Philippines Toolkit: AYSRH Community Support
Coordinating and Harmonizing Strategic Behavior Change Efforts for Preventing Adolescent Pregnancy
Social and behavior change (SBC) is an approach that promotes and facilitates changes in knowledge, attitudes, norms, beliefs and behaviors. Using SBC strategies, TCI aims to improve youth’s knowledge and attitudes about their sexual and reproductive health, generate demand for services and promote linkages to quality services, ultimately leading to their uptake of contraceptive services when they become sexually active. These same strategies can also be used to promote a more informed and supportive enabling environment.
The following SBC strategies have been found to be effective: interpersonal communication (IPC) specifically through household visits by barangay health workers (BHW) and population volunteers/officers, social mobilization activities by trained youth influencers, mid-media activities, such as drama and theater group performances, mass media and social media campaigns.
Many different governmental agencies, civil society organizations and others conduct these strategies given that health education and promotion is a key strategy of the Adolescent Health and Development (AHD) Program of the Philippines. As a result, it is critical that SBC strategies across the various institutions and levels – barangay, municipality, city, province, regional level and national level– are coordinated and harmonized to have the biggest impact.
This coordination can be facilitated by the information and service delivery network at the city level or as part of the establishment since that approach brings all stakeholders together in a locality to setup a holistic service package for AHD.
What are the benefits of SBC?
- Interpersonal communication, social mobilization and mid-media help deepen discussions on AHD issues, overcome misinformation barriers about specific contraceptive methods and social stigma and support referrals to services.
- Mass media has been found to prompt dialogue at the household level to normalize contraceptive use, introduce specific methods and encourage spousal/partner communication.
- Adolescents and Youth seek information from their peers and social media, so it’s imperative to reach them via these channels and empower them with accurate information and referrals to services.
- Coordination and harmonization of SBC efforts ensures consistency of messaging, maximizes the reach of the messages and SBC strategies which are often under-funded and increases the likelihood of sustainability of SBC activities.
How to implement
Step 1: Identify SBC capacity resources, gaps, and needs at the LGU level
Conduct an assessment that explores the opportunities for strengthening demand-side components at the barangay and municipality/city levels. Who are all of the key actors in health promotion/health education, service delivery systems that include some component of IPC or SBC as well as implementing partners, aside from government, such as civil society organizations and non-governmental organizations and what is their capacity? And, what are the main government investments in SBC?
Evidence-based research can also be helpful in said assessment and situation analysis. Steps 1 and 2 from the Information and Service Delivery Network and intergenerational dialogue approaches can also help to inform this assessment.
Bring together the following stakeholders for a 1.5 to 2 day-long workshop along with relevant provincial and national representatives:
If the workshop needs to be facilitated virtually, then it is recommended that it be planned for 3 or 4 half day long meetings.
|Important Consideration: At the barangay level, the SK or youth council has various activities and programs depending on the priority of the SK leader and/or the Barangay Chair. SK has to be involved because Local Youth Development Councils (LYDO) and SK have specific budgets for health. SKs are required to convene an ASRH committee to discuss various ASRH concerns. However, they are not exclusively focused on health. So, it’s important to engage them in this approach as well as broaden the discussion to social determinants of health that lead to risky sexual behavior and ultimately unintended pregnancy.|
The workshop should be conducted in the following stages:
- Review ZFF’s Bridging Leadership and orientation to TCI project
- Complete ZFF’s design thinking session during its leadership training
- Review the insights shared during the design thinking session and come up with an action plan for implementation and monitoring
- Prioritization of areas for capacity strengthening
- Identification of timing, resources and responsibilities
Tips for developing an action plan:
Step 2: Provide ongoing capacity strengthening support
To foster ongoing learning and capacity strengthening, the LGU and SBC partners will receive virtual and face-to-face networking and coaching support on key SBC skills and proven approaches, as deemed as priority from the assessment and the local context.
|Illustrative key SBC skills||Illustrative proven SBC approaches|
Step 3: Review and adapt existing media and materials to enhance stakeholder accessibility
- Review the existing SBC media and materials and identify the key materials and approaches for potential adaptation at the LGU level
- Map existing materials to their various target audiences
- Ensure that the technical content for messaging is up-to-date (see DOH’s Behavior Change Communication Strategies for Preventing Adolescent Pregnancy Sourcebook and POPCOM’s Sexually Healthy and Personally Effective (SHAPE) Modules for examples of messages) and branded
Tip: Pair loss-oriented messaging (e.g., “What will happen to me? How will it affect my future?”) with messages promoting self-efficacy (e.g., “How can I protect myself?”) and calls to action (e.g., “Talk to you parents about your RH and FP needs). See other recommendations from Breakthrough RESEARCH and De La Salle University (2020) “Improving reproductive health and family planning outcomes among out-of-school adolescents and youth in the Philippines.”
These insights from USAID’s ReachHealth Project’s human-centered design activity with teens should be used to inform adapting existing media and materials.
Step 4: Ensure strategic communication planning
Make sure that SBC stakeholders have a shared understanding about the issues effecting the adolescent and youth population in their communities. This can be achieved through Step 1 as well as gathering other formative research inputs from Steps 1 and 2 of the Information and Service Delivery Network and intergenerational dialogue approaches. This shared collective understanding will help SBC stakeholders to jointly and strategically plan for social and behavior change communication (SBCC) activities that address behavioral objectives.
One of the most respected tools used in strategic communication planning is the P Process, which is a step-by-step roadmap that can guide you from a loosely defined concept about changing behavior to a strategic and participatory program that is grounded in theory and has measurable impact. The P Process has five steps:
- Step 1: Inquire
- Determine severity and causes of problems
- Identify factors inhibiting or facilitating desired changes
- Develop a problem statement
- Carry out formative research
- Step 2: Design your strategy
- Establish communication objectives
- Develop program approaches and positioning
- Determine channels
- Draw up an implementation plan
- Develop a monitoring and evaluation plan
- Step 3: Create and test
- Step 4: Mobilize and monitor
- Produce and disseminate
- Manage and monitor program
- Adjust program based on monitoring
- Step 5: Evaluate and evolve
Design thinking can also be used as a way to operationalize the five steps of the P Process.
Tip: Make sure to weave in all of the 7 Cs of Effective Communication in your strategic communication planning
Step 5: Utilize social media as a key channel for promoting SBC messages
Two key findings from Breakthrough RESEARCH and De La Salle University (2020) study can help to inform the LGU’s use of social media to promote accurate information and healthy adolescent sexual and reproductive health (ASRH) behaviors:
- Out-of-school youth (OSY) actively search and passively acquire RH and FP information from Facebook or YouTube. The information they receive is often inadequate, misleading, and inaccurate. As a result, adolescent and youth-friendly health services (AFHS) at the barangay level may want to establish Facebook pages that promote accurate information. It could be staffed by youth influencers who are also students with health and social welfare background who can serve as a helpline of sorts.
- OSYs are introduced to influencers who talk about issues relevant to them (e.g., failed romantic relationships, depression) through social media. While most OSY influencers are mainstream, or well-known through traditional media, some are alternative, or prominent in social media (influencers and vloggers). Through a netmapping exercise with youth, the LGU can identify young people who are social media influencers and train them to use their social media platforms and post and blog on ASRH and FP information and messaging using the media advocacy manual.
Tips for delivering appropriate content via social media platforms:
Step 6: Ensure accountability
Use the City Local Health Board Meetings as a platform for monitoring the action plan, reviewing current SBC activities implemented by partners and future plans, enhancing linkages and synergies between SBC activities across partners and reviewing data from SBC activities. Make sure that the review of the action plan happens at least on a quarterly basis.
Conduct joint supportive supervision visits of community-level SBC strategies, whenever approach.
Indicators for success
- Changes in SBC capacity scores between the baseline and endline assessments
- Number of SBC practitioners trained on AYSRH issues across the LGU
- Number of adolescents and youth posting about AYSRH-related issues (likes, comments, follows, etc.) on facility, LGU and national government social media platforms
- Number of AYSRH campaigns and public discussions aired on national, provincial and local radio and television
- Quarterly meeting venue
- Printed SBC materials
- Transportation reimbursement for youth participation and supportive supervision visits, as needed
What’s the evidence that SBC strengthens AYSRH programming?
- The use of community health workers for family planning counseling and provision of methods increases contraceptive use. For a comprehensive yet succinct analysis of the evidence, see the High Impact Practices in Family Planning brief on CHWs.
- Overall exposure to mass media messages was significantly related to contraceptive uptake in Nigeria (radio), Senegal (radio for women and TV for men), India (TV) and Kenya (radio).
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- Funds for SBC-related strategies are available via the local government unit funds. The LGU needs to include this in their local investment plans and present a proposal for funding for the health facility improvement pocket of funding.
- Identify youth influencers who can review existing IEC and SBC campaign materials and provide suggestions for adaptations for the local context.
- Adolescents are not a homogenous group: Develop SBC strategies with specific audience segments in mind.
- ASRH is often seen as a health issue, so some stakeholders and agencies are excluded from the discussions. This needs to be reframed since a lot of the factors that affect ASRH are socio-economic in nature and governed by other programs than health.
- Agree on data sources from the outset for monitoring SBC strategies coverage and impact.
- The Barangay Health Assembly Meetings are not regularly held by the physicians.
- Frequent turnover at the training hospitals so referrals and information back to the local health centers does not always take place.
- Not all barangays have health workers. Some cities have one health center for several barangays so BHWs are sometimes shared.
- BHWs are overloaded with lots of program activities. So, the population volunteers serve as a compliment. Both should be coached on how to effectively talk to adolescents and their parents about ASRH issues.
- Currently, most SBC activities are IEC materials and public advocacy aimed at awareness building.
- ReachHealth’s research reports
- ReachHealth’s FP booklets for couples
- ReachHealth’s FP booklets for young adults
- DOH’s Behavior Change Communication Strategies for Preventing Adolescent Pregnancy Sourcebook
- POPCOM’s Sexually Healthy and Personally Empowered (SHAPE) Modules
- POPCOM’s IEC Materials
- CCP’s Urban Adolescent SRH SBCC Implementation Kit
- CCP’s Gender Integration in Social and Behavior Change: what does it take?
- CCP’s Integrating Gender into Social and Behavior Change Communication