SBC Palika Package: Social and Behavior Change Capacity Strengthening Support Material for the Local Level

"SBC is the inevitable foundation on which to create demand for health care."

This Social and Behavior Change Palika Package, developed by Breakthrough ACTION, is intended for local-level health personnel in Nepal to support the development, advocacy, implementation, monitoring, and evaluation of social and behaviour change (SBC) efforts. Developed specifically for the Nepalese context, it includes an introduction to SBC for health, the rationale and process for including SBC in annual planning efforts, and guidance on how to include and implement SBC for health activities in local-level annual plans.

As explained in the guide, when Nepal transitioned to a federal system, the strategic, financial, and programmatic decision-making about all services, including health, was moved to the local municipal level. "The nexus of decision-making power has devolved to 753 of these municipalities. Local decision-making can transform a municipality to better serve its local populace; however, the transition comes with challenges. One of these challenges for those in the health sector is how health and social and behavior change (SBC) for health can lose priority in the strategic planning process, especially among a newly elected cadre of local officials. In addition, with the transition to the federal system, it was not clear how the municipal-level health coordinator - the government designate for managing health planning, including SBC - was meant to do their job within this new system."

The SBC Palika Package was therefore designed (using a human-centred approach involving local staff) to support local-level officials and elected bodies to:
 

• Develop capacity and skills to plan, implement, and monitor and evaluate evidence-based SBC activities in local-level health programmes;
• Understand the objective and importance of reaching the targeted groups for health programmes;
• Clarify planning and implementation of SBC for health programmes that ensure maximum participation of local stakeholders and resource mobilisation; and
• Build the capacity to include evidence-based SBC for health activities in local annual plans through a seven-step planning process. 
   

The guidance in the package is linked to the timing and roles of the Nepal government seven-step planning process and consists of the following five sections:

1. Introduction to the SBC Palika Package
This section introduces the package's objectives, content, intended audience, and guidelines for when to use it. It also clarifies the roles of each of the different government agencies and stakeholders needed to incorporate SBC for health into the existing system.

2. Introduction to Social and Behavior Change
SBC is a new term for many local-level government staff and not well understood or valued as an important approach. This section seeks to help government staff understand what SBC is and why it is important to consider when designing and implementing programmes. It provides an example of a programme in Nepal that used behaviour change approaches and had a significant impact.

3. Pre-planning
This section offers support to government staff to incorporate SBC into the actual pre-planning phase. It includes guidance for the following steps:
 

• 3.1 Collect and analyse local-level statistical data on population and health
• 3.2 Collect information from the community about behavioural and social factors related to health
• 3.3 Present findings at the Health Facility Operation and Management Committee (HFOMC) meeting
• 3.4 Present activities and budget to ward committee 
   

4. Advocacy: The process of annual action plan and budget formulation at the local level - role of health section
This section offers support to government staff to incorporate SBC into advocacy during the planning process. It offers guidance for reaching the following stages:
 

• Stages 1 and 2: Information about the programme and budget received from the conditional grant
• Stage 3: Involvement of health workers in the selection of cluster-level plans
• Stage 4: Confirm plans are prioritised in the cluster-level meeting
• Stage 5: Confirm activities of the budget and programme formulation committee
• Stages 6 and 7: Advocacy with executive members

5. Implementation, monitoring and evaluation: Post approval of annual programme and budget - role of health section
This section offers support to government staff to incorporate SBC into post government planning processes. The section includes guidance on the following steps: 
 

• 5.1 Preparation of the comprehensive action plan based on approved programme and budget
• 5.2 Implementation of the action plan
• 5.3 Monitoring and evaluation of SBC programmes
• 5.4 Presentation of the monitoring and programme report.

The package also includes the following Annexes with further guidance: 
 

1. Example community dialogue plan with community members and audiences/populations of interest
2. Report of the community dialogue with community members and audiences/populations of interest
3. Checklist to review the materials for use at the local level
4. Methods to adapt available communication materials at the local level
5. Stages of material production
6. Details to include according to the agreement while issuing a call for proposal for material production
7. Health indicators for monitoring and evaluation of social and behaviour change programmes for health
8. Roles, duties, and responsibilities of the Health Facility Operation and Management Committee chairperson
9. Members involved in the development of this support material