Social and behaviour change communication (SBCC) is the use of communication to change behaviours by positively influencing knowledge, attitudes and social norms at the individual and
community level. Approaches to SBCC include, but are not limited to: media campaigns, peer educators and mentors, small group sessions, community dialogues and events, and digital
tools.
This rapid literature review focuses on SBCC interventions in Mozambique across four sectors:
family planning (FP); girls’ empowerment; water, sanitation and hygiene (WASH), and nutrition.
The most common SBCC approaches across the four sectors include:
- Inter-personal communication: Peer-to-peer and mentor approaches in schools and communities. Examples include Programa Geração Biz (PGB) – a national adolescent sexual and reproductive health (ASRH) programme including peer education activities, and the Care Group approach to improving nutrition in pregnant and lactating mothers and children under 5, which is based around small counselling sessions.
- Community participatory approaches: Community education and mobilisation sessions are a common approach to hygiene promotion in WASH programmes.
- SMS based platforms: two SMS platforms target adolescents with ASRH information, and one platform provides users with nutrition information.
- Media channels: these approaches have been used across the four sectors. For example, radio spots have covered issues including FP, gender-based violence (GBV), and the importance of exclusive breastfeeding for the first six months.
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SBCC interventions are often part of larger programmes, and adopt more than one approach. For example, UNICEF’s small towns WASH programme in Nampula Provine combined community participatory approaches with radio and media approaches. Combining approaches allowed different audiences to be reached, and ensured the saturation of messaging across groups.
Interpersonal and community participatory approaches are high intensity approaches in terms of resources and time. Their reach can be quite small in comparison to radio and media channels. Evaluations of these approaches, included in this review, include evidence of effectiveness in positively changing knowledge and attitudes, and behaviour change. For example, PGB has reduced the adolescent fertility rate amongst beneficiaries, and hygiene promotion initiatives have increased handwashing, leading to reductions in diarrhoea.
In contrast, radio and media approaches are low intensity and have a larger reach. However, it is harder to measure the impact of these approaches. The ‘Ouro Negro’ radio show reached approximately 1.5 million listeners between July and November 2016 and rapid audience assessments have measured recall of key messages. Low levels of literacy, and poor access to sources such as TV (especially in rural areas), mean that information in Mozambique is often disseminated through radio (UNICEF, 2018).
SMS platforms can have a large reach but can be resource-intensive. For example, peer educators (PEs) have been utilised to register beneficiaries in the mCENAS ASRH platform. There is some evidence that SMS platforms have positively affected knowledge and attitudes.
Evidence base: This review draws on evaluations of SBCC intervention, donor reports, and qualitative evidence collected by implementers and funders. There is a relatively large evidence base for FP and nutrition interventions and a comparatively smaller one for WASH and girls’ empowerment. No lessons learned from integrating WASH and nutrition programming could be found during the course of this review. Although there are examples of nutrition programming including WASH in their counselling interventions, as well as calls for the development of multisectoral programmes. For example, in 2017, UNICEF signed a multi-sectoral proposal covering WASH, nutrition, and behaviour change funded by the EU. The programme will work in Nampula and Zambezia Provinces between 2017 and 2021.
Lessons learned from across SBCC interventions in the four sectors in Mozambique
Formative research is important for understanding the sociocultural context and designing SBCC interventions: it is necessary in order to understand the socio-cultural context. This includes social and community norms, traditional practices, and stigmas and taboos within the target group or intervention area. Differences across Mozambique, including rural and urban, ethnicity, language, and the geographic area should also be considered when designing an intervention. A strong understanding of existing social norms and traditional values can help implementers design effective programmes (USAID, 2019).
Different approaches and tools will be suited to different target groups: low levels of literacy amongst women in rural areas means that pictorial messaging may be more appropriate during PE or counselling sessions in the community. UNICEF’s small towns WASH programme found that hygiene promotion approaches used in rural areas are not necessarily suited to periurban areas, and need to be combined with other SBCC approaches.
Content development and messaging: across all four sectors and across approaches, the evidence base suggests that it is important to involve target groups in the development of content
and messaging. Formative research should also inform content and messaging. Drawing on existing social norms can help to message to be well-received.
Community mobilisation and ownership is important for interpersonal communication and community participatory approaches: this involves parents, caregivers, local community leaders and traditional leaders. For example, potential opposition to PGB, due to stigmas around adolescent sexual activity, were mitigated by community sensitisation and involving community leaders in selecting PEs and monitoring the programme. Facilitating communities to select their own volunteers to be part of the intervention (as PEs, or community counsellors) can lead to better results than programme or local government staff selecting participants. There is some evidence that community ownership can contribute to the success of community volunteers and achieving behaviour change (USAID, 2019).
Interventions must be aware of the potential for reproducing or reinforcing inequitable gender norms: evidence from the Women’s First female empowerment programme suggests that the SBCC intervention reinforced existing stigmas towards girls’ sexual activity. This included staff introducing their own biases. In FP programmes there is evidence of community counsellors replicating their own beliefs about IUDs and only promoting certain methods of FP. Within PGB steps were taken between 2006 and 2010 to combat gender inequality in the programme including male Pes holding more leadership roles and gaining more recognition. Gender norms can also affect female participation in FP programmes. For example, motherhood is seen as the realisation of womanhood, therefore girls who are not mothers may not see FP as something for them.
For PE and mentor programmes it is important to value volunteers. Across the sector, programmes offer incentives. These can be in the form of transport to meetings or school supplies. Lesson learned from Food for Humanity’s Care Groups approach to nutrition found that non-monetary incentives can be effective. Women who participated in the programme as Care Group Volunteers (CGVs) reported being more respected by their husbands and in the community due to their role and contributed to volunteer retention.
SBCC interventions should be connected to the government. There is evidence that government involvement in or support for interventions can contribute to effectiveness. This includes the incorporation of key messaging into training for teachers and health workers.
Men and boys need to be included in SBCC interventions: a number of interventions included in this review primarily target women and girls. However, formative research has shown that men have an impact on nutrition behaviours in their families. GBV interventions should also target men and young boys in order to tackle social norms.
Interventions should be integrated with other programmes and local services. SBCC generating demand for FP or increasing health-seeking behaviour related to nutrition needs to be supported by improved access to services. This includes both availability and removing barriers to access. Hygiene promotion programmes should be integrated into wider WASH programmes.
