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Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Gillian McKay_5.6.14
1. Gillian McKay
Behaviour Change & Gender Officer
GOAL Ireland
Global Health Practitioners Meeting
“Health Starts at the Community”
Silver Spring, Maryland
May 5th -9th 2014
2. GOAL’s Work in Kutum, North
Darfur, Sudan
Integrated Programme
Primary Health Care
Community Health
Nutrition
Livelihoods
WASH
REFLECT (Regenerated Frerian Literacy Through
Empowering Community Techniques)
3. GOAL & Gender
GOAL is committed to gender equality throughout the
organization and in addressing the basic rights and
needs of vulnerable populations throughout the
developing world by focusing on gender issues across
the full range of sectors within existing
policies, development strategies and priorities.
Mainstreaming of Gender across organisation
Consideration of Women, Girls, Boys and Men
4. The DBC Framework
The DBC Framework is an Evidence Based Behaviour
Change Planning Technique
Uses Barrier Analysis Formative Research to Discover
the Barriers and Motivators of Behaviour Change
Helps Us to Choose Activities That Directly Address
Those Barriers and Motivators
Can be Done Quickly, Cheaply and At Any Stage in the
Project Life-Cycle
5. The DBC Framework
Behaviour Priority and Influencing Group
Description
Significant Determinants Bridges to Activities Activities
Outcome
Indicators:
Process Indicators:
6. The Problem
Women in Kutum are not empowered to be involved in
decision making about themselves or their children to
visit the health care facility in times of illness.
7. The Behaviour
Women in REFLECT Circles in Kutum are
contributing to decision making concerning health
seeking behaviour.
9. Determinants of Behaviour
Determinant
Self – Efficacy / Access (transport, money)
Social Norms (Neighbours, Aunts/Uncles approve,
Grandparents disapprove)
Action – Efficacy (high likelihood of negative effect, effect will
be severe if do not contribute)
10. Bridges to Activities
Determinant Bridges to Activities
Self – Efficacy/
Access (transport,
money)
• Increase the perception that women can
control household money
• Increase the ability of women to access health
services
Social Norms
(Neighbours, Aunts/
Uncles approve,
Grandparents
disapprove)
• Increase the perception that Neighbours and
Aunts/Uncles approve of them contributing to
decision making
• Increase the perception that Grandparents
approve of contributing to decision making
Action – Efficacy
(high likelihood of
severe, negative
effects)
• Increase the perception that not contributing
to decision making can result in a high
likelihood of serious effects on health
11. Activities
Bridges to Activities Activities
Increase the
perception that
women can control
household money
Village Savings and Loan Associations
• “Social Funds” to access emergency care
• Control of own money earned through IGA
Discussion Fora
• Role play how to discuss accessing the clinic
• Invite key influencers to participate in
discussions
Increase the ability of
women to access
health services
12.
13. Activities
Bridges to Activities Activities
Increase the
perception that
Neighbours and
Aunts/Uncles
approve of
contributing to
decision making
• Follow up Focus Groups with these identified
influencing groups to discover their true
feelings on the behaviour
• Discussion fora with influencers and Priority
Group members to create space to hear
opinions and develop solutions
• Women supported to identify their “support
person” who they can go to in the event they
require support in contributing to decision
making
• “Hands Up Approval” in Community Meetings
• Training of Community Leaders
Increase the
perception that
Grandparents
approve of
contributing to
decision making
14. Activities
Bridges to Activities Activities
• Increase the
perception that
not contributing
to decision
making can result
in a high
likelihood of
serious effects on
the health of the
children
• Sharing of Most Significant Change stories
• Creation of Contrast Stories by the women in
the Circles for sharing
• Discussion fora with local health extensionist
• Training of REFLECT facilitators by health
extensionist on prompt care-seeking
• REFLECT manual reviewed and additions
made by the Endemic Sickness Unit
15. Next Steps
Identified activities to address barriers are being
integrated into a number of ongoing GOAL projects
REFLECT Circles
NIPPs Circles
We are planning to trial Care Groups in Kutum and
will integrate DBC activities.
Framework is considered when we are developing new
projects to show evidence-base of our selected
activities
16. Early Results
Increase from 30% to 50% of REFLECT circle women
who contribute to decision making
VSLA activities have improved the perception of
women that they have the emergency funds to make
the decision to access care.
Pre/Post Test increase from 5% to 75% of community
leaders who report their approval of women
contributing to decision making for care seeking
following training
17.
18. DBC’s Added Value
No more assumptions!
Building the evidence base for how to increase access
and control for women
Respecting the time of our target population
More emphasis on influencers
19. Lessons Learnt
Challenging to come up with innovative activities to
address barriers
Support from Global Tech Team
Global Community of Practice
Integration of activities requires buy-in from all levels
of in-country team
Reflect is an innovative approach to adult learning and social change that fuses the theories of Paulo Freire with participatory methodologies developed for Participatory Rural Appraisal (PRA). Central to Reflect is an awareness of power dynamics and relationships, and the effect of this on participation and learning. As such, the approach requires a transformation of traditional classroom roles, placing learners at the centre of their own learning process. The teacher becomes facilitator, their role transformed from one of directing or transferring knowledge to one of facilitating, sharing, enabling and catalysing, as well as learning and reflecting themselves. The participants therefore set their own agenda, identify their own issues, prepare their own learning materials and act on their analysis. Underpinning the approach is a huge (and ever-expanding) range of participatory tools and techniques.
REFLECT aims to achieve social change
Demographics: female, aged 15-49, most married with children, 10 SDG/day income, Arabic speaking, little to no formal educationWhat They Do: farming, selling in market, childcare, social engagements, keeping the home, attendance at REFLECT, other community activities.What They Want: education for self and children, regular income, food security
Perceived Self EfficacyNonDoers perceive that as women do not have money, it is difficult to contribute to the decision NonDoers perceive that having no transport to the clinic makes it difficult to contribute to the decision Perceived Social NormsNonDoers perceive that Neighbours and Aunts and Uncles approve of them contributing to the decisionNonDoers perceive that Grandparents disapprove of them contributing to the decisionDoers perceive that the majority of the people they know support their contributing to the decisionPerceived Action EfficacyNot contributing to the decision can lead to a high likelihood of a negative effect on the health of the childrenNot contributing to the decision can result in very serious effects on the health of the children
Training of community leaders led to 75% saying they approve of women being involved.
Comm leader dancing with Reflect women.Acknowledgement of men as agents of change