module 3 unit 2 - andrew carlsonprofessorcarlson.net/c4dcourse/module_3/m3_unit2/m... · module 3...

Module 3 Unit 2This is a OPTIONAL READING.

Sood, S. and Cronin, C. (2014). Behavioural Monitoring Plan. In Celebrating Everyday Heroes in Nepal: A Comprehensive C4D Strategy. pp. 70-95. Please read pages 73-76 on behavioural indicators and refer to pages 80-90 for a detailed discussion of participatory behavioral monitoring tools.

CELEBRATING EVERYDAY HEROES IN NEPAL

A Comprehensive Communication for Development Strategy

COMMISSIONED TO RAIN BARREL COMMUNICATIONS, LLC BY UNICEF NEPAL

JUNE 2014


70

SECTION 3. BEHAVIOURAL MONITORING PLAN

LEAD AUTHORS: SURUCHI SOOD, ASSOCIATE PROFESSOR AND CARMEN CRONIN, MPH

Department of Community Health and Prevention Drexel University School of Public Health

Nesbitt Hall 3215 Market Street,

Philadelphia, PA 19104


71

Chapter 4 – Behavioural Monitoring Plan 5.1 Monitoring Framework In the context of C4D, the critical and most direct question is how C4D specifically contributes to intermediate outcomes at the individual, family and community levels to create an overal l environment of change, as well as the extent to which these behaviours are practiced. In so far as these intermediate outcomes are considered vital to promoting behaviour and social change, such change can be indirectly attributed to the Everyday Heroes C4D strategy. Evidence-based programme design and implementation requires concurrent monitoring and evaluation. Formative research including both literature reviews of existing information and primary research among communities of interest is critical to design of programmes. The extent to which programmes are implemented according to plan (outputs) and generate the short and medium term outcomes can be measured and validated through the establishment of monitoring systems to accompany implementation processes. Impact assessment utilizing a robust research design allows for individual and social changes to be tracked and linked back to programme modalities, which in turn allows for the measurement of programme effectiveness. Historically, most monitoring processes for C4D programmes are linked only to activities conducted and outputs from those activities (for example, number of materials produced). It is relatively rare for monitoring systems to be established upfront in conjunction with a C4D strategy and to serve as a mechanism to measure changes over time, which can then be attributed to C4D. Behavioural monitoring is an innovative alternative with several unique strengths: • It allows for the tracking of behaviours among all the intended audiences or stakeholders through

proxy indicators, thereby measuring the efficacy of C4D programmes. • It is participatory in nature and thus serves as a tool for empowering children, adolescents and

adults. • Repeated and continuous monitoring is embedded in programme implementation, allowing for

change to be measured over time. • Participatory behavioural monitoring, while answering the “how” questions, also provides a

mechanism for identifying needed improvements in programme design and implementation to form a strong programmatic feedback loop.

In summary, participatory behavioural monitoring allows measurement of programme implementation, enables us to determine programme outcomes more directly attributable to the intervention, and specifically captures the processes by which these outcomes are achieved. The C4D strategy covers a vast array of issues across the three focus areas. As it is not possible to monitor everything at once, it is important to consider ways to consolidate the information that should be monitored. Therefore, a layered approach has been devised in consultation with the Nepal Country Office. This approach primarily addresses a first phase of monitoring, which can serve as the basis for additional bursts of targeted monitoring through feedback from the findings from use of these tools. As a f irst step, al l the behavioural results included in the behaviour matrix 63 have been reworded from a purely measurement perspective. Where feasible, behaviours have been reworded using the latest measurements in the DHS and MICS. For example, the behavioural result for “Mothers are assisted by SBA during delivery” has been converted to a more specific format: “During delivery, mothers will receive assistance from a SBA.” In order to facilitate the operationalization of these results, it is important to track the current trends in these behaviours as available through existing

63 See Table 1


72

sources such as the DHS and MICS64. Concurrently, it is vital to review and revise the potential for change based on the extent to which continued policy or programmatic attention will have a direct bearing on this behaviour. When and where results are not available through existing DHS and MICS mechanisms, the need for project level baselines becomes imperative. For example, one of the essential pregnancy care behaviours refers to nutrition. This behavioural result has been operationalized as: “Once a woman knows she is pregnant, she will increase her food intake to include three meals and one animal source food.” Since maternal nutrition is not covered in the DHS or MICS, a project baseline should be established to measure the potential for change. In addition, the cultural connotations associated with measuring this behavioural result need to be considered. For instance, it is important to determine how many meals pregnant women in impoverished communities are eating to begin with, and to consider the relevance of including an “animal protein” for women who for cultural or religious reasons might not eat meat. The second level of indicators to be monitored consists of the guiding principles and crosscutt ing dimensions of the Everyday Heroes strategy. These crosscutt ing dimensions include: inclusion and equity, part ic ipation, social norms and empowerment (eff icacy). While these are not “behavioural results” in the str ictest sense of the term, they are intermediate outcomes that cut across the three prior ity focus areas and serve as a means to promote equitable and empowering social change outcomes. These outcomes are inherent to both the overal l UNICEF Nepal Country Programme and the overarching Everyday Heroes C4D strategy. For example, in order to promote changes associated with the six umbrel la behaviours under the three focus areas of ODF, 1000 days and violence against chi ldren, individual, social and cultural barr iers and motivators associated with these areas must be addressed. In the presence of resource constraints, two simple techniques have been outlined to help with the selection of viable indicators for measuring the behavioural results and outcomes. The f irst cr iter ion focuses on “high investment” i tems65 needed to operational ize the behavioural results , i.e., those upon which the Nepal Country Programme and the C4D Strategy will focus most attention.

5.2 Behavioural Indicators This section presents the behavioural results and indicators to be addressed in Phase 1. The Everyday Heroes C4D strategy provides guidelines for subsequent implementation of Phases 2 and 3. The monitoring to accompany these phases can only be developed when the specific communication approaches and modalities for achieving the components of Phases 2 and 3 have been clearly outlined. As such, this specific behavioural monitoring plan consists of the first burst of monitoring, with subsequent monitoring plans to be developed over time.

64 According to the DHS the percentage of pregnant women receiving assistance from an SBA during delivery is as follows: 48.5 per cent (DHS 2001); 43.7 per cent (DHS 2006); and 58.3 per cent (DHS 2011). Assuming this secular trend continues, we can expect a five per cent increase over time. 65 The Everyday Heroes C4D strategy has outlined the following high investment components. Component # 1 Role Models as Everyday Heroes Component # 2: Children for Change: Community Mapping Component # 3: Men for Equality Component #4: Participatory content creation for entertainment-education


73

5.3 Indicators Indicators are what allow us to actually measure the behavioural results. They provide simple and reliable means of measuring change and therefore are critically important. One can also think of indicators as behavioural results re-written using measureable terms. For monitoring purposes, indicators are not used to evaluate the final outcome or impact of interventions. Instead, indicators act as “progress markers” (UNICEF, 2006). They help us determine whether behaviour and social change is taking place, as well as the directionality of the change. It is this information that will tell us whether or not we are on track towards achieving our programme objectives.

Essential pregnancy care There are four essential pregnancy care behavioural results; these focus on maternal nutrition, antenatal care visits and joint counselling, delivery with a SBA, and treating pregnancy as a special time (see Table 5 below). Maternal nutrition will be measured using the Household Dietary Diversity Score. Information on the types of food women eat will be elicited from “draw and describe” activities. Health facility records will provide data on antenatal care visits, joint visits, and deliveries with an SBA. Pregnancy as a special time will be measured using household observations and operationalized as: helping with household chores (carrying water, fodder, and firewood), eating meals together, and spousal communication. Table 5: Behavioural results and indicators for essential pregnancy care

Practice essential pregnancy care Behavioural results Indicator

Pregnant women eat three meals a day including an animal source

# Of foods or food groups consumed within a specified period of time66

________________________________ # Of pregnant women in a community

Once a women knows she is pregnant, she will make/receive 4 ANC visits from a skilled provider

# Of women who completed 4 ANC visits

____________________________________ # Of pregnant women in the community

During delivery, mothers will receive assistance from a SBA # Of women who received assistance from an SBA during delivery

___________________________________ # Of women who had a live birth in a community

Primary caregivers will treat pregnancy as a special time67 # Households treating pregnancy as a special time

__________________________________ # Households with a pregnant woman in a community

Essential newborn care There are two behavioural results related to essential newborn care: birth registration and delayed newborn bathing (See Table 6 below). VDC records will provide data on the number of registered births while health facility records will reveal the number of births in a community. Information on newborn bathing can be gleaned from Oral Histories of birth experiences. 66 This time frame could encompass an 8 – 12 hour period or focus on a specific meal. 67 Pregnancy as a special time is being operationalized as: helping with household chores (carrying water, fodder, and firewood), eating meals together, and spousal communication.


74

Table 6: Behavioural results and indicators for essential newborn care

Practice essential newborn care

Behavioural results Indicator Within 35 days of birth, parents will register their child at the VDC # Of registered births in a community

___________________________________ Total # of live births in a community

Caregivers delay newborn bathing for 24 hours after birth # Of newborns not bathed within 24 hours Total # of live births in the community

Essential post-natal care Three essential post-natal care behaviours have been identified for Phase 1 (See Table 7 below). Post-natal care visits will be ascertained from both health facility records and the Oral Histories. The post-partum period as a special time and maternal nutrition will be measured and operationalized as it was for essential pregnancy care. Table 7: Behavioural results and indicators for essential postnatal care

Practice essential post natal care Behavioural results Indicator

Within 24 hours of delivery, mothers will complete their first PNC visit with a skilled provider

# Of mothers who completed first PNC visit within 24 hours of delivery

____________________________________ Total # of women who gave birth in the community

Primary caregivers will treat the post partum period as a special time68

# Household treating the post partum period as a special time

__________________________________ Total # households with a woman who gave birth in a

community Lactating mothers eat one additional meal a day

# Of foods or food groups consumed within a specified

period of time4 ____________________________________

Total # of women with a child under 2 years in a community

Adequate infant and young child feeding practices There are three behavioural results regarding infant and young feeding practices: exclusive breastfeeding and dietary diversity (frequency of meals and diversity of foods eaten) for children between 6-23 months (See Table 8 below). Exclusive breastfeeding will be monitored using mother self-reports. Young child dietary diversity will be measured using the Individual Dietary Diversity Score. Again, information on foods consumed by children 6-23 months will be elicited using “draw and describe” activities with mothers.

68 The post-partum period as a special time and maternal nutrition will be measured and operationalized the same way as it will be for essential pregnancy care.


75

Table 8. Behavioural results and indicators for adequate infant and young chi ld feeding

Essential hygiene The six essential hygiene behavioural results focus on handwashing at critical times and toilet use at home and school (See Table 9 below). The number of household and school toilets and handwashing stations will be obtained from community mapping activities. Toilet use and correct handwashing practices will be assessed using household and school observations. Table 9. Behavioural results and indicators for essential hygiene

Practice essential hygiene Behavioural results Indicator

At every critical time, caregivers of under-five children will practice handwashing with soap and water

# Of households with under-five children practicing correct handwashing

_____________________________________ Total # of households with under-five children in a

community

Households use toilets for defecation

# Of households using toilets for defecation ___________________________________

Total # of households in a community Children will practice correct handwashing with soap

and water at critical times at home

# Of children practicing correct handwashing at home _____________________________________

# Of children in a household with a handwashing station

Children will practice correct handwashing with soap and water at critical times at school

# Of children practicing correct handwashing at school ____________________________________

# Of children attending a school with handwashing stations

Children use toilets in their homes for defecation # Of children using toilets at home ________________________________________

# Of children living households with toilets

Children use toilets in their schools for defecation # Of children using toilets at school Total # of children attending schools with toilets

Protection and secondary education for al l children Five behavioural results address protection and secondary education for all children (See Table 10). They include child marriage prevention, disclosure of incidents of corporal punishment, regular school attendance, sharing information on harmful social norms, and exploring livelihood options. VDC records can provide data on the number of children under 18 in a community and the number of secondary school-aged children in a community. The number of adolescents enrolled in life skills programs can be obtained through programme records. School attendance records will be consulted to ascertain the

Practice adequate infant and young chi ld feeding Behavioural results Indicator

For the first six months, mothers will breastfeed exclusively with no water

# Of mothers exclusively breastfeeding for the first six months

____________________________________ Total # of women who gave birth in the community

Children 6-23 months consume the minimum number of meals a day according to IYCF standards

# Of foods or food groups consumed within a specified period of time4

_____________________________________ Total # of households with children 6-23 months in a

community


76

number of adolescents attending school regularly. (Regular attendance is operationalized as attending school 80 per cent of the time, in other words attending 176 days of school). The Ask 5 activity will validate school attendance records. Table 10. Behavioural results and indicators for protection and secondary education

Ensure protection and secondary education for al l chi ldren Behavioural results Indicator

Primary caregivers will not arrange marriages of children under 18

# Of children under 18 in the community who aren’t

married _____________________________________

Total # of children under 18 in the community

Children disclose incidents of corporal punishment when they occur

# Of children disclosing incidents of corporal punishment

___________________________________ Total # of children in the community

Adolescents attend secondary school regularly

# Of secondary school age children regularly attending school

____________________________________ # Of secondary school age children in a community

Adolescents do not get married before the age of 18 # Of girls 15-19 who are married in the community ____________________________________

# Of girls 15-19 in the community Adolescents share their learning on 4 issues (child

marriage, gender-based violence, chhaupadi, and dowry) with their peers, families and communities

# Of adolescents who shared learning on 4 issues within their networks

___________________________________ Total # of adolescents in life skills programme

Adolescents explore different options for livelihood based on their skills and market demand

# Of adolescents who applied for jobs ___________________________________ Total # of adolescents in the community

5.4 Behavioural Monitoring Tools The participatory behavioural monitoring tools being proposed to monitor the behavioural results through the indicators mentioned earlier are summarized here. In addition, linkages between the overall Everyday Heroes C4D strategy and this behavioural monitoring plan are explained vis à vis information on the tools as they link with the:

a) Overall guiding principles/crosscutting dimensions of the Everyday Heroes Strategy b) Six umbrella behavioural results across the three focus areas c) High investment components

This is followed by detailed descriptions of the tools, including the purpose of the tools and background information on them. Examples of how the technique has been used in the Nepali context and around the world are also provided. Detailed methodologies with information on “how-to” implement the tools are attached as an annex.


77

Behavioural Monitoring Tools Table 11. Key tools proposed and overal l objectives these tools serve Method Objectives Transect Walk/Community Mapping

Transect Walks and community mapping activities are ways to identify problems and start a dialogue that can lead to social change. Walking lets you observe what natural resources and community assets are available and understand the social impact of the location and accessibility of those resources.

Word Associations/Free-listing

Word associations and free-listing activities are simple methods of gaining insight into local terminology, feelings, and beliefs about concepts or phenomena. These activities can uncover what terms like positive discipline, inclusion, participation, and empowerment mean to Nepalis and what terms they associate with such concepts.

Draw & Describe Draw and Describe uses visuals to understand how participants perceive and experience the world. This activity is an example of plate mapping and will be used to assess the foods that pregnant and lactating women consume, as well as the meals their children (under two years of age) eat.

Social Network Mapping Social network mapping allows us to understand how individuals are connected and can also be used to figure out how information flows through social networks. It is a way of diagramming who talks to whom and about what. With this activity, adolescents will create maps showing whom they talk to about harmful social norms – specifically, child marriage and dowry, chhaupadi, and corporal punishment.

Oral Histories Oral Histories are in-depth biographical interviews about past events or experiences. For this project, Oral Histories will be used to capture experiences around childbirth and the events that transpire during the first 24 hours after birth. The collection of multiple caregiver perspectives (mother, father, siblings, grandparents) will help create a rich, granular account of the event. They will yield important information regarding early initiation of breastfeeding, newborn bathing, and postnatal care visits.

Direct Observations Observations let us to see what people are actually doing and what their surroundings look like. Directly observing key behaviours is critical for generating data that may not be available in existing records and to validate self reported data both at the household level, as well as in schools.

Facility Surveys Facility surveys will yield insight into the quality of care that pregnant women receive at the health facility. Such surveys consist of three parts: 1) Collecting data from health facility records 2) Interviewing the health worker; and 3) Conducting a satisfaction survey with clients

Ask 5 Activity This activity is designed to validate whether or not adolescents are attending school regularly, to provide a robust estimate of regular school attendance rather than tracking school records.

Photovoice Photovoice is a technique whereby participants are given cameras to capture scenes of their world. Photographs can help us determine if programmes are achieving their stated objectives. Photovoice can be used to monitor adolescents taking social action to address harmful social norms. It can also be leveraged to highlight and celebrate the stories of organizations and institutions that are Everyday Heroes.


78

Most Significant Change Stories

These stories give participants an opportunity to reflect upon their involvement in an intervention and any changes they identify with or feel have had a significant impact on their lives and that of their family, peers, and community.

Village-level Case Studies (with Public Declarations)

These studies will highlight examples of how an environment of change is created and visualized within a village. The goal is to obtain examples of change (both positive and negative) from many different individuals. This activity is linked with public declarations, which are visible markers that social norms are shifting and allow for the documentation of how communities are working towards social change.

Linking behavioural monitoring tools with the guiding principles and crosscutting dimensions of the C4D strategy The Everyday Heroes C4D strategy has outlined a set of guiding principles and crosscutting dimensions as a means to promote equitable and empowering social change outcomes. The behavioural monitoring plan operationalizes these dimensions to understand what these concepts mean in Nepal and what terms they are associated with, by undertaking a Word Associations/Free listing activity. For the purposes of the phase 1 Everyday Heroes strategy, these two techniques will be combined into one tool to understand the local significance of terms like positive discipline, inclusion, participation, and empowerment. Additional rounds of behavioural monitoring will need to be devised at future points in time to further understand individual and social changes associated with these concepts. The current behavioural monitoring plan operationalizes the guiding principles and cross cutting dimensions in several ways. For example: (1) Inclusion and Equity Focus. The behavioural monitoring plan furthers the inclusion and equity agenda proposed by the Everyday Heroes strategy by ensuring that the voices of marginalized and vulnerable populations are reflected in the Transect Walkand community mapping activities. Further, specific attention will be paid to underserved populations when conducting household and school-based observations, as well as through the Ask 5 activity to track school attendance. The Photovoice, Most Significant Change, Social Network Mapping, and the Draw and Describe activities all utilize visual and narrative forms of expression to recognize and give voice to those who are often overlooked or excluded. Oral Histories and village-level Case Studies will strive to collect multiple perspectives so that richer and more complete stories can be told in order to inspire social change. (2) Part ic ipation. The behavioural monitoring plan is grounded in principles of participation by involving children and adolescents across all elements of the plan – in the design of the tools, data collection, analysis, and reporting. In addition, the principle of participation is inherent in having communities define and describe their local conceptualizations of key issues such as positive discipline through the Word Association/Free-listing tools. All tools have been created to include discussion and dialogue among groups (especially Child Clubs) to further understanding and responsiveness to locally generated solutions. The behavioural monitoring plan is unique in that it promotes participation, discussion, and dialogue among individuals with diverse backgrounds and characteristics (e.g., gender, age, ethnicity, caste, religion, socioeconomic status, and disability). Transect Walks and Community Mapping, Oral Histories, and Facilities Surveys require participants to interact with different groups of individuals. In so doing, these activities facilitate richer discussions and have the potential to increase community cohesion.

(3) Social norms. Social norms exist when behaviours are practiced across a community or social system by almost everybody. The Everyday Heroes communication strategy will build on positive social norms that exist in all communities, while encouraging communities to abandon harmful social norms (e.g., chhaupadi and child marriage) through deliberations and declarations, in order to create and foster


79

new, positive social norms. The behavioural monitoring plan focuses on social norms through Social Network Mapping and by tracking public declarations, which are visible markers of shifting norms. (4) Empowerment. Similar to the underlying focus on participation in all the behavioural monitoring tools, every one of the tools is also designed to be inherently empowering. By allowing participants to become more aware of their situation and conditions, and by raising the level of discussion and dialogue on these conditions, the behavioural monitoring tools attempt to create an enabling environment. The extent to which such environments are created will be tracked through tools such as Photovoice, Most Significant Change stories, and village-level Case Studies (with public declarations). Moreover, training community members on how to carry out the behavioural monitoring activities builds their capacity to assess issues, collect, analyse and interpret data, and generate solutions. Such training has the potential to sustain programme effects beyond the project timeframe and even the potential to be applied to issues beyond the scope of the Everyday Heroes strategy.

Linking behavioural monitoring tools with the umbrella behavioural results in the Everyday Heroes C4D strategy The Everyday Heroes C4D strategy presents six umbrella behavioural results that have been identified for three levels of participants across the three focus areas. The behavioural monitoring tools presented in this plan link with these umbrella behaviours, as summarized below (Table 12). Table 12. Linking behavioural monitoring tools with the umbrel la behavioural results

Method Key Behavioural Results

Essential

pregnancy care

Practice essential newborn

care

Practice essential post natal

care

Practice adequate infant and young child

feeding

Practice essential hygiene

Ensure protection and

secondary education for all children

Transect Walk Community

Mapping ✔ ✔ ✔ ✔ ✔ ✔

Word Associations Free-listing

✔

Draw & Describe ✔ ✔ ✔ Social Network

Mapping ✔

Oral Histories ✔ ✔ ✔ Direct

Observations ✔ ✔ ✔ ✔ ✔

Facility Surveys ✔

Ask 5 Activity ✔

Photovoice ✔ ✔ ✔ ✔ ✔ ✔ Most Significant Change Stories ✔ ✔ ✔ ✔ ✔ ✔

Village-level Case Studies (with Public

Declarations)

✔ ✔ ✔ ✔


80

The following section details how each of the tools or techniques is relevant to the behavioural monitoring plan and provides specific examples of what behavioural results can be monitored.

Linking behavioural monitoring tools with the “high investment components” of the Everyday Heroes C4D strategy

The behavioural monitoring tools have been developed keeping the four high investment components of the C4D strategy in mind. The tools that specifically apply to the high investment components are highlighted in Table 13 below. Table 13. Linking behavioural monitoring tools with the "high investment" components High Investment Component

Links with the Behavioural Monitoring Plan

Component # 1 Role Models as Everyday Heroes

The operationalization of role models as Everyday Heroes will happen through a number of behavioural monitoring tools, specifically the Photovoice, most signif icant change stories and vi l lage level case studies at the community and organizational/institutional levels

Component # 2: Children for Change: Community Mapping

The Transect Walks and community mapping activity serves as the starting point for the entire behavioural monitoring plan and establishes young people as change agents

Component # 3: Men for Equality

The Transect Walks and Community Mapping activity, the Direct Observations at home and school, the Ask 5 activ ity , the Word Associat ions/free- l ist ing, the Draw and Describe, and the Faci l i ty Surveys will help uncover gender roles and dynamics in Nepali society. Change in gender norms will be tracked through Photovoice, Most Signif icant Change stories and vi l lage level Case Studies that spotl ight examples of boys and men who champion and practice gender equality .

Component #4: Participatory content creation for entertainment education

Word Associat ions/free- l ist ing will provide appropriate Nepali conceptualizations of critical issues. The Transect Walks and Community Mapping, Social Network Mapping, Draw and Describe, Oral Histories, Direct Observations and Faci l i ty Surveys, will generate information on ground realities. Photovoice, Most Signif icant Change stories and vi l lage level Case Studies will directly facilitate user-generated content for communication materials.

5.5 Behavioural Monitoring Tools The behavioural monitoring plan places a major emphasis on using a combination of visual, textual, and numeric techniques to track behaviours69. Visual and narrative techniques are especially powerful and 69 As noted above, one of the unique elements of behavioural monitoring is that repeated and continuous monitoring is embedded in programme implementation. Given this link between implementation and monitoring, we have (with the exception of conducting “observations”) not provided information on issues of informed consent and human subject research protocols, especially as they pertain to conducting and generating generalizable data from children and adolescents. According to U.S. Federal regulations, research is a: "a systematic investigation... designed to develop or contribute to generalizable knowledge." Further, a human research subject is considered to be a living individual about whom a research investigator obtains data through: 1) intervention or interaction with the individual, or 2) identifiable private information (Collaborative Institutional Training Initiative). Whether or not the tools outlined in this behavioural monitoring plan are considered as research involving human subjects down the line, it is critical that the implementation of this plan rigorously adheres to ethical guidelines, especially when involving children and adolescents.


81

empowering as they allow participants to tell their own stories and recount their experiences in ways that feel comfortable to them. These techniques enrich our understanding of the very processes by which change occurs. It is our hope the behavioural monitoring tools outlined here will illuminate not only how the participatory behavioural monitoring will come to life, but perhaps more importantly, how the participatory nature of the behavioural monitoring plan will foster and inspire individual and collective change through the use of innovative and creative techniques.

Transect Walk Purpose: Transect Walks are a great way to identify problems and begin dialogues that can lead to social change. Transect Walks can be used to take stock and monitor community assets or resources over time. For this project, Transect Walks can be used to assess: • The number and distribution of toilets and handwashing stations (household, school, and shared) in

a community • What foods are available and accessible at local markets • Monitor overarching dimensions of the C4D strategy such as equity by assessing the location and

distribution of community resources with regards to gender, socioeconomic status, caste, disability and ethnicity.

Background: A Transect Walk is a simple tool that allows researchers, together with community members, “to observe, to listen, and to ask questions which would enable [the] identification of problems and collectively evolve solutions” (World Bank, n.d., p. 1). Utilized primarily in agriculture, a Transect Walk can yield information on environmental aspects such as natural resources, land use, and cropping systems. More recently, it has been used in public health to assess the linkages between environmental and social aspects. A Transect Walk can illuminate issues pertaining to social structures, mobility, and public/community assets. By understanding the impacts of both environmental and social factors in a community, a Transect Walk takes stock of the current situation in a community while also serving as an entry-point for more in-depth analysis. They are typically accompanied by a Transect diagram or a Community Mapping exercise, as well as a discussion with local analysts. It is at this point that the generation of local solutions can occur. Lastly, Transect Walks can also help us identify key community members and potential role models to interview at a later date. Examples: In Nepal, WaterAid has used Transect Walks to crosscheck verbal information about a community’s sanitation status by mapping latrines and noting the condition of the latrines using a checklist (Jones, Jones, Kumar, & Evans, 2009). In Malawi, WaterAid conducted a toilet observation walk, paying special attention to facilities for menstrual hygiene and management (Pillitteri, 2011). The Walk enabled community members to discuss the problems with the location and status of facilities and the needs of women and girls during menstruation. In Malawi, Transect Walks have been used to map school-related gender-based violence. Children and facilitators mapped unsafe spots and discussed other issues children faced when walking to and from school (Centre for Educational Research and Training and DevTech Systems, Inc. [CERTD], 2008). WaterAid has used Transect Walks to connect water, sanitation and hygiene issues to health.

Community Mapping Purpose: Community Mapping, especially mapping conducted by children and adolescents, aligns closely with the C4D strategy’s Children for Change component. As a participatory research tool, Community Mapping can be used in several ways.


82

First, as a complementary activity after conducting a Transect Walk. For instance, in this project, Community Mapping can help: • Community members figure out ways to take advantage of locally available foods to improve

maternal and child health. Second, Community Mapping can be used to collect information not recorded elsewhere such as: • Toilets (household, shared and school) • Handwashing stations (household, shared and school) • Classroom discrimination vis a vis segregation in terms of seating Third, it can be done to supplement and validate existing data such as: • Birth registration Repeated mapping at specific intervals will help assess whether or not changes are taking place. For example, an analysis of toilet maps over time will reveal whether the number of toilets in a community is changing, but it can also show the distribution of toilets. In other words, if there is an increase in the number of toilets in a community, is the distribution of toilets equitable or are certain social groups being left out? In this way, Community Mapping can help us monitor equity – another one of our crosscutting dimensions. Mapping does not have to cover the entire community; maps of schools and even classrooms are viable options. Maps need not focus only on physical things, as they also have the capability to capture more abstract concepts. Discrimination in schools, for example, can be mapped by having children and adolescents draw seating charts of their classroom. If given first and last names of students, gender and caste can be determined. An analysis of these maps over time will reveal whether or not teachers and the education system are becoming more inclusive, as mandated by law and official guidelines. Community maps can also be used to validate existing data such as birth registration through visual inspections of birth registration cards and crosschecking this information with VDC records. Background: Community Mapping, as the name indicates, is the process of having community members map the details of their community – where individuals reside, resources, infrastructure, geographic details, social issues, and more. Mapping activities empower individuals to capitalize on their collective knowledge in order to diagnosis problems and devise local solutions to issues of importance to them. While similar to Participatory Rural Appraisal, Community Mapping is fundamentally different in that the process works towards achieving social change. “The goal is not a certain number of latrines or water points, but to build the capacity of the poor to find ways of meeting all their needs” (WaterAid, 2005, p. 2). Maps can be made using the simplest of resources – e.g., sticks and stones -- or capitalize on recent technological advances by using mobile phones, mapping software, and GPS systems. Examples: In Nepal, WaterAid uses Community Mapping to understand

the intersection between poverty and WASH, as well as to guide and monitor their projects both in urban and rural contexts. Community groups in Nepal have already leveraged the power of Community Mapping as the Rain Barrel team saw during the field visit in Parsa. In discussion with a citizen ward forum, the social mobilizer showed the team one of their community maps. This speaks to the feasibility of using such a technique, as well as the empowerment that can come of teaching communities how to map their worlds. Another viable option that can be applied, at least on a pilot basis, is the use of smart phones to collect mapping data. This has successfully been tried in Kolkata, India, through a local NGO, Prayasam, which involves school children creating maps of their communities using new Map Your World

Figure 20. A community map from Parsa, Nepa l


83

technology, in conjunction with experts from Stanford and Columbia universities. (See: http://revolutionaryoptimists.org/map-your-world). The school-related gender-based violence study in Malawi, mentioned earlier, also had children draw maps of the school (including the school building, playground, and toilets) and identify places where they felt safe and unsafe (CERTD, 2008). The children were then asked to explain why they labelled places as safe or unsafe. Word Associations/Free-l isting Purpose: Word Associations/free-listing tools can provide a means of uncovering: • What terms like positive discipline, inclusion, participation, and empowerment mean to Nepalis and

what they associate with these concepts • Values, attitudes and feelings about cultural taboos and other socially-sensitive topics related to the

priority focus areas Repeating these activities over time can shed light on the evolution and acceptance of new concepts. However, they cannot directly tell us about the actual practices described by these terms or concepts in everyday life, nor do they help us track changes over time. Additional bursts of monitoring will be required to operationalize these concepts in the future. Background: Word associations are a type of projective technique, originally developed by psychologists. Projective techniques use unstructured stimulus objects or situations to “provide non-threatening ways for participants to indirectly explore and discuss feelings” (Hines, n.d, p. 2). The technique is a great way of engaging participants, especially on sensitive topics. Projective techniques can help participants overcome communication barriers, reduce participants’ fear of coming across as ignorant, and even help participants admit to certain deviant or socially unacceptable behaviours. By talking about a word or object, the participants can indirectly talk about their own feelings or behaviours. Free-listing is a technique in which researchers ask participants to make a list of words, phrases, expressions, or instances to describe a particular concept or phenomenon (Ulin, Robinson, & Tolley, 2005). Free-lists capture local perceptions of a specific topic and offer a lens through which to understand cultural beliefs. Free-listing is often used in Formative research to help design culturally appropriate tools and interventions, but it can also be harnessed for monitoring purposes, much like word associations. Examples: In India, free-listing has been used to collect rural mothers’ perceptions of newborn danger signs and newborn care practices in the home, in addition to exploring reasons for changes in healthcare-seeking behaviours linked to newborn danger signs (Dongre, Deshmukh, & Garg, 2010; Dongre, Deshmukh, & Garg, 2008). In Nepal, a free-listing activity elicited local perspectives on acts and behaviours that constituted sexual violence by a partner during the early years of marriage (WHO, 2009). The table below depicts the acts and behaviours considered to be sexual violence within marriage by Nepalis with their corresponding frequency and percentage. How Nepalis defined sexual violence was then compared against the WHO definition, and the data collected was then used to inform programme strategies.


84

Table 14. Acts and behaviours defined as sexual v iolence within marriage (WHO, 2009)

Draw and Describe Purpose: The visual nature of this tool allows it to be inclusive and is suitable for working with women who tend to have higher rates of illiteracy. For this project, Draw and Describe activities will be particularly useful to assess: • Dietary diversity among pregnant and lactating women as well as their children under two years of

age. Background: The “Draw and Describe” activity is an example of plate mapping – a type of social mapping. Plate mapping is a fairly new method of eliciting information about an individual’s food consumption by having them draw what they eat or may eat on a plate (Sharp & Sobal, 2012). Plate mapping can be used as a learning activity to teach individuals about nutrition. As an assessment tool, plate mapping can measure food intake, portion sizes, and shed light on how meals are conceptualized. Examples: MyPlate, the USDA’s current nutritional guide, maps out what a healthy plate should look like. A simple visual, this guide can be easily understood by a diverse group of individuals. Colouring sheets of the plate are a popular learning activity to teach children about nutrition. Sharp and Sobal (2012) used plate mapping to better understand how plate size influences food portions and meal composition among U.S. college students.

Social Network Mapping Purpose: Given that a major thrust of the Everyday Heroes C4D strategy entails promoting the participation of children and adolescents in society and positioning them as advocates of social change,

ResultsThe majority of young men interviewed: were aged 25–27 years (61%); had completed high school (53%); had married after age 18 years (64%); and were working in agriculture (61%). The women tended: to be younger (74% were between 20 and 24 years of age); to be less educated (26% com-pleted high school); to have married before age 18 years (69%); and not to be working outside the home (72%).

What constitutes sexual violence from the perspectives of respondents?

During the free-listing exercise, participants were asked to list all acts and behaviours of their partners that they considered as sexual violence. Interviews identified a total of 43 different acts and behaviours as sexual violence. Table 1 shows the 10 most frequently mentioned acts and behaviours defined by respondents as sexual violence.

Average rank refers to the order that respondents spontaneously mention specific acts of sexual vio-lence. Therefore, the item with lower ranking indicates that the term was mentioned earlier by re-spondents in their listing. ‘Smith’s salience’ is an indicator that weights the frequency that an item is mentioned by the average rank. For example, participants were likely to mention forced sex and forced sex despite verbal refusal early in their listing of sexually violent acts (rank 2.433 and 2.0). However, more respondents mentioned forced sex despite verbal refusal than forced sex resulting in a higher Smith Salience score (0.531 vs 0.195).

www.who.int /reproductive-health

Items (Nepali) English translations Frequency (n=106)

Percentage Average rank

Smith’s salience

Ichha biparit yon samparka Sex against partner’s wishes 69 65 2.000 0.531

Jaad raksi khayera yon samparka

Sex after consuming alcohol 43 41 3.326 0.261

Bimari huda yon samparka Sex during illness 42 40 4.071 0.206

Mahinawari huda yon samparka

Sex during menstruation 41 39 3.488 0.223

Sutkeri huda/bachcha sano huda yon samparka

Sex after delivery/when baby is small

36 34 3.917 0.194

Yon samparka garna namane kutpit/gali/dhamki

Physical or verbal abuse or threats following refusal of sex

33 31 3.364 0.197

Jabarjasti yon samparka Forced sex 30 28 2.433 0.195

Thakeko bela yon samparka Sex in spite of being tired 20 19 4.000 0.112

Ichha biparit youn anga chalaune/stan samaune

Unwanted touching of breast/private parts

19 18 3.684 0.098

Ichha biparit sarirma hat halne Unwanted fondling of body 17 16 4.176 0.083

Table 1. Acts and behaviours defined as sexual violence within marriage: results from free-listing

Perspectives on sexual violence during early years of marriage in Nepal: findings from a qualitative study

Figure 26. MyPlate nutr it ional guide (USA)

F igure 21. MyPlate nutr it ional guide (USA)


85

it is important to monitor how they share information with their peers, family members, and the larger community. Social Network Mapping is well suited to uncovering: • Local patterns of trust, influence and power • With whom children and adolescents share information about harmful social norms • It can also be used to map relevant referents (e.g., friends, siblings, teachers) to whom children and

adolescents disclose incidents of corporal punishment Background: Network analysis takes an ecological approach to understanding health and enables us to describe and uncover structural and relational aspects of health (Luke & Harris, 2007). In this sense, network analysis works as both a theoretical framework and research tool. In public health, network analysis has been used to examine transmission networks, social networks, and organizational networks. Social network theory posits that individuals seldom make decisions alone. Rather, individuals are influenced by group relationships, norms, and expectations (Ulin, Robinson, & Tolley, 2005). Mapping social networks allows us how individuals are connected, which in turn helps us understand and uncover the pathways that assist or hinder knowledge flow, as well as those that create shared norms within a population. Other relational networks such as information networks can be mapped, e.g., where individuals get information or how individuals disseminate information. By examining relational patterns, network maps can be utilized to identify where and how to make changes. Public health has harnessed the insights from network maps to develop effective interventions, especially to change risky behaviour (Ulin Robinson, & Tolley, 2005). Examples: During the field visit to Parsa, the Rain Barrel team carried out a Social Network Mapping exercise with the Para-Legal Committee (also known as the Gender-based Violence Watch Group) to better understand the individuals and the institutions that the committee could turn to for help in their endeavours (“allies”), as well as the people and institutions that were perceived as working against them (“barriers”). Social network maps can take many forms. In Malawi, “net-maps” were used to evaluate the impact of a mobile phone intervention for community health workers (Campbell, Schiffer, Buxbaum, McLean, Perry, & Sullivan, 2014). An analysis of the maps over time revealed that the community health workers’ networks changed as they transformed from being passive recipients of information to active information agents for their communities. The Kishori Abhijan project in Bangladesh used Social Network Mapping to understand how programme participants shared messages with others.

Oral Histories Purpose: For the purposes of the Everyday Heroes strategy, Oral Histories seem particularly suitable for capturing birth experiences or the events that occur during the first 24 hours after birth. These Oral Histories will provide behavioural results related to: • Postnatal care visits • Early initiation of breastfeeding • Newborn bathing

Figure 27. A social network map from Parsa, Nepa l

Figure 23. A socia l network map from the Kishori Abhijan program (Bangladesh)

F igure 22. A socia l network map from Parsa, Nepal


86

In keeping with the participatory nature of the project, trained children and adolescents should conduct the Oral Histories, that is, elicit the stories through interviews of parents and community members. Not only will this empower children and adolescents with new skills, but conducting Oral Histories also has the potential to foster community connectedness. Children and adolescents should collect multiple caregiver perspectives (e.g., the mother, father, and mother-in-law, or neighbour) to create a richer story of the experience. A comparison of experiences between those who delivered in institutionalized settings versus those who delivered at home, as well as those who delivered with a SBA versus those who did not is likely to provide important information for programming, media outreach and advocacy. Background: Ethnographers, anthropologists, historians and development communicators have used this technique for decades to cover the widest possible range of subject areas. Oral Histories are a storytelling technique in which an interviewer spends a significant amount of time with a participant discussing a specific experience or set of experiences. It is, in essence, an in-depth biographical interview about a life experience, as told from the perspective of the participant. The storytelling process gives the individual a voice, allows them to create meaning, express attitudes, feelings, and beliefs, connect personal experiences with those of others, and ultimately emphasize what is important to them. Oral Histories allow for moments of “realization, awareness, and ideally education and empowerment during the narrative process” (Hesse-Biber & Leavy, 2011, p. 150). Examples: The Newtown Creek Community Health and Harms Narrative Project in New York used community-based Oral Histories to advocate for victims of environmental injustice and to create a public health report and map of environmental hazards, all of which served to promote social change (Weiss & Heimbinder, n.d.). Oral Histories were used in rural Canada to better understand birthing and maternity care experiences (Orkin & Newbery, 2014). In Nepal, Oral Histories have been used to uncover the lived experiences of women in the remote Himalayan district of Mugu, with a particular focus on the intersection of gender and education (Mitchell, 2011).

Direct Observations Purpose: Direct Observations are useful for gathering data on actual behaviours and practices and will be used to monitor a range of behavioural results. Observations are critical for two reasons: 1) to generate data that is not available in existing records; and 2) to validate data, especially self-reported data (de Zeeuw & Wilbers, 2004). For the Everyday Heroes initiative, household observations should take stock of the following behaviours: • Handwashing at critical times • Toilet use through proxy measures of lock, water, soap, and smell • Maternal nutrition (during pregnancy and lactation) • Pregnancy and post partum period as a special time (operationalized as sharing of household chose,

joint eating, and spousal communication) • Infant and young child feeding practices School/ECD observations should focus on: • Toilet use through proxy measures of lock, water, soap, and smell • Handwashing • Instances of punishment as a form of discipline Background: Direct Observation involves gathering data by making note of things as they happen. Observations can capture the frequency and/or intensity of behaviour and can be done in an unobtrusive manner (Guest, Namey, & Mitchell, 2013). They are a great way of confirming if individuals are doing what they claim to be doing, especially when it comes to sensitive issues (e.g., corporal punishment) or concepts that are somewhat subjective (e.g., not all cultures interpret exclusive breastfeeding the same way). Observational data can enrich our understanding of gender dynamics and its influence on


87

behaviour change. Patterns and trends can be detected when analysing data collected over time. It is important to remember that data is limited to what is observed. The day and time of data collection can easily skew the data -- therefore, it is important to conduct multiple observations at different times of the day, week, month, year, and even setting. Examples: As part of the Community-led Total Sanitation movement, latrine observation checklists have been used in Nepal when conducting household interviews to take stock of the presence or absence of a toilet and the condition of the toilet (WaterAid, 2009). The Radio Communication Project in Nepal used clinic-based observations to assess client-provider interactions (Storey, Boulay, Karki, Heckert, & Karmacharya, 2010). A study in Ghana used structured classroom observations to validate teachers’ self-reported data on the use of corporal punishment as a form of discipline (Agbenyega, 2006).

Health Facil ity Survey Purpose: Health Facility Surveys are a method of monitoring the quality of care delivered at health facilities. For the behavioural monitoring plan, such surveys would allow for the collection of data from facility records and offer opportunities to interview health workers and patients. This would include information on: • Pregnant women’s experiences at the health facility • Use of health facilities through their records • The practice of inclusive behaviours by health workers Background: Health Facility Surveys can assess different facets of healthcare. They can be used to better understand how experiences at the health facility affect health-seeking behaviour and health outcomes. Specifically, this information can shed light on discriminatory practices in healthcare settings. Health Facility Surveys can be used to understand perceptions and behaviours of health workers. Such information can then be used to find ways of motivating health workers to deliver the best care they can (Lindelow & Wagstaff, 2003). This can also help identify the need for training to improve the practice of inclusive behaviours. Other such surveys can be tailored to focus on organizational and management aspects, such as cost, efficiency, and quality of healthcare. Examples: The Radio Communication Project in Nepal used Health Facility Survey data to track changes in contraceptive prevalence and also assess client satisfaction with improved services (Storey, Boulay, Karki, Heckert, & Karmacharya, 2001). A study conducted in Ethiopia, northeast Nigeria, and Uttar Pradesh, India, linked household, health facility, and heath worker surveys to measure skilled attendance at birth and quality of care (Marchant & Schellenberg, 2013). In Burkina Faso, Ghana, and Tanzania, Health Facility Surveys were used to assess quality of antenatal and childbirth care in rural health facilities (Duysburgh et al., 2013). This study surveyed the quality of care at the health facility, directly observed antenatal and childbirth care, reviewed patient records, and conducted exit interviews with patients.

Ask 5 Activity Purpose: The “Ask 5” activity offers a creative method of validating school attendance records. Adolescents will be asked five questions which will reveal whether or not they have attended school recently.


88

Background: Filter questions are very common in survey research. Filter questions check whether or not a participant is qualified to answer a question or is telling the truth. The “Ask 5” activity presented here is essentially a set of filter questions to obtain a more accurate estimate of: • The number of adolescents attending school Examples: Household drinking water and sanitation “Ask 5”surveys often utilize filter questions to test whether respondents actually know appropriate sanitation and hygiene practices. For instance, participants who respond in the affirmative to “Do you treat your water in any way to make it safer to drink?” are subsequently asked about the specific method(s) they use to treat their water (WHO & UNICEF, 2008).

Photovoice70 Purpose: From a monitoring perspective, Photovoice can reaffirm programme goals or highlight any necessary mid-course corrections. The tangible and immediate benefits of Photovoice can help build and sustain momentum for behaviour and social change, especially with regards to identifying and celebrating positive role models from all walks of life. For this behavioural monitoring plan, Photovoice will be used to: • Monitor adolescents taking social action to address harmful social norms such as child marriage and

corporal punishment • Highlight and celebrate the stories of Everyday Heroes • Document public declarations and denouncement of harmful traditional practices Background: Photovoice is a data collection technique in which researchers give individuals cameras enabling them to capture scenes that are representative of their lives and convey their perceptions and experiences in more depth than words often do. Photovoice draws upon Paulo Freire’s idea of critical consciousness, feminist theories, and community-based approaches to documentary photography. Visual images are an easy way to get groups to think critically about important community issues and discuss the social, cultural, economic, and political forces at play (Wang & Burris, 1997). As cameras are increasingly easy to use, the images can be taken by virtually anyone. Giving individuals cameras recognizes and leverages their expertise and allows researchers to gain an Insider perspective. In so doing, Photovoice can help empower marginalized and vulnerable populations as it gives a voice to those who are often unheard and makes the invisible visible. Examples: In Nepal, a Photovoice component enriched in-depth interviews and focus group discussions with refugees living in Kathmandu. It provided visual examples of how refugees coped with displacement, helped refugees and researchers begin conversations on sensitive issues, and enhanced the researchers understanding of resilience (Thomas, Roberts, Luitel, Upadhaya, & Tol, 2011). In Yunnan Province (China), Photovoice enabled rural female villagers to document their lives with a special emphasis on health and work (Wang & Burris, 1997). A modified Photovoice method was used in Dar es Salaam, Tanzania to understand household water, hygiene, and sanitation practices. The photographs shed light on behavioural risk factors for diarrheal disease, specifically with regards to appropriate water treatment and storage as can be seen in the images below (Badowski, Castro, Montgomery, Pickering, Mamuya, & Davis, 2011).

70 Given the proliferation of mobile phones and recording technologies, it may be possible to do Videovoice instead of Photovoice. The basic premise behind the activity will remain the same regardless of the medium utilized.


89

Figure 24. Photovoice photographs from Tanzania From right to left: Child defecating outside. This is common practice due to fears of children falling into the toilet holes; a typical toilet where water is used to clean the latrine rather than washing hands; Handwashing after cooking. Handwashing is commonly practiced as running hands under water without soap. (Badowski et al., 2011)

Most Signif icant Change Stories Purpose: Most Significant Change (MSC) stories when gathered and analysed with rigour are increasingly accepted as narrative proof of behaviour and social change. MSC stories can bring to the forefront discussions and actions that participants experienced as a result of their involvement in an intervention and serve as repositories of historical memory. They can be used to spark future discussions and thus build or maintain momentum for social change. As such, MSC stories seem perfectly suited to identify and celebrate Everyday Heroes. For this project, MSC stories would be most appropriate to monitor: • Child marriage prevention efforts • Adolescent engagement in social action • Adolescents advocating an end to harmful social norms • Institutional and community-level behavioural results Background: The MSC approach leverages stories as a means of assessing an intervention’s impact. It uses both a systematic and subjective approach. It is subjective in that participants decide what changes to record and systematic in that all participants are asked the same question or questions (Byrne, Gray-Felder, Hunt, & Parks, 2005). The stories can shed light on the impact an intervention is having (or not having) and also the processes by which behaviour and social change is taking shape (Davies & Dart, 2005). From a behavioural monitoring perspective, information from the stories can allow for mid-course corrections to be made, if programme objectives are not being met. Examples: In India, CMS Communication used the MSC technique to appraise Bell Bajao! , an anti-domestic violence campaign, and monitor how it was impacting change among those it reached (CMS Communication, 2010). In Bangladesh, girls who participated in the Kishori Abhijan programme wrote MSCs about the most important changes they experienced as a result of their involvement in the initiative. These stories were used to monitor the programme and captured both project successes and failures in empowering girls and preventing child marriage.

Vi l lage-level Case Study Purpose: Specifically, Village-level Case Studies are well suited to monitor community-level behaviours such as: • Communities treat pregnancy as a special time • Communities treat the post partum period as a special time


90

• Local community groups ensure equitable use of WASH facilities • Local community groups ensure schools are free of corporal punishment. Using villages as the unit of analysis for a case study aligns better with the SEM underpinning the entire C4D strategy. It also permits a multiplicity of voices and perspectives to be incorporated, which in turn will contribute to a richer and more comprehensive analysis. Extended case studies, whereby the events in a village are monitored over time, offer a window into how and why behaviour and social change evolves. Not only will case studies celebrate role model villages (e.g., VDCs declared free of open defecation, chhaupadi, child marriage, etc.), but will also provide a detailed account of why a village considers itself to be an Everyday Hero for a specific behaviour. Background: Qualitative Case Studies are in-depth analyses of a unit or small subset of units such as individuals, groups of individuals, programmes, institutions, cities and their contexts. They draw upon a constructivist paradigm in which truth is considered relative and dependent upon one’s experiences and point of view (Baxter & Jack, 2008). Their richness comes from their ability to capture immense detail and multiple perspectives. They allow researchers to uncover and understand the context in which events or actions occur. Thus, Case Studies are especially useful tools for process monitoring or evaluations (Balbach, 1999). Examples: Some examples of Case Studies (not necessarily village-level ones) specific to Nepal include: the impact of social mobilization on Nepal’s National Vitamin A Programme; the impact of establishing and sustaining birthing centres closer to communities to improve maternal and newborn health; and the impact of school-led total sanitation efforts in creating open-defection free communities (UNICEF, 2005; UNICEF, 2013; UNICEF, 2009). UNICEF frequently utilizes Case Studies to understand how interventions and initiatives work towards behaviour and social change, and to identify lessons learned for future endeavours. Village-level Case Studies were used in Bangladesh as part of the Kishori Abhijan programme to see if it had successfully created an environment of change, one that no longer promoted child marriage.

Public Declarations Purpose: Given the growing number of villages declaring themselves open-defecation free and even chhaupadi-free in Nepal, Public Declarations are clearly a viable mechanism of monitoring certain behavioural results. Declarations to be tracked for the Everyday Heroes initiative include: • The number of schools that declare themselves corporal punishment free • Communities that treat pregnancy as a special time • Communities that treat the postpartum period as a special time Background: Public Declarations can serve as visible and coordinated stands against the practice of specific harmful social norms (UNICEF, 2007) and the adoption of certain positive practices. They have been most widely and successfully used in interventions trying to eliminate female genital mutilation/cutting. Public Declarations are rooted in our understanding of how self-enforcing social norms work in social systems. As social convention and game theory explain, the decision to practice a harmful social norm is affected by and affects the decisions made by others, as well as the social rewards and sanctions at stake. Public Declarations lower the high psychological, social and economic cost that individuals would have to pay if they were abandoning the traditional practice on their own, by announcing a collective shift in behaviour supported by the entire community. Examples: In Nepal, Public Declarations marking communities as chhaupadi-free or open defecation-free are now common. Tostan, a Senegalese NGO, has used Public Declarations to help build momentum to end FGM/C (UNICEF, 2007). The organization views Public Declarations as a logical outcome of increasing awareness of the harm associated with FGM/C.


91

5.6 Pretesting the Behavioural Monitoring Tools Methodology Following their design, the behavioural monitoring tools were pretested in Nepal. It is essential to pre-test the behavioural monitoring tools with participant groups, specifically children and adolescents, to understand the extent to which the tools measure what they are supposed to measure, are culturally appropriate, and can be incorporated within C4D and programme interventions. Field-based pretesting took place in the following districts: Lalitpur, Morang (specifically Biratnagar), Saptari, and Banke. In addition to field-based pretesting, a Child/Adolescent Behavioural Monitoring Validation Workshop was held in Kathmandu to further pretest and validate the tools using a participatory methodology. This workshop involved children from various districts across Nepal: Accham, Dhanusha, Parsa, Saptari, Rauthat, Sindhupalchawk, Nuwakot, and Kathmandu. Of the eleven tools, nine were pretested in the field. Direct in-country supervision was provided for the pretesting of the Transect Walk, Community Mapping, Social Network Mapping, Photovoice, and Ask 5. The innovative nature of these five tools meant the exact implementation of the tool required training and adjustment at the field level. IRB approval to pre-test these five tools was obtained through Drexel University. Five tools were pretested at the validation workshop with children and adolescents. As two of the tools -- Oral Histories and Village-level Case Studies -- could not be pretested in the field, peer interviews were conducted as a way to test the feasibility of “citizen journalism” – the underlying concept of these tools. Table 15 below shows the breakdown of where each tool was pretested and Table 16 contains sample size information for each behavioural monitoring tool. Table 15. Location of pretesting by behavioural monitoring tool Behavioural Monitoring Tools Field Workshop Transect Walk/Community Mapping ü

Word Associations/Free-listing ü ü Draw & Describe ü

Social Network Mapping ü ü Direct Observations ü

Facility Surveys ü

Ask 5 Activity ü ü Photovoice ü ü Most Significant Change Stories ü ü Oral Histories

Peer Interviews Village-level Case Studies (Public Declarations)


92

Table 16. Pretesting sample sizes by behavioural monitoring tool

Behavioural Monitoring Method

In the f ie ld In the workshop

Transect Walk/Community Mapping

n=2 (participants=38)71

✗

Word Associations/Free-listing n=33 n=36

Draw & Describe n=16 ✗ Social Network Mapping n=7

(participants: 35)72 n=4 (participants=36)

Direct Observations Household: n=16 ✗ School: n=1 ✗

Facility Surveys Records from health facilities: n=2

✗

Health Worker Interview: n=7 ✗ Patient Satisfaction Survey: n=9 ✗

Ask 5 Activity n=34 n=36 Photovoice n= 751

(participants=43)73 ✗

Most Significant Change Stories ✗ n=29 Oral Histories ✗ Peer interviews Village-level Case Studies (with Public Declarations)

✗

Key changes For the numeric tools, findings from the pretesting primarily involved adding or dropping categories. Some other changes involved re-wording questions -- for example, changing an open-ended question into a close-ended question to minimize errors and the amount of work being asked of children and adolescents. For the visual and narrative tools, modifications were made in order to allocate more time for the activities; ensure that activities are done in small groups; allow participants to make rough drafts of maps (fear of making a mistake on a map was an issue); and start with simple prompts and build up to more abstract ones. In the case of narrative tools, it is important to consider the impact of literacy challenges. Some ways of overcoming barriers to writing include: 1) having a peer write the narrative; 2) audio recording the narrative and listening to it; 3) drawing the narrative; and 4) using photographs to narrate. In terms of capacity building, it is critical to train facilitators to ask the research questions correctly, to prompt and probe when necessary, and to pick up non-verbal cues. Similarly, capacity building in the areas of data collection, entry, interpretation, analysis, as well as report writing and the dissemination of results is essential if monitoring is to be systematic, robust, and rigorous. Lastly, while these tools have been created with the idea of training Child Club members, it is also important to consider and devise ways of reaching children and adolescents who are not in clubs, often the most marginalized and hard-to-reach.

71 For the Transect Walk/Community Mapping, n refers to the number of times the tool was implemented in the field. 72 For Social Network Mapping, n refers to the number of maps created during the implementation of the tool during pretesting. 73 For Photovoice, n refers to the total number of photographs collected from participants.


93

5.7 “How to” use Behavioural Monitoring Tools

The attached annex provides step-by-step instructions on implementing the behavioural monitoring tools.

5.8 Next Steps Implementation Plan The following steps have been determined as the immediate and long-term actions required to implement this Behavioural Monitoring plan: 1. M&E Task force: Establish an M&E task force to finalize all indicators and means of verification

provided in the BM plan. Coordinate with the programme implementation strategies to roll out the Behavioural Monitoring Plan. This task force will be charged with the responsibility of ensuring that all tasks to implement the BM plan are approved by the task force. It is recommended that the task force members meet bi-weekly in order to provide some continuity and oversight to all tasks involving the BM plan.

2. Translation and Back translation of the BM plan and How-to Tools: Hire two independent professional translators, one to translate the BM plan and tools into Nepali and another to back translate the plan and tools into English. Compare the back-translated English version with this original and modify accordingly to ensure accuracy. While the role of the translators and back translators is fundamental till the BM plan and the How-to Tools are finalized in Nepali, given the vast ethnic diversity in Nepal, it is important to note that translators and back translators are critical throughout the project as tools and activities are tweaked to meet on the ground needs and translation into different languages. Ensuring the availability of translators for the tools to be implemented according to plan – specifically the narrative tools -- is key for quality control. Another relevant step is the creation of a multilingual glossary of key terms that will be used across all elements and throughout the course of the behavioural monitoring.

3. Integrating the BM Plan and Tools into key programmes: Identification of key programmes which plan to achieve the results being measured through this Behavioural Monitoring Plan is critical. This plan and the accompanying tools can be integrated into existing programmes, for example under ADAP. In addition, upcoming or new programmes into which these tools can be built should be determined. This BM plan and the tools that accompany it are designed to be participatory and not stand alone research activities by experts. In order to ensure the complete integration of these tools, it is important to select programmes that have a curricular design and involve training of trainers to undertake behavioural monitoring activities.

4. Select s ites for behavioural monitoring: This BM plan and tools have specifically been designed to examine the effectiveness of the Everyday Heroes C4D strategy, specifically through a measurement of the behavioural results articulated in the C4D strategy. As such it is important to use this plan as a way to monitor the implementation and evaluation of behavioural outcomes resulting from the implementation of this C4D strategy. An essential first step is to create a population base of all sites where the C4D strategy will be implemented. From this list, use key criteria to select sentinel sites where the behavioural monitoring can be implemented. The selection of sentinel sites will be based on a combination of factors, including: ease of implementation (where basic systems and structures exist) and intensity of implementation (where multiple activities are being implemented to achieve maximal impact). At the same time, it is important to keep representativeness in mind. The number of sites to be selected will depend on the extent to which the information is generalizable to the population at large. While the Behavioural Monitoring plan will be operationalized in the sentinel sites alone, it is vital that these sites do not receive any distinct or special programme interventions and are therefore representative of the implementation sites as a


94

whole. Some criteria for site selection for the Behavioural Monitoring plan and the Creative Strategy have been designed 74.

5. Sampling Frame Selection: Once the sites have been selected, the next step is to determine adequate sampling frames (types of participants, sample sizes, unit of analysis). Decisions about sampling frames will also rely on judgements about the scope and size of the interventions themselves and the need for generating data from a sample that is representative of and generalizable to the population as a whole.

6. External Technical Assistance: The successful implementation of this behavioural monitoring

component -- so that it follows monitoring and evaluation standards of robustness -- requires external technical assistance at various levels:

- International technical assistance: Individuals involved in the creation of this Behavioural Monitoring plan and the how-to tools that accompany it should continue to be engaged in operationalizing the implementation of this plan. This engagement will need to be fairly intensive at the outset and gradually scaled back over time once local capacity is build to the fullest extent to make this locally sustainable.

- Regional and national technical assistance: There are several regional and some national organizations that have expertise in the specific types of monitoring activities noted in this BM plan. This expertise can be tapped to provide training to individuals tasked with implementing the behavioural monitoring in this context. For example: Prayasam, a local NGO based in Kolkata, with whom preliminary discussions have already been undertaken, can serve as a resource for training on a variety of training tasks critical to the implementation of the Behavioural Monitoring plan. In addition, SURCH, a local research agency based in Dhaka, has extensive expertise in implementing behavioural monitoring and could provide research related assistance in data collection, entry, cleaning, analysis and report writing.

7. Local agency (research and implementation partners) training: Contracting with a local

research agency (for example: VaRG, CREPHA or NDRI) is crucial to translate the technical assistance needs into actual implementation on the ground. The local agency charged with the Formative research for the C4D strategy, NDRI, has some relative advantage given their current familiarity with the C4D strategy itself. This local research agency will be responsible for conducting trainings for field-based staff charged with data collection. A second crucial role for the local research agency involves undertaking validation checks on the data being generated in order to verify the quality and accuracy of the data being reported by the programme staff.

The single most critical element required to ensure that the Behavioural Monitoring plan is successful is capacity building. Capacity building at all levels will help the BM plan achieve its full potential of being integrated as a crosscutting element of the programmes as a whole, and will fulfil the needs of providing robust data against which programmatic refinement and ultimate successes can be tracked (Figure 21). Capacity building is required from the data collection all the way through the dissemination stages.

74 Criteria for sentinel site selection:

• Solid local FM radio and availability of other communication infrastructure (i.e. local newspaper) • Presence of ADAP interactive theatre program • Functioning Child Club network (holding regular meetings and activities), Ward Citizen Forums and social

mobilizers • High penetration of mobile phones / good network coverage • Presence of functioning community groups that can be mobilized, especially those with male

representation (i.e. forest groups) • Representativeness in terms of socioeconomic status, ethnicity and population density


95

Figure 25. Capacity bui lding needs for the implementation of the Behavioural Monitoring plan Along with the capacity building activities being provided at various levels - from international experts to the regional/national experts to the local research agency to the actual participants -- from a sustainability perspective it is important to establish a transfer of knowledge and skills framework which will allow for scaling back of externally driven expertise while simultaneously scaling up of activities by local participants. A gradual scaling back over multiple rounds of behavioural monitoring is anticipated. The exact nature and modalities involved in the scaling back of external help and scaling up the actual implementation of the Behavioural Monitoring plan will be determined based on the scope of the activities to be undertaken and the local ground realities.

Capacity Building

Data collection

Data entry

Data analysis

Data interpretation

Report writing

Dissemination

module 3 unit 2 - andrew carlsonprofessorcarlson.net/c4dcourse/module_3/m3_unit2/m... · module 3...

Documents