Investing in Social and Behavior Change: Understanding Costing

Breakthrough RESEARCH, led by Avenir Health, is gathering, analyzing, and sharing evidence on the costs and impact of social and behavior change (SBC) interventions. The goal is to make the case that investing in SBC is essential for improving health outcomes and advancing development. Social and behavior change interventions aim to change behaviors by addressing factors such as knowledge, attitudes, and norms. Costing is the process of data collection and analysis for estimating the cost of a health intervention. Nicole Bellows, Senior Associate at Avenir Health, explains that costing is essential for monitoring and evaluation (M&E) and that SBC is complex, making costing more challenging. However, once the interventions are broken down into main cost components, costing SBC is not that hard. Breakthrough RESEARCH has developed a suite of products and tools to make it easier for those interested in SBC to conduct costing work. The suite includes a technical report, "Guidelines for Costing of Social and Behavior Change Health Interventions," a research to practice brief, "The Added Value of Costing Social and Behavior Change Interventions," a social and behavior change cost data repository, and an interactive tool that shows how various SBC interventions affect the modern method contraception prevalence rate (mCPR). The primary objectives of Breakthrough RESEARCH's costing work are to build evidence on SBC cost-effectiveness and to enable others to conduct quality SBC costing. Breakthrough RESEARCH and Breakthrough ACTION are sister projects that collaborate on some activities but are independent. Breakthrough ACTION works in partnerships within countries to implement SBC activities, while Breakthrough RESEARCH focuses on conducting research to generate evidence on what approaches are most effective and cost-effective. Both projects are funded through USAID. The more family planning implementers, donors, and governments integrate costing into M&E frameworks, the larger the resulting evidence base will become. Breakthrough RESEARCH has modeled the cost-effectiveness of family planning SBC investment scenarios in Guinea, Niger, Togo, and Zambia, asking two major questions: What exactly are you doing, and what are your unit costs to reach someone through SBC? For example, in Zambia, Breakthrough ACTION worked with partners to make the case to the National Family Planning Technical Working Group (TWG) to include strategic and specific SBC approaches in the next Costed Implementation Plan (CIP), 2020-2026. The results of the Breakthrough RESEARCH modeling exercise for Zambia were used to make the case for increased family planning SBC investments on the basis that it was found to be highly cost-effective. Looking forward, Breakthrough RESEARCH aims to increase cost data collection and improve the modeling of SBC costing.