The "Lead, Assist, Observe" (LAO) Coaching Model as a Strategy for Sustained Social and Behaviour Change: Lessons from The Challenge Initiative (TCI) Nigeria

Summary:

The Lead, Assist, Observe model is a 3-step model where trained social and behavior change communication experts are embedded in state governments to co-locate with officers of the state government and transfer skills and knowledge to them by demonstrating strategies to improve their reproductive health indices. During the Lead stage, the experts demonstrate these strategies, in the Assist stage, the experts allow the officers from the state government to practice these strategies while they assist, by the Observe stage, the state governments become the experts and execute strategies they have learned without support. As a proposed model of Social and Behaviour Change Communication, the LAO model systematically introduces new ideas to state governments through demonstration then encourages adoption of these ideas by giving states the opportunity to execute these ideas. Sustainability is achieved when states have developed the confidence to lead and execute these ideas without external support. The model encourages sustainability because interventions demonstrated are adopted by government and used long after demonstration is over. Using the LAO model, TCI has demonstrated social mobilization strategies like neighborhood campaigns and community engagements to government staff in 10 states. The demonstration led to state governments adopting these strategies and including them in their state workplans. The state health educators who understudied TCI experts have trained other staff in their health promotion units promoting diffusion and sustainability of the strategies thereby making the LAO model successful. Health Program Managers and Implementers should consider this model for social and behavior change.

Background/Objectives:

The Lead, Assist, Observe model is a 3-step model where trained social and behavior change communication experts are embedded in state governments to co-locate with officers of the state government and transfer skills and knowledge to them by demonstrating strategies to improve their reproductive health indices. During the Lead stage, the experts demonstrate these strategies, in the Assist stage, the experts allow the officers from the state government to practice these strategies while they assist, by the Observe stage, the state governments become the experts and execute strategies they have learned without support. As a proposed model of Social and Behaviour Change Communication, the LAO model systematically introduces new ideas to state governments through demonstration then encourages adoption of these ideas by giving states the opportunity to execute these ideas. Sustainability is achieved when states have developed the confidence to lead and execute these ideas without external support. The model encourages sustainability because interventions demonstrated are adopted by government and used long after demonstration is over. Using the LAO model, TCI has demonstrated social mobilization strategies like neighborhood campaigns and community engagements to government staff in 10 states. The demonstration led to state governments adopting these strategies and including them in their state workplans. The state health educators who understudied TCI experts have trained other staff in their health promotion units promoting diffusion and sustainability of the strategies thereby making the LAO model successful. Health Program Managers and Implementers should consider this model for social and behavior change.

Description of Intervention and/or Methods/Design:

The LAO model is a 3-step model where trained social behavior change communication experts are embedded in state governmentsду» ministries of health to co-locate with officers in the Health Education and Promotion units and transfer skills and knowledge to them by demonstrating strategies to improve their reproductive health indices. 

At the Lead stage of the model, the experts lead implementation of social and behavior change strategies while building the capacity of state government counterparts to implement these proven strategies for increased uptake of family planning services. 
 
In the Assist stage, the state government officials take the lead in implementing interventions while the experts transit to an assist role. 
 
The Observe stage is the final stage; the state governments drive implementation of strategies they have learned. At this stage, the strategies are owned by the state government and form part of their response to reproductive and maternal health issues.

Results/Lessons Learned:

Using the LAO model, TCI has demonstrated social mobilization strategies like neighborhood campaigns and community engagements to government staff in 10 states. The demonstration led to state governments adopting these strategies and including them in their state workplans; the governments currently implement these strategies for improved reproductive health. The states have created social behavior change communication committees to lead social mobilization for family planning and identify new avenues for social mobilization. The state health educators who understudied TCI experts have trained other staff in the health promotion units promoting diffusion and sustainability of the strategies, making the LAO model successful. 
 
Of the 10 states supported by TCI, 5 of the states have moved through the stages to the Observe stage; the remaining 5 states are at the Assist stage. The movement of the states along the LAO stages indicate successful transfer of skills relevant to adoption of strategies and sustainability.

Discussion/Implications for the Field:

The LAO model as a model of Social Behavior Change Communication systematically introduces new ideas to state governments through demonstration. The model encourages adoption of these ideas by giving states the opportunity to execute these ideas. Sustainability is achieved when states have developed the confidence to lead and execute these ideas without external support. The model allows health practitioners and governments to demonstrate then adopt new strategies. It also encourages sustainability because interventions demonstrated are adopted by the government and used long after demonstration is over. Health Program Managers and Implementers should consider this model for social and behavior change.

Abstract submitted by:

Nneoma Anieto - Nigerian Urban Reproductive Health Initiative (NURHI) 
Lekan Ajijola - NURHI
Victor Igharo - NURHI