This presentation was made possible by the American people through the U.S. Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project.

Building blocks of great

nutrition SBCC: innovating

while getting the basics rightAshley Aakesson, The Manoff Group

Lauren Bailey, JSI

Sascha Lamstein, JSI

Michael Manske, USAID

“Behavior matters—particularly in nutrition. We know what works. We have

to work together across uncommon allies . . . 45% of under-five mortalities

are related to nutrition. If we do the right things for survival, then we do the

right things for health. We can’t do these things without behavioral

change.”

—Katie Taylor, Deputy Child and Maternal

Survival Coordinator, USAID

Why Social and Behavior Change?

Why Social and Behavior Change?

The 2010 Global Burden of Disease report indicates that 5

of the top 20 health risk factors are predominantly

behavioral, and the other 5 are highly influenced by

behavior. (Lim et al., 2013)

USAID in its Multi-Sectoral Nutrition Strategy considers

SBCC strategies and approaches to be “essential for

increasing optimal nutrition practices, demand for services

and commodities, and ultimately, increasing utilization of

services.” (USAID 2014)

Behavior permeates global nutrition efforts (across sectors

and whether preventive or curative).

Thinking Beyond the Individual

1. Freestanding, personal or lifestyle

behaviors

2. Care-seeking behavior or demand

3. Client adherence and collaboration

4. Provider behavior

5. Pro-social and anti-social behavior

6. Policy and priority setting

Source: Shelton 2013. Global Health Science and Practice

Strengthen global and

country efforts to scale up

high impact nutrition

practices

Prevent stunting and anemia

in the first 1,000 days

Link agriculture and nutrition

under Feed the Future

About SPRING

Who we are What We Do

Enhance evidence for

promising SBCC delivery

strategies

Apply, document, share promising strategies

Implement SBCC activities in the Sahel

Build evidence and develop guidance

for systems thinking approaches

to nutrition

Build capacity for systems

thinking for nutrition

programming at scale

Engage with countries to

strengthen anemia

programming

Build evidence on

implementation and effective

scale-up of existing interventions

for anemia

Partner with the global community to inform

anemia prevention and control programs

Build evidence (operations research,

technical guidance documents,

tools)

Deliver technical assistance

scale

Share, learn, and build an

active community of

practitioners

Strengthening Systems for

Nutrition

Linking Agriculture & Nutrition

Preventing Anemia

Catalyzing Social and Behavior Change

Our Work

Evidence for SBCC: Why SBCC?

“SBCC is fundamental to improving nutrition. . . . We need to de-mystify

SBCC, and get lessons learned about success out there. We must push

people to take risks, and learn from it. We need to inspire people and be

creative.”

—Ellen Piwoz, Senior

Program Officer, Bill and

Melinda Gates Foundation

SBCC is Crucial for Nutrition;

Nutrition is Crucial for Development Nutrition has gained importance for the development agenda,

in large part due to the Lancet Nutrition Series 2008 and

2013 which documented the scope of malnutrition and the

evidence base for effective interventions.

Scaling Up Nutrition has estimated that malnutrition costs

some countries up to 3% of their GDP per year.

Recent evidence has supported the crucial role of SBCC as a

fundamental strategy for most nutrition-specific and nutrition-

sensitive interventions.

WHO, Maternal and Child Nutrition Study Group, 2013

Alive &Thrive special issue of the Food and Nutrition Bulletin, 2013

Journal of Health Communication, 2014

Core Elements of SBCC

Social Change to achieve shifts in the definition of

an issue, people’s participation and engagement,

policies, and gender norms and relations

Behavior Change through efforts to make specific

health actions easier, feasible, and closer to an

ideal that will protect or improve health outcomes

Communication using channels and themes that fit

a target audience’s needs and preferences

Adapted from: The Manoff Group. See: http://manoffgroup.com/documents/DefiningSBCC.pdf

Evidence for Nutrition

SBCCEvidence of the effectiveness of SBCC approaches in

improving breastfeeding practices is strong and broad

and supports the claim that SBCC approaches can and

do succeed in improving uptake of the behaviors

promoted.

There is extensive evidence for positive impact of SBCC

on improving infant feeding practices.

There is little experience or evidence regarding the

priority nutrition practices for adolescent girls and

other WRA and how to effectively promote them.

Evidence for Nutrition

SBCC (cont.)There is evidence of effectiveness for a wide variety of

delivery strategies including: interpersonal

communication, community mobilization, social

marketing; and to a lesser extent, mass-media

campaigns, and environmental nudges.

One-on-one or small group communication is the

approach most consistently and effectively used, with

the most published evidence supporting it.

There is emerging evidence that mass media can be

cost effective in creating individual behavior change.

Evidence for Nutrition

SBCC (cont.)Mutually reinforcing interventions through multiple

delivery strategies, channels, and points of contact

improves effectiveness of SBCC.

The CORE Group and TOPS Project analyzed project

data and found that projects using any SBCC approach

had better outcomes than those not using SBCC.

Continued recognition of the importance of social and

structural/environmental change to support individual

behavior change. Mass media and advocacy for

enabling policies and structural investments play a role

in bringing about those changes.

What We Need…

Evidence of the optimal combinations of

approaches, channels, and target audiences

More complete and comparable documentation of

“the black box of design”

Indicators which are standardized, endorsed by

WHO, and widely used, to measure nutrition-related

behaviors and SBCC processes

Best approaches and tools for bringing about and

measuring social change

Maternal, infant, and young child nutrition care practices

Initiate BF early

Introduce CF at 6 months

BF on demand

Feed with appropriate frequency

Eat a diverse diet

Eat adequate quantity of food

Continue BFfor 2 years

Exclusive BF for 6 months

Sleep undertreated bednet

Take de-worming medication

Take iron / IFA supplement

Eat Vitamin A supplement / fortified

foods

Use alatrine

Wash hands at critical moments

Properly store/treat water

Feed a diverse diet

Takeprotein/energy supplements

Feedactively /

responsivelyFeed appropriately

during/after sickness

Improved nutritional status during the first 1000 days

Dietary practices during pregnancy and lactation

Complementaryfeeding (CF)

Control and prevention of anemia WASHBreastfeeding (BF)

practices

Use multiple micronutrient powder

Take malariaprophylaxis

Properlydispose of

feces

Eat iron-rich/ fortified foods

Properly store/prepare food

www.spring-nutrition.org/publications/briefs/sbcc-pathways-improved-maternal-infant-and-young-child-nutrition-practiceswww.spring-nutrition.org/publications/series/evidence-effective-approaches-social-and-behavior-change-communication

Improved nutritional status

Government, business, NGO, and faith leaders

Community leaders and service providers

Families, partners, and peers

Individuals / caregivers

Community / social mobilization

(campaigns, community events)

Advocacy(raising resources and political/social

leadership commitment)

Behavior change communication

(IPC, small media, and mass media)

Non-Communication Strategies (policy change, systems strengthening)

Diet during

pregnancy

and lactation

Complementary

feeding

Control and

prevention of

anemia

WASHBreastfeeding

De

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Demand Environment Supply

Ability to act

(skills and efficacy, agency, and control

of resources)

Enabling systems and policies

Awareness,knowledge, and understanding

Availabilityof health

services and food

Qualityof health

services and food

Social norms and role models

Motivation, attitudes, convictions,

perception, and beliefs

Un

de

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ng

ca

use

s

Ca

tego

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s

of

ca

re

pra

cti

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Food security Access to quality health services and environment

Care Practices

Dietary intake Health status (disease)

Building Blocks for Great

Nutrition SBCC

Taxonomy of Behaviors

Stages of Change Model

Drivers of Behavior

Drivers of behavior can be conscious or

unconscious, internal or external, physical or social,

and at multiple systemic levels

The World Bank’s recent Mind, Society, and

Behavior report highlights cognitive drivers

Humans think automatically

Humans think socially

Humans use mental models

Good design makes the optimal behavior easy and

desirable, and sometime the default

Choice architecture and cues for action approaches

Choice

Architecture

Great design makes it easy

and fun to do the optimal

behavior. "Flies" in urinals

improve, well, aim. When

Amsterdam's Schiphol

Airport was faced with the

not uncommon issue of

dirty urinals, they chose a

unique solution: by painting

"flies" in the (center of)

commodes, men obligingly

aimed at the insects,

reducing spillage by 80

percent.Source: Slideshare presentation by Lola Sanchez

Brainstorming Key Design

Elements

Strategic Agenda for Great

Nutrition SBCCPromote SCALE-FOCUSED nutrition SBCC

Drive EXCELLENCE in design and implementation

Engage WORLD-CLASS people and partners

Build on the EXISTING EVIDENCE BASE for SBCC’s

impact on nutrition

Persuade decision-makers that SBCC IS CRITICAL for

tackling malnutrition

Innovation at SPRING

(round tables)

Community generated, human mediated

digital media

Applying SBC basics to nutrition-sensitive

agriculture design

Avoiding “faith-based scaling” through

evaluation

Resources• Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk

assessment of burden of disease and injury attributable to 67 risk factors and risk factor

clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of

Disease Study 2010. Lancet. 2012;380(9859):2224–2260.

• USAID.2014. Multi-Sectoral Nutrition Strategy 2014-2025. Washington D.C.

http://www.usaid.gov/sites/default/files/documents/1867/USAID_Nutrition_Strategy_5-

09_508.pdf

• Shelton JD. The 6 domains of behavior change: the missing health system building block.

Glob Health Science and Practice 2013;1(2):137-140. http://dx.doi.org/10.9745/GHSP-

D-13-00083.

• http://www.thelancet.com/series/maternal-and-child-undernutrition

• http://www.thelancet.com/series/maternal-and-child-nutrition

• http://scalingupnutrition.org/about/why-nutrition

• Alive &Thrive special issue of the Food and Nutrition Bulletin, Food & Nutrition

Bulletin, 34:3 (Supplement), 2013

• Population-Level Behavior Change to Enhance Child Survival and Development in Low-

and Middle-Income Countries: a Review of the Evidence. Journal of Health

Communication 19:1, 2014.

• World Bank. 2015. World Development Report 2015: Mind, Society, and Behavior.

Washington, DC. http://www.worldbank.org/en/publication/wdr2015

Thank you!For more information on SPRING, visit:

www.spring-nutrition.org