Providers as an Audience: Addressing Provider’s Perspectives and Barriers through Social and Behavior Change Approaches

Many factors are linked to the underutilization of modern contraception. On July 31, 2018, Breakthrough ACTION hosted a webinar exploring provider-side barriers and facilitators to method adoption and continuation. Speakers presented on Transform/PHAREBeyond Bias, and Breakthrough ACTION’s use of innovative social and behavior change (SBC) approaches to deepen understanding of provider’s attitudes and behaviors and their impact on their clients’ family planning choices. The fact that a service provider’s opinions and biases, attitudes and behaviors, capacity and skills, and working conditions can influence their ability or motivation to deliver quality services has been well documented. However, these projects are building on that knowledge by using advanced audience segmentation, human-centered design, and behavioral economics to generate new behavioral insights to identify positive deviants, address bias toward young and/or unmarried women, and ensure clients are counseled on all appropriate methods.

Luis Fernando Martinez, Social and Behavior Change Communication Senior Technical Advisor, from the USAID-funded Transform/PHARE projected presented healthcare provider barriers and positive deviance linked to quality sexual and reproductive health service provision in Cote d’Ivoire. Transform/PHARE conducted a literature review, individual interviews, and focus group discussions with healthcare providers and clients and identified provider barriers in three areas: personal opinions and biases, capacity and skills, and attitudes and behaviors. Then positive deviants who effectively address those barriers and excel at their work were identified and confirmed using mystery shoppers and an evaluation workshop. Positive deviants offer the full range of family planning services; they demonstrate empathy; and they practice good listening skills. The primary driver of their positive practices is love of their family planning work. This love is not a skill that can be taught through training but providing opportunities for role models to share their experiences may help inspire and foster a love for the trade among their peers.

Jessica Vandermark, Senior Marketing Advisor, Breakthrough ACTION, discussed the results of the Gates-funded Beyond Bias Projects in Tanzania, Burkina Faso and Pakistan led by Pathfinder International with Camber Collective, YLabs, and BERI. Beyond Bias seeks to better characterize and address provider bias toward young and/or unmarried women seeking family planning services. Based on a situation analysis and interviews, Camber used advanced statistical methods to identify six provider segments common across all three countries. These segments were: detached professionals, average passives, content conservatives, impromptu sisters, sympathetic guardians, and paternalistics clinicians. The segments reflect varying degrees of closeness or distance providers feel from clients; how conservative they feel in relation to social norms; and how well they are informed or trained. The next step for Beyond Bias is to use the segmentation results and human-centered design to develop, test, implement and evaluate segment-specific provider behavior change interventions.

Kanyinsola Aibana, Senior Associate at ideas42, described Breakthrough ACTION Malawi’s current work piloting behavioral economics approaches to motivate provider behavior change among family planning providers. The process started with a problem definition phase to identify key provider behaviors to change or mitigate and populations of interest. That was followed by a behavioral diagnosis to generate hypotheses about drivers of behavior and a behavioral mapping that looked at the various decisions and action steps that providers need to take to council women on appropriate contraceptive methods. The next step for Breakthrough ACTION Malawi is to test their primary hypothesis and identify insights to develop and test intervention ideas.

These presentations remind us how important SBC is to both improving service delivery and driving demand for family planning. Providers are gatekeepers and it is crucial that they serve as a bridge to services rather than a barrier. The better we understand the various perspectives, practices, and barriers that exist within provider communities, the more bridges we build.

Breakthrough ACTION is offering two new resources to support provider behavior change.  The Service Providers as an Audience for Behavior Change Trending Topic hosts peer-reviewed literature, program tools, and project examples. Through the Trending Topic you can find the Transform/PHARE provider behavior change mini toolkit which includes videos and exercises meant to be used in a training setting.  The Provider Behavior Assessment How-to Guide provides overview guidance for identifying individual, interpersonal, organizational, and institutional factors contributing to provider behaviors. This guide is a work-in-progress and will continue to be developed as new insights emerge from ongoing provider behavior interventions.

We want to hear from you about which SBC approaches your programs apply to provider behavior change. Do you have insights or lesson learned from other health and development areas that should be considered in the context of family planning counseling?  If so, we encourage you to share your experiences, ideas, and questions on this Springboard discussion. We look forward to learning from you.

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