immunization; and water, sanitation and hygiene (WASH). IMA introduced effective people-centered best practices to ensure community engagement in the continuity of quality primary health care, such as community scorecards and community health committees. The latter were used to 1) promote social inclusion; 2) engage communities in facility management; and 3) ensure women, youth, and people with disabilities have a voice in health service delivery. These activities fostered social accountability, the two-way flow of information and trust between communities and the health system. The health facilities utilizing scorecards found they helped improve gender mainstreaming in community health committees, led to better coordination of health and nutrition services, and resulted in increased immunization rates as well as decreased malnutrition rates and malaria cases.