Designing Linkages between SBCC and Service Delivery
Designing Linkages between SBCC and Service Delivery
Given the importance of quality service delivery to sustained behavior change on many health topics, it is important to think about how your integrated SBCC program connects to service delivery. As noted previously, SBCC programs can be considered integrated even when they are not integrated with or within service delivery. However, even when an integrated SBCC program is not formally mandated to integrate with service delivery, it is important to consider the implications of your program for service delivery. This is especially true when driving demand for multiple health areas. In most cases, there is at least a basic level of integration between SBCC and service delivery, and within health services themselves.
Whether or not your integrated SBCC program has a formal service delivery component, consider factoring the following into the strategic design.
Service Delivery Considerations
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Engage relevant institutions and providers in the early stages to gain buy-in for integration. Explore how to ensure service availability, and seek out input on and approval of key messages – especially information the program wants providers to deliver. Invite service delivery representatives to SBCC coordinating bodies or working groups if they are not already a part of these groups. Attend service delivery meetings, observe counseling sessions or find other ways to better understand providers’ needs.2 of 5
Determine the extent to which service delivery health programs are already integrated. For example, how many health programs will the SBCC program have to link with? One integrated structure, or several vertical structures? How much extra effort will this require in terms of message approval, provider training, monitoring and other areas?3 of 5
Map out all of the contact points with clients along the continuum of care for the various health areas of focus. Think about how best to optimize each of those points, and ensure no opportunities are missed to provide necessary information and links to services at each point. At the health facility, for example, there are opportunities at ANC, intrapartum, postnatal care, immunization, family planning and well child visits, among others. Similarly, map out the timing of each of the CHW’s home visits and consider other opportunities at these entry points.4 of 5
Determine the capacity of the health system and providers to meet an increased demand for services. What efforts will be necessary to ensure a quality supply of services? Do you need to consider a phased approach to allow supply to match demand?5 of 5
Consider how to effectively engage and train service providers. Service providers must be knowledgeable about and comfortable discussing the range of topics with clients. They must be able to provide the services or make effective referrals. They must also be willing and able to report on service delivery for monitoring purposes. All of these have implications for the design of your program. Will capacity strengthening be necessary? What job aids and other support will be required? What structures need to be put in place?
Engaging and Preparing Providers
In an integrated SBCC program, service providers at the community and facility levels usually have a role to play in delivering and reinforcing key information. It is critical that they feel involved and capable of doing what is being asked of them. Find more information about IPC interventions here.
- Assess the capacity of the providers you plan to work with, then strengthen capacity where necessary. What IPC skills and practices do they possess? What do they already know about the health topics? How able are they to make connections between health topics? Build on what providers know and be sure not to add tasks or information too quickly.
- Build health worker capacity to communicate in interpersonal settings in a meaningful way. Ensure they are truly able to understand a client’s needs and challenges, tailor communication to their needs, facilitate meaningful and participatory dialogue, and employ approaches that facilitate community-driven ownership and action.
- Determine the providers’ workload. Design strategies for helping providers effectively integrate topics and meet multiple needs at once. Train providers to probe and make connections to maximize client benefit. Help providers see the benefits of integrated programming – particularly how it can help them. Sometimes it may be beneficial to consider opportunities for task shifting, or sharing certain elements of the service delivery process with other providers, volunteers or health champions.
- In collaboration with service delivery programs, help establish systems and structures for quality services. For example, how to provide referrals between and within the SBCC and service delivery programs; how to ensure effective coordination between community-level and facility-based providers; and policies or systems for enabling task shifting.
Tip
Integrated SBCC programs have found different ways to assist CHWs and facility-based providers in counseling and message prioritization for integrated SBCC through training and materials. Some possible approaches include: phased-in training, discussion cards organized by topic, multi-topic flip charts, pre-loaded tablets and mobile applications (apps) for basic or smart phones. Examples can be found in Project Examples.
Tip
For integrated programs, providers especially need to be able to quickly get the client talking about her/his needs, issues and status to be able to cover the critical topics well, given the time available. Ensuring providers practice effective IPC can be key to helping clients adopt and maintain desired behaviors.
Program Experience
Task shifting (specifically around counseling) might be required to ensure enough time to effectively communicate multiple messages. In Malawi, for example, Mentor Mothers provide HIV education, support and referrals on TB, infant and maternal nutrition, cervical cancer and malaria, so the provider only needs to verify the clients’ understanding and needs. Additionally, group-based ANC has been a way to provide higher quality care to women in a more efficient manner.
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