Gillian McKay
Behaviour Change & Gender Officer
GOAL Ireland
Global Health Practitioners Meeting
“Health Starts at the Com...
GOAL’s Work in Kutum, North
Darfur, Sudan
 Integrated Programme
 Primary Health Care
 Community Health
 Nutrition
 Li...
GOAL & Gender
 GOAL is committed to gender equality throughout the
organization and in addressing the basic rights and
ne...
The DBC Framework
 The DBC Framework is an Evidence Based Behaviour
Change Planning Technique
 Uses Barrier Analysis For...
The DBC Framework
Behaviour Priority and Influencing Group
Description
Significant Determinants Bridges to Activities Acti...
The Problem
 Women in Kutum are not empowered to be involved in
decision making about themselves or their children to
vis...
The Behaviour
 Women in REFLECT Circles in Kutum are
contributing to decision making concerning health
seeking behaviour.
The Priority Group
Determinants of Behaviour
Determinant
Self – Efficacy / Access (transport, money)
Social Norms (Neighbours, Aunts/Uncles a...
Bridges to Activities
Determinant Bridges to Activities
Self – Efficacy/
Access (transport,
money)
• Increase the percepti...
Activities
Bridges to Activities Activities
Increase the
perception that
women can control
household money
Village Savings...
Activities
Bridges to Activities Activities
Increase the
perception that
Neighbours and
Aunts/Uncles
approve of
contributi...
Activities
Bridges to Activities Activities
• Increase the
perception that
not contributing
to decision
making can result
...
Next Steps
 Identified activities to address barriers are being
integrated into a number of ongoing GOAL projects
 REFLE...
Early Results
 Increase from 30% to 50% of REFLECT circle women
who contribute to decision making
 VSLA activities have ...
DBC’s Added Value
 No more assumptions!
 Building the evidence base for how to increase access
and control for women
 R...
Lessons Learnt
 Challenging to come up with innovative activities to
address barriers
 Support from Global Tech Team
 G...
Acknowledgements
Questions?
Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Gillian McKay_5.6.14
Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Gillian McKay_5.6.14
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Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Gillian McKay_5.6.14

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  • Reflect is an innovative approach to adult learning and social change that fuses the theories of Paulo Freire with participatory methodologies developed for Participatory Rural Appraisal (PRA). Central to Reflect is an awareness of power dynamics and relationships, and the effect of this on participation and learning. As such, the approach requires a transformation of traditional classroom roles, placing learners at the centre of their own learning process. The teacher becomes facilitator, their role transformed from one of directing or transferring knowledge to one of facilitating, sharing, enabling and catalysing, as well as learning and reflecting themselves. The participants therefore set their own agenda, identify their own issues, prepare their own learning materials and act on their analysis. Underpinning the approach is a huge (and ever-expanding) range of participatory tools and techniques.
  • REFLECT aims to achieve social change
  • Demographics: female, aged 15-49, most married with children, 10 SDG/day income, Arabic speaking, little to no formal educationWhat They Do: farming, selling in market, childcare, social engagements, keeping the home, attendance at REFLECT, other community activities.What They Want: education for self and children, regular income, food security
  • Perceived Self EfficacyNonDoers perceive that as women do not have money, it is difficult to contribute to the decision NonDoers perceive that having no transport to the clinic makes it difficult to contribute to the decision Perceived Social NormsNonDoers perceive that Neighbours and Aunts and Uncles approve of them contributing to the decisionNonDoers perceive that Grandparents disapprove of them contributing to the decisionDoers perceive that the majority of the people they know support their contributing to the decisionPerceived Action EfficacyNot contributing to the decision can lead to a high likelihood of a negative effect on the health of the childrenNot contributing to the decision can result in very serious effects on the health of the children
  • Training of community leaders led to 75% saying they approve of women being involved.
  • Comm leader dancing with Reflect women.Acknowledgement of men as agents of change
  • Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Gillian McKay_5.6.14

    1. 1. Gillian McKay Behaviour Change & Gender Officer GOAL Ireland Global Health Practitioners Meeting “Health Starts at the Community” Silver Spring, Maryland May 5th -9th 2014
    2. 2. GOAL’s Work in Kutum, North Darfur, Sudan  Integrated Programme  Primary Health Care  Community Health  Nutrition  Livelihoods  WASH  REFLECT (Regenerated Frerian Literacy Through Empowering Community Techniques)
    3. 3. GOAL & Gender  GOAL is committed to gender equality throughout the organization and in addressing the basic rights and needs of vulnerable populations throughout the developing world by focusing on gender issues across the full range of sectors within existing policies, development strategies and priorities.  Mainstreaming of Gender across organisation  Consideration of Women, Girls, Boys and Men
    4. 4. The DBC Framework  The DBC Framework is an Evidence Based Behaviour Change Planning Technique  Uses Barrier Analysis Formative Research to Discover the Barriers and Motivators of Behaviour Change  Helps Us to Choose Activities That Directly Address Those Barriers and Motivators  Can be Done Quickly, Cheaply and At Any Stage in the Project Life-Cycle
    5. 5. The DBC Framework Behaviour Priority and Influencing Group Description Significant Determinants Bridges to Activities Activities Outcome Indicators: Process Indicators:
    6. 6. The Problem  Women in Kutum are not empowered to be involved in decision making about themselves or their children to visit the health care facility in times of illness.
    7. 7. The Behaviour  Women in REFLECT Circles in Kutum are contributing to decision making concerning health seeking behaviour.
    8. 8. The Priority Group
    9. 9. Determinants of Behaviour Determinant Self – Efficacy / Access (transport, money) Social Norms (Neighbours, Aunts/Uncles approve, Grandparents disapprove) Action – Efficacy (high likelihood of negative effect, effect will be severe if do not contribute)
    10. 10. Bridges to Activities Determinant Bridges to Activities Self – Efficacy/ Access (transport, money) • Increase the perception that women can control household money • Increase the ability of women to access health services Social Norms (Neighbours, Aunts/ Uncles approve, Grandparents disapprove) • Increase the perception that Neighbours and Aunts/Uncles approve of them contributing to decision making • Increase the perception that Grandparents approve of contributing to decision making Action – Efficacy (high likelihood of severe, negative effects) • Increase the perception that not contributing to decision making can result in a high likelihood of serious effects on health
    11. 11. Activities Bridges to Activities Activities Increase the perception that women can control household money Village Savings and Loan Associations • “Social Funds” to access emergency care • Control of own money earned through IGA Discussion Fora • Role play how to discuss accessing the clinic • Invite key influencers to participate in discussions Increase the ability of women to access health services
    12. 12. Activities Bridges to Activities Activities Increase the perception that Neighbours and Aunts/Uncles approve of contributing to decision making • Follow up Focus Groups with these identified influencing groups to discover their true feelings on the behaviour • Discussion fora with influencers and Priority Group members to create space to hear opinions and develop solutions • Women supported to identify their “support person” who they can go to in the event they require support in contributing to decision making • “Hands Up Approval” in Community Meetings • Training of Community Leaders Increase the perception that Grandparents approve of contributing to decision making
    13. 13. Activities Bridges to Activities Activities • Increase the perception that not contributing to decision making can result in a high likelihood of serious effects on the health of the children • Sharing of Most Significant Change stories • Creation of Contrast Stories by the women in the Circles for sharing • Discussion fora with local health extensionist • Training of REFLECT facilitators by health extensionist on prompt care-seeking • REFLECT manual reviewed and additions made by the Endemic Sickness Unit
    14. 14. Next Steps  Identified activities to address barriers are being integrated into a number of ongoing GOAL projects  REFLECT Circles  NIPPs Circles  We are planning to trial Care Groups in Kutum and will integrate DBC activities.  Framework is considered when we are developing new projects to show evidence-base of our selected activities
    15. 15. Early Results  Increase from 30% to 50% of REFLECT circle women who contribute to decision making  VSLA activities have improved the perception of women that they have the emergency funds to make the decision to access care.  Pre/Post Test increase from 5% to 75% of community leaders who report their approval of women contributing to decision making for care seeking following training
    16. 16. DBC’s Added Value  No more assumptions!  Building the evidence base for how to increase access and control for women  Respecting the time of our target population  More emphasis on influencers
    17. 17. Lessons Learnt  Challenging to come up with innovative activities to address barriers  Support from Global Tech Team  Global Community of Practice  Integration of activities requires buy-in from all levels of in-country team
    18. 18. Acknowledgements
    19. 19. Questions?

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