Recent years have witnessed a shift from development programs that focus on a single health or development topic, to initiatives that encompass multiple topics within a single program. This shift is reflected in the Sustainable Development Goals (SDGs) indicating that integrated programming is a priority across the range of global development areas. In global health specifically, the shift to an integrated approach is a key focus of movements concerned with universal health coverage, primary health care, health systems strengthening and client-centered care. Corresponding to this larger trend toward integrated development, interest in integrated social and behavior change communication (SBCC) programming–SBCC that addresses multiple health topics and behaviors under the same program–has also been increasing as a critical strategy to improve health and development outcomes.
Integrated SBCC refers to SBCC programming designed to cohesively address more than one health or development issue within the same program. Typically, this involves developing a logical and unified SBCC strategy that addresses multiple topics and/or behaviors and considers how they relate or interact with one another. Examples include programs that address:
Integrated SBCC programs can follow one of four different models:
More detailed information on these models can be found in the Implementation section.
SBCC programs may integrate to varying degrees among several dimensions, such as co-location , coordination , collaboration or cross-training (FHI360, 2016). While these dimensions may indeed (and perhaps should) be part of any integrated SBCC initiative, taken separately, they do not constitute complete integration. This I-Kit seeks to guide SBCC programs looking to achieve complete integration, that is when multiple health sectors (e.g., family planning, HIV and RMNCH) jointly plan and implement activities, and comprehensively address all relevant audiences. A completely integrated SBCC program is able to deliver cohesive and logically packaged SBCC interventions that unite divergent health areas.
An integrated SBCC program addresses the interplay among multiple topics. In contrast, a vertical SBCC program addresses an issue in relative isolation. For example, a vertical program may develop an SBCC strategy only for malaria control or only for increasing demand for family planning, but not address RMNCH, HIV or other health topics in the same strategy.
Vertical SBCC Programs
This I-Kit provides guidance to programs seeking to develop an integrated SBCC strategy. It offers insights, recommendations, examples, tools and links to useful resources. It focuses on the aspects of SBCC unique to integrated programming and avoids basic SBCC content that would be applicable to any SBCC program. For information on general SBCC strategy development, visit HC3 Implementation Kits and SBCC How-To Guides. The emphasis of this I-Kit is health, but the concepts and tools may be applied to a range of development issues.
The intended users of this I-Kit are project managers who are considering developing an integrated SBCC strategy, regardless of whether or not service delivery is integrated. This I-Kit assumes the user has prior experience designing and implementing SBCC strategies and wants guidance specific to SBCC for integrated programs. Staff who are not directly implementing programs but who provide oversight or funding for integrated SBCC programs, such as those working for a government ministry or donor agency, and who want to develop a general familiarity with SBCC integration will also benefit from this I-Kit.
Managers may use this I-Kit as a guide to help develop, implement and evaluate an integrated SBCC program that covers multiple health and development topics. Please carefully consider which recommendations may apply to your program and which may need to be modified.
This I-Kit is organized into five sections, each containing a variety of resources.
Start by deciding whether or not to use integrated SBCC. What are the pros and cons of integrated SBCC, and what evidence exists to demonstrate its value?
Next, lay the foundation for integrated SBCC by mapping the landscape, engaging support and preparing for implementation.
Then, strategically design or adapt the integrated SBCC program. Learn what to take into consideration when designing integrated versus vertical programs, how formative research differs in integrated programs and what elements of a communication strategy and concept and materials development and testing are unique to integrated SBCC programs.
Finally, learn about the implementation considerations specific to integrated SBCC programs,
and consider how to monitor and evaluate integrated SBCC, with an emphasis on how to assess the extent and impact of integration.
This I-Kit is a collaboration of the United Nations Commission on Life Saving Commodities and the Health Communication Capacity Collaborative (HC3). Based on an initial systematic literature review, it was clear that SBCC professionals are still in the process of exploring what does or does not work in integrated SBCC programs and how programs can be improved. This I-Kit reflects the findings of that review as well as a two-day expert consultation that convened over 40 experts from around the world to develop recommendations and guidance on the design, implementation and evaluation of integrated SBCC programs. Other source materials include literature reviews, articles and program documents (listed in the Resources section of this I-Kit) as well as interviews with SBCC professionals who have designed and implemented integrated SBCC programs.
This I-Kit draws from the rich discussions at a two day Expert Consultation on Integrated SBCC Programs held in Baltimore, MD in April 2016 and sponsored by HC3 and the UN Commission on Life Saving Commodities. Approximately 46 individuals representing 15 organizations attended and provided their insights, ideas and experience on best practices in integrated SBCC programs.* Those organizations, listed in alphabetical order, were: Abt Associates, Aga Khan University (Karachi Pakistan), Bill and Melinda Gates Foundation, FHI360, Gent University (Belgium), Jhpiego, Johns Hopkins University Center for Communication Programs (CCP), JSI, National Institute of Hygiene and Epidemiology (Hanoi Vietnam), PSI, Save the Children, The Manoff Group, UNICEF, University of Queensland (Australia) and USAID.
We would like to particularly thank the following individuals who gave their time and provided critical feedback and content in the development of the I-Kit: Amos Zikusooka (FHI360), Angela Brasington (USAID), Antje Becker (Save the Children), Carol Hooks (Independent Consultant), Chelsea Cooper (Jhpeigo), Cheryl Lettenmaier (CCP) Joanna Skinner (CCP), Doug Storey (CCP), Heather Chotvacs (PSI), Hope Hempstone (USAID), Ian Tweedie (CCP), Ketan Chitnis (UNICEF), Lydia Clemmons (The Manoff Group), Ron Hess (CCP), Rupali Limaye (CCP) and Stephanie Levy (USAID).
Special thanks to Jen Orkis, Heather Hancock, Katherine Holmsen, Sanjanthi Velu and TrishAnn Davis of CCP for their extensive contribution and assistance in finalizing the I-Kit, and to the communication team at HC3 including Marla Shaivitz, Anna Ellis, Missy Eusebio and Brandon Desiderio for their support in proof reading, formatting and getting the I-Kit online.
Finally, we would like to express our thanks to the HC3 USAID management team for their enthusiasm, support and intellectual contributions to this project.
*The participant list of individuals and their organizational affiliation can be found under the Resources section of this I-Kit.
Start by deciding whether or not to use integrated SBCC.
Map the landscape, engage support and prepare for implementation.
Strategically design or adapt the integrated SBCC program.
Learn about the implementation considerations specific to integrated SBCC programs.
Consider how to monitor and evaluate integrated SBCC, with an emphasis on how to assess the extent and impact of integration.