Building Capacity in Social and Behaviour Change Communication (SBCC) for HIV Prevention An African-based Programme Sara Nieuwoudt (1), Nicola Christofides (1) & Shereen Usdin (2) 1.Division of SBCC, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Wits) 2.Soul City Institute for Health and Development Communication (SC:IHDC)

Partnership Vision To create a recognized and accredited African- led and based platform supporting the development of practitioners and academics with the SBCC competencies required to address Africa’s public health priorities

Location: Johannesburg, South Africa Geographic Focus: Sub-Saharan Africa Estimated HIV prevalence among young adults (15-49) by country Image Credit: Wikimedia Commons

Communication as a tool for HIV prevention

Social & Behaviour Change Communication as a Discipline Image credit: McKee, Manoncourt & Chin, 2000 Promotes: Multi-level analysis of situation, including social determinants of health Targeted and multi- level responses Evidence-based programming

Universities Training for the Market Competency-based Curricula Knowledge of:  key monitoring, evaluation, and research concepts  tools and methodologies for monitoring, evaluation and research  qualitative and quantitative research methods  participatory research methodologies  frameworks for project evaluation Ability to:  select relevant indicators for measuring project processes and results  develop and implement monitoring plan with data collection tools  determine effectiveness of communication strategy  identify problems in design and/or implementation  maintain management information system (MIS)  use MIS to inform project direction  conduct participatory monitoring, evaluation, and research  document and communicate best practices Values:  do not “doctor data”  learn from mistakes or non-success in programs  use monitoring and evaluation data to improve program activities  reliance of multiple methods for monitoring and evaluation  systematic use of monitoring and evaluation at all levels of SBCC work Example: Research, Monitoring & Evaluation Competency Framework

Problem Analysis In 2008, many SBCC Practitioners working on HIV prevention were: – In leadership positions, without public health or specific communication qualifications – Desiring professional development opportunities beyond non-accredited training – Not able to afford overseas study (SC:IHDC, 2008; 2010)

Establishing a platform for capacity building takes time Secured funding from DFID, CDC & C-CHANGE in 2008/09 Hired external staff to lead program development Study tour and adaptation of competency framework May 2009 Consultative Meeting Course development and accreditation Pilot of first course in December 2009 First cohort enrolled in 2010 Division Launch in 2010 The entire process involved a mix of stakeholders, including practitioners & academics from region & abroad

Result: Division of SBCC Open to all course participants, MPH students & program stakeholders (guest lecturers, board, etc.) Academic staff MPH research reports Full and part-time offered over 2-4 years 5 SBCC specific courses 1-week blocks offered for Attendance or Competency 7 accredited Short Courses MPH Program Community of Practice* SBCC Research * Under review due to resource constraints

Division Participant Profile Over 200 short course and 32 MPH students Aged Leaders in HIV responses: – National AIDS Committees, e.g. NERCHA – Government advisors – NGO leaders – Research institutions – Donor agencies, e.g. CDC

Division Reach: Africa and beyond MPHShort course South Africa Botswana Swaziland Lesotho Zimbabwe Ethiopia Malawi Uganda U.S.A. (in RSA) (same as MPH) Namibia Mozambique Nigeria Sudan Niger Egypt Eritrea Ghana Uganda Tanzania Kenya Zambia D.R.C. Burundi India Switzerland Afghanistan + Institutional support to universities in: Nigeria Tanzania Albania

Individual capacity built “ Starting the MPH two years ago, I had lots of practical experience, but now, I have the added benefit of knowing the principles and theory behind the practice. In my work in a large unit dealing with HIV prevention, and working closely with the Department of Health, I have become the go-to person on social and behavior change communication. We no longer tolerate “spray and pray” prevention efforts: it’s all a whole lot more targeted and effective.” – MPH Student

Institutional capacity strengthening Individuals contribute to their institutions Institutions sending multiple individuals on short courses/MPH note shift in institutional culture Plans to systematically evaluate outcomes & impact Tracer study – MPH student professional development/employment – Performance (self- and employer-assessed) Comparison of short-courses vs. integrated degree learning

Lessons: Factors of Success Allows for professional development with accredited certification/degree, while maintaining focus on developing the hard skills required for practitioners Partnership between academic and practitioner institutions Allows division to keep current on both academic & practitioners debates related to SBCC Multidisciplinary (communication & public health) Advisory board with local and international membership Bringing on board someone with a core set of skills to guide process Hiring externally to lead and manage program We add value to an already interdisciplinary field with a strong applied focus Able to draw on a broad range of skills (epidemiology, policy, etc.) Housing program within a School of Public Health More open to addressing social determinants of health through intersectoral collaboration, at multiple levels SBCC Framing

Implications for Capacity Strengthening in HIV Understanding HIV with an ecological perspective and being able to use evidence to develop and evaluate our programmes is critical Practitioners have an important role in defining what competencies (knowledge, skills & values) are needed, while universities are well placed to delivery competency-based training in a systematic way Embedding training in an academic institution supports sustainability – Also, accreditation offers opportunities for career progression and quality assurance unlike non-accredited training courses Basing the programme in Africa is more cost-effective than sending African practitioners to study overseas and supports instruction and content that is tailored to the African context

Thanks to our past donors!

Slide References Labonte R, Mohindra K, and Schrecker T The Growing Impact of Globalization for Health and Public Health Practice. Annual Review of Public Health, 32: 263–83. McKee N, Manoncourt E, Chin SY, Carnegie R, eds. Involving People, Evolving Behavior. New York: UNICEF; Penang, Malaysia: Southbound; 2000.

SUPPORTING SLIDE

SBCC Accredited courses Applying Social & Behaviour Change Theory to Practice Research, Monitoring & Evaluation for SBCC SBCC Approaches Planning and Implementing SBCC Communication, Media & Society Introduction to Health Promotion Entertainment Education

Context: Complexity & Resource Constraints Image credit: Labonte, Mohindra & Shrecker, 2011