South Sudan Provider Behavior Change Toolkit: Family Planning Focus

"The keystone of this toolkit is empathy. It is critical to remember that providers are real people whose behavior is influenced by diverse factors, some of which are outside of their direct control."

The South Sudan Provider Behavior Change Family Planning (PBC FP) toolkit seeks to support the design, implementation, and evaluation of effective facility-based provider behaviour change initiatives within family planning and reproductive health (FP/RH) programmes. It guides users through a holistic, yet rapid and flexible, process for supporting providers in adopting and maintaining positive behaviours towards their clients and in the workplace. The toolkit is a slightly adapted version of the Provider Behavior Change (PBC) Toolkit that was created by Breakthrough ACTION, together with the Provider Behavior Ecosystem Map (see Related Summaries, below). The adaptations of parts of the toolkit were undertaken by MOMENTUM Integrated Health Resilience for use in fragile and conflict-affected settings (see more information below on the adaptation process).

As Breakthrough ACTION explains, "Providers' interactions with clients can influence health-seeking behavior, including those related to family planning. Thus, it is critical to understand both what influences provider behavior and how to encourage and support provider behaviors that help clients achieve their reproductive intentions or fertility desires. Furthermore, providers operate in complex systems that directly and indirectly impact who they are and how they act. Provider behavior results from a complex web of interrelated internal (e.g., knowledge, attitudes, beliefs, values, and preferences) and external (e.g., social norms, medical education and training, professional development, workplace environment, and health care financing and resources) factors. Designing impactful, scalable, and sustainable interventions requires a contextual understanding of providers and the people who interact with them."

The PBC FP toolkit follows a four-step process:
 

1. Prepare - involves identifying focus behaviours and facilities and laying the groundwork for data collection and ideation;
2. Inquire - involves collecting data on provider behaviour influences across several levels of the ecosystem, including the client, provider, community, workplace environment, and health system levels;
3. Synthesise - involves making sense of the data and identifying areas to prioritise in programme design; and
4. Act - involves generating solutions for supporting provider behaviour based on the needs identified.

The toolkit consists of the following: 

South Sudan Provider Behavior Change Toolkit: Family Planning Focus - Instruction Booklet [PDF]: This booklet provides step-by-step guidance to prepare, implement, and use the toolkit, and it includes sample schedules, mobilisation plans, and team structures.

Accompanying the booklet are various worksheets and materials for each step of the process. They are:

Step 1. Prepare
 

• Behavior Mapping Worksheet [PDF]

Step 2. Inquire
 

• Behavioral Blueprint for Health Officers [PDF]
• Behavioral Blueprint for Providers [PDF]
• Influencing Factor Cards [PDF]
• Observation Guide [PDF]
• Scenario Tool [PDF]

Step 3: Synthesis 
 

• Daily Synthesis Sheet [PDF]
• Global Synthesis Sheet [PDF]
   

Step 4: Act
 

• Ideation [PDF]
• Inspiration Cards [PDF]
• Action Plan [PDF]
   

The adaptations for the South Sudan context, which is marked by conflict, were made based on consultations with field teams and core-level resilience and gender teams. As explained by MOMENTUM Integrated Health Resilience, "These challenging settings have a different set of constraints, logistics, and operations that sometimes warrant adaptations of tools and approaches used for health service delivery." For example, when staff were orienting stakeholders from the South Sudan Nurses and Midwives Association and the United States Agency for International Development (USAID) Mission on the toolkit, it became apparent that more visual aids were needed to allow the team to more readily grasp the toolkit's overarching concepts and understand how they could be applied at ground level. Changes also had to be made based on the fragile social and political context. For example, new influencing factor cards were made, taking into account issues such as community-level discriminatory or stigmatising practices towards gender-based violence survivors; community experiences of outbreaks, shocks, or stresses (climatic, economic, social); limited family/community cohesion; insecurity and political instability; and high turnover or strikes among health staff.

A seven-part video series was developed by MOMENTUM Integrated Health Resilience to help unpack the South Sudan Provider Behavior Change Toolkit and to guide viewers/trainees through the adaptation and implementation process, while highlighting the adaptations suggested for fragile settings. Click here to access the seven-part video series.