How Donors Can Collaborate to Improve Reach, Quality, and Impact in Social and Behavior Change for Health

"Global health programming is grounded in mutually reinforcing investments in policy, supply chains, service delivery, and social and behavior change (SBC), which uses evidence-based interventions to increase the adoption of healthy behaviors by individuals and influence the social norms that underpin those behaviors."

Funders of global health initiatives grounded in social and behaviour change (SBC) approaches have increasingly recognised demand-side barriers to improved health and the value of collaboration around SBC programming, research, and evaluation. Such collaboration could help reduce duplication of effort, improve support to implementers, and increase co-investment. In December 2018, the Bill & Melinda Gates Foundation (BMGF), the United States Agency for International Development (USAID), and the Children's Investment Fund Foundation (CIFF) convened a meeting of the newly formed SBC Donor Group with staff from several donor organisations to discuss how their efforts to use SBC to create demand for health products and services could be better coordinated among donors and multilateral organisations. This commentary builds upon and expands the document review and in-depth interviews undertaken to inform a background paper for the meeting.

First, the article presents four models of donor collaboration and offers examples of each from SBC investments. The models share some common features, including a recognition that collaboration occurs along a spectrum - from informal groups that are loosely structured, to more formal groups that are more closely integrated. The models include: GrantCraft, Catalyst of San Diego and Imperial Counties (formerly San Diego Grantmakers), Bridgespan, and Collective Impact (CI). Details are provided about each; for example, the "Learn-Plan-Act" model proposed by San Diego Grantmakers describes funders' motivations to work with other funders along a continuum of how committed they are to learning together, planning together, or acting together. (See the commentary's Supplement [PDF] for additional examples.)

Next, the commentary outlines factors associated with the success and failure of donor collaborations, particularly those focused on demand and behaviour change in global health. To facilitate donor collaboration, participating donors are encouraged to:

1. Define group purpose, goals, and roles clearly and early on - "Facilitators should...work to understand the politics, backstories, and relationships among group members that may impact the achievement of shared goals."
2. Support host country leadership - "This principle is particularly true of SBC, given a historical over-reliance on donor funding in many countries and potential sensitivities around the imposition of sociocultural norms."
3. Recognise and leverage the different strengths of private and public donors - "The Ouagadougou Partnership offers an example of this public-private collaboration. USAID, the William and Flora Hewlett Foundation, BMGF, and other private donors have worked closely together to highlight the need for increased attention to demand-side drivers of family planning use."
4. Demonstrate commitment by investing resources - "Members of collaborations must have a vested interest in the collaborative activity, but they need not commit equal amounts of funding to participate as equals."
5. Use honest conversations about failure to inform a joint learning agenda - "Having some agreed-upon goals as well as indicators of progress and success can help facilitate these honest conversations."
6. Encourage proactive communication and informal discussion - "Members of strong collaborations stress the importance of cultivating trust among new and existing members and establishing expectations and habits that facilitate constructive relationships over time."
7. Take the time to understand collaborating organisations' grantmaking, procurement, and compliance processes - "Doing this can...allow donors to leverage each other's funding streams effectively and efficiently."
8. Consider using a trusted member (or an intermediary) to progress work - For example, Alive & Thrive (A&T) has provided backbone support for a multilayered SBC initiative, funded by BMGF and Irish Aid. A&T organised large events with the United Nations Children's Fund (UNICEF) to build and maintain momentum around infant and young child feeding (IYCF) policy enhancement in seven countries in southeast Asia.
9. Seek early wins that build confidence in the group - "In preparation for the group's initial meeting in December 2018, participants provided information to BMGF about their organization's investments in SBC in prioritized countries. BMGF and a consultant collated this information and reformatted it into a database and maps of donors' SBC investments in selected countries."

As reported here, since the December 2018 meeting, the SBC Donor Group met several times in 2019 and twice in 2020 to discuss "how donors were responding to the coronavirus disease (COVID-19) pandemic in the area of risk communication. The group's first meeting of 2021 addressed expanding the use of SBC for health systems change rather than limiting its use to individual behavior change. The group intends to support agenda-setting for the next International SBCC Summit (scheduled for December 2022) and will likely use this forum to assess the group's results to date, expand membership with more donors based in countries of implementation, and identify specific opportunities for collaboration and cofunding."

In conclusion, the authors urge funders to move beyond a small number of participating donors and their staff to engage a broader range of organisations and individuals in investing in demand-side SBC programming. Achieving this broader participation will require both documentation of the results of donor collaboration and targeted outreach. As collaborations such as the SBC Donor Group mature, "it will be important that they move beyond sharing information to enable more integrated coordination, co-investment, and even cocreation of investments. Global and regional collaborations among donors must also seek to engage host country governments and regional coordinating bodies as leaders in the work of SBC."