Critical Role of Social and Behavior Change (SBC) Across the Service Delivery Continuum Impact and measurement of SBCC in service delivery Mojisola Odeku June 8, 2017

Outline Background/Context Service provider ideation for SBCC intervention Data source Impact of targeting provider ideation on quality of provider interaction, counseling, and provider bias in service delivery

Service delivery context among providers Provider bias is high, more than half of providers do not offer some methods based on parity, marital status and age Interpersonal communication and counselling (IPCC) needs improvement Client-provider interaction (CPI) is poor Clinical training has not yielded much in improving provider attitude and interaction with clients Some of the problems from poor provider attitude includes…provider bias, poor counselling etc 4/21/2019

Service Provider Ideation NURHI research showed that provider ideation affects quality of interaction and counseling. To improve IPCC we used SBC to improve these ideational factors: provider rejection of myths and rumors perceived peer contraceptive attitudes and prescribing behaviors perceived social/religious approval for family planning gender-related attitudes.

provide information that allows clients make informed choices. NURHI implemented SBC Interventions for service delivery providers to focus on: How to: counsel and communicate with clients in a non-judgmental and client-focused way provide information that allows clients make informed choices.   4/21/2019

Platforms adopted for SBCC interventions Interactive distant learning videos Client-provider Dialogue/Feedback meetings Guidelines & Job Aids “Know your provider” initiative Whole site orientation

Data source: NURHI study on the effect of IPCC intervention for Providers in Zaria and Benin NURHI/MLE facility survey at baseline and endline in six urban cities Both studies were funded by the Bill and Melinda Gates Foundation 4/21/2019

Mean index score1 on information provided by providers on modern methods increased across cities *** *** *** Index based on whether or not the provider provided information on the following for ten modern methods (male sterilization, female sterilization, implant, IUD, injectable, Pill, emergency contraception, male condom, female condom, LAM): how method is used or given, how method works, advantages and disadvantages, and complications/side effects. 1 Out of a possible total score of 40 Notes: *** p<0.001

% of providers that talked about different methods, how used, and side effects increased post intervention *** *** *** *** *** p<0.001

% of providers that restrict provision of methods based on parity and marital status (respectively) decreased at endline

Conclusion: Provider ideation is related to the quality of family planning services, information provision and provider bias. Focusing on Provider ideation using SBCC should be a critical part of effective service delivery interventions. This study has demonstrated that provider ideation, a generally neglected concept, is related to the quality of family planning services and client satisfaction. Programs should take provider ideation into consideration when developing capacity strengthening initiatives for FP service providers. 4/21/2019