Behavior Change Communication for Better Health Outcomes in Africa

This 40-page evaluation report discusses using strategic communication to achieve better health outcomes - something that the World Bank identifies as critical to achieving its goals in Africa, including the Millennium Development Goals. The objective of the study is to contribute to strengthening the work of the World Bank on health, nutrition, and population (HNP) in Africa by distilling experience and lessons learned from behaviour change communication in Bank-financed HNP investment projects in Africa. The principal audience for the paper is World Bank health, nutrition, and population staff, as well as Bank development partners. The study covers sixty-one projects in thirty-six African countries over more than twenty years.

The evidence in this study suggests that, despite acceptance of communication as a legitimate and appropriate project component, behaviour change and behaviour change communication (BCC) have failed to receive the attention they merit in World Bank health, nutrition, and population (HNP) operations. The study also suggests that there are sufficient technical resources available, inside and outside the Bank, for those who would draw upon them. Partnerships are shown to be an important element of successful communication programmes. The study further suggests that communication should be an essential element of the management of all Bank-financed HNP operations, whether they support disease control or health reform. The failure of the Bank to deploy strategic communication to support health reform projects Africa is a striking gap identified in the study.

The study concludes that behaviour change communication is an important part of the landscape of World Bank health, nutrition, and population projects in Africa. The main messages of this report for future action are:

• The techniques of communication can and should make increasing contributions to achievement of the Bank’s HNP goals, not only in connection with HNP investments but also in connection with health reform.
• A social research focus is increasingly important for Bank-supported BCC programmes, throughout the project cycle.
• Changes in perspective by Bank staff are needed: to make its BCC work more effective; to think in terms of long-term programmes and not simply individual HNP investment projects; to move away from a technical assistance focus and formulate objectives in terms of results and measurable changes in behaviour; to draw upon partnerships and support from others; and to conceive of BCC as a management tool.

The growing emphasis on demand variables in Bank operations, the increasing requirements for measurement of results, and the overwhelming importance of HIV/AIDS in the Bank’s work in Africa are all likely to stimulate increasing attention to behaviour change communication and particularly to the social research that underlies it. However, BCC has not had, and is unlikely in the future to assume, financial magnitudes that would justify recruitment of a cadre of technical specialists dedicated full time to support BCC. This makes the availability of internal and external information resources, and the will and ability of staff to draw upon this information and to work in partnership with others, critical to future success.