Outcome Harvesting Evaluation of Social and Behavior Change Activities Focused on Zoonotic Diseases

"...this approach [outcome harvesting] enabled Breakthrough ACTION Guinea to identify both anticipated and unanticipated outcomes, providing a comprehensive yet nuanced understanding of the project's impact."



This report shares the results from an outcome harvesting evaluation of Breakthrough ACTION Guinea's activities to address priority zoonotic diseases, including COVID-19 and Ebola. It provides an overview of project activities and the multi-step outcome harvesting process used to evaluate it. The report presents and synthesises the outcomes, including the potential sustainability of the outcomes. It is hoped that the report's discussion and recommendations may help other projects, stakeholders, and donors interested in implementing their own outcome harvesting process.



As explained in the report, "Since 2018, Breakthrough ACTION Guinea has supported and collaborated with the government of Guinea, particularly the Agence Nationale de Sécurité Sanitaire (ANSS) and Service National de Promotion de la Santé (SNPS), to effectively address priority behaviors, build demand for health services and healthy behaviors, develop capacity in SBC among Guinean institutions, and strengthen linkages between communities and the health system. Its health focus areas include integrated health, COVID-19, priority zoonotic diseases, and other emerging threats. Breakthrough ACTION uses a coordinated range of communication channels and approaches grounded in behavioral theory and informed by research and programmatic experience. The approaches are designed and implemented following a systematic and proven process to achieve individual and collective behavior change."



The outcome harvesting was conducted in 2023 to evaluate the success of its zoonotic disease prevention efforts, including COVID-19. Outcome harvesting is described in the report as "an evaluation methodology that involves collecting evidence on what has changed since implementation of the project and working backwards to assess how the project contributed to those changes. The process can identify both intended and unintended outcomes. Outcome harvesting uses existing program documentation as the primary source of evidence to justify the connection between project activities and specific outcomes. Once initial outcomes have been drafted, they are subsequently subjected to internal and external verification to confirm the link between project activities and outcomes." The report explains the process in detail and how it led to 36 outcomes being identified across four chosen health areas and four types of programme activities (the 26 outcomes are listed in the Annex). The three health areas are Ebola, COVID-19, and global health security (GHS). The four types of programme activity are:

• Coordination and risk communication systems
• Public communication
• Capacity strengthening of individuals
• Community engagement

The findings outlined in the report look at outcomes per programme activity, number of outcomes per year, outcomes by social and behaviour change communication (SBCC) capacity ecosystem level (individual, organisational, and system) and the sustainability of outcomes. For example, the majority of outcomes stemmed from either risk communication (n = 15) or public communication activities (n = 13). From a socio-ecological perspective, the results showed that the impact was at the following levels: individual (n = 16), organisational (n = 13), and system (n = 7) levels.



The results are discussed for each activity area, offering a description of the activity, a sample of the outcomes in that area, and implementation details related to the most notable outcomes. The following are examples of some of the outcome harvesting results that highlight Breakthrough ACTION's success:



Project Area: Coordination and Risk Communication Systems

• Outcome: Guinea's Coordination and Risk Communication Systems IHR (International Health Regulations) scores rose from 1s and 2s in 2018 to all 4s at the 2023 joint external evaluation.
• Importance: Improved scores increased confidence in Guinea's Coordination and Risk Communication Systems capacity.
• Breakthrough ACTION contribution: Breakthrough ACTION supported the implementation of several coordination and risk communication systems activities that led to increased IHR scores, including the development of standardised documents, support for coordination and risk communication systems meetings, and capacity building.

Project Area: Ebola

• Outcome: In 2021, journalists reported on Ebola based on information from the National Health Security Agency, a reliable source.
• Importance: Reliable news and information minimise rumours and fear by keeping the public informed.
• Breakthrough ACTION contribution: In March 2021, Breakthrough ACTION trained journalists on communication in the fight against Ebola.

Project Area: COVID-19

• Outcome: Since December 2021, vaccinations for COVID-19 have risen steadily in Faranah, Boké, Kindia, Labé, and Nzerekore regions.
• Importance: Increased vaccination coverage promotes protection against COVID-19.
• Breakthrough ACTION contribution: Breakthrough ACTION has run a multi-channel communication campaign since May 2021, including interactive voice response (IVR), interactive broadcasts, audio and video spots, and billboards.

Project Area: Community Engagement

• Outcome: Since 2020, some nongovernmental organisations (NGOs) have continued to implement Community Action Cycle (CAC) activities, although they are no longer under contract with Breakthrough ACTION.
• Importance: Continued use of CAC strategies for community engagement effectively communicates messages and drives effective community outreach.
• Breakthrough ACTION contribution: Since 2019, Breakthrough ACTION has participated in building community players' capacity for innovative CAC approaches and has provided logistical and financial support for implementation.

Based on the findings, the report shares insights related to each of the activity areas:  



Public communication: Most outcomes in this programmatic area stemmed from the One Health and Risk Communication training programme held in June 2021. This training aimed to empower journalists, government representatives, and public health spokespeople with skills to discern reliable information from misinformation and to enhance their ability to effectively communicate that information.



Coordination and risk communication systems: This programmatic area yielded the highest total number of outcomes (n=15) and the most sustainable outcomes (n=9). These outcomes were closely tied to Breakthrough ACTION Guinea's activities, such as facilitating the organisation of Integrated Operational Action Plan (IOAP) evaluations and revisions, crafting and disseminating guides and protocols to streamline programmatic efforts, and extending support through technical expertise to other coordination and risk communication systems and GHS actors to better prepare the Guinean government to respond to a GHS emergency.



Capacity strengthening of individuals: Only one outcome was related to capacity strengthening of individuals. Although Breakthrough ACTION Guinea worked to enhance the country's ability to handle zoonotic diseases and enhance the capacity of individuals, the results of this effort are not best captured through evaluation methodologies such as outcome harvesting.



Community engagement: Among the various activities undertaken in this programmatic area, the community dialogue events contributed many outcomes, nearly all of which highlight the importance of community engagement in amplifying voices and facilitating learning. The impact of this approach extended beyond individual behaviour change to produce transformative effects at the organisational level. After receiving training on this activity by Breakthrough ACTION Guinea personnel, partner organisations embraced it.



The report concludes with the following recommendations, which are based on the above insights:

1. Enhance coordination and risk communication systems. Trainings and support provided under this programmatic activity proved to be sustainable and increased the capacity for partners to independently carry out programming activities, even after Breakthrough ACTION Guinea concluded its involvement.
2. Expand communication avenues with the public by providing effective communication methods training to a broader target. Investing in communication training is vital to maintain information accuracy. Breakthrough ACTION Guinea's work decreased the spread of misinformation related to zoonotic diseases; more work in this area could bridge remaining information gaps and ensure traditionally hard-to-reach communities receive accurate health information.
3. Brainstorm methods to effectively evaluate capacity-strengthening efforts for individuals.
4. Continue training partners on One Health topics to ensure widespread adoption of community-based dialogue as a means of conveying messages, ultimately contributing to the enhancement of overall public health communication.

Click here for the French version of this 102-page report in PDF format.