NGO networks for health : technical approach to behavior change programs

This paper outlines principles and a strategic framework for behavior change (BC) programs, a major Networks focus. Key lessons learned by Networks regarding BC are as follows: (1) BC is both an individual and a group process and is part of the larger process of social change. Many prominent behavior change theories do not sufficiently take into account the cultural and social contexts in which individuals decide and act. (2) BC programs should view partners as agents of their own change rather than as "target audiences" and "beneficiaries" who are objects of change as defined by outside experts. (3) Sound public health knowledge alone cannot effect BC; social, economic, and political factors are also important. There is often a gap between public health knowledge and practice, indicating that while this knowledge plays an important role in BC, it does not necessarily predict behavior. Other social, economic, and political factors greatly influence people"s health-related behaviors. (4) Using the community"s own resources, knowledge, and assets increases the likelihood that BC will be sustained. (5) BC programs should respond to explicit or latent demands that already exist in the community, even those that are unrecognized. In the latter instance, the program should help people articulate their needs and identify their own solutions. (6) Service providers must be empowered if they are to adequately address the needs of their clients and offer quality health services. In most health facilities throughout the world, service providers feel powerless to effect change, are often underpaid and overworked, lack essential supplies, and feel unappreciated. (7) To ensure quality and adequate use of health services, dialogue with the community must be fostered. Health- seeking behaviors depend on a number of factors, but the perceived quality of care is key to whether people use health services or not. Networks itself does not carry out BC programs, but rather supports its partners in focus countries as they design and implement their own programs. The Networks approach encourages partners to begin by gathering information about health conditions and prevailing health practices in program areas through three assessments: an epidemiological assessment to identify the most serious, frequent, and preventable causes of illness and death; a social or quality of life assessment which uses a number of key methodologies, including community diagnosis, participatory rural appraisal, and stepping stones, to determine the views of the community (households, health facilities, key stakeholders) on major health problems; and a behavior and lifestyle assessment, which seeks to identify which behaviors in the community perpetuate health problems and which behaviors prevent them. Networks advocates using a mix of technical approaches to BC, preferably those likely to lead to social mobilization. The four specific technical approaches to promote social mobilization are community mobilization, communication for social change, policy advocacy, and social marketing. At the heart of all four approaches, and of Networks" community-centered, empowerment philosophy and, indeed, of all behavior change, is communication. Networks recommends using a variety of communication channels, including interpersonal communication, counseling, print, popular media (theater, puppet shows, songs, dances), and electronic and other types of mass media.