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 eramamonjisoa@mahefa.mglmorales@mahefa.mgseagan@jsi.com