Helping local leaders solve local problems: Incorporating evidence-based SBC into a Nepal's newly federalized system including government, academia and partners

Summary:

Local leaders are best placed to solve local problems. Governments in many countries, including Nepal, see the value of decentralization. But many local entities in Nepal lack the realization of importance of and skills necessary to develop evidence-based SBC for health programs. Evidence-based SBC can play a role in improving communities. Breakthrough ACTION through a USAID-funded SBC systems strengthening project in Nepal co-created with government partners a process and package of SBC tools that is enabling local entities to include evidence-based SBC for health in their own plans. Working closely with local governments, Breakthrough ACTION used a suite of design thinking-informed processes to: increase local entities understanding, skills and value of evidence-based SBC; interpret and use local data to inform program planning; and integrate and budget for health-related SBC in their annual work plans. The co-creation process included a human-centered design (HCD)-informed co-designed and pilot-testing to develop an SBC package for the local level. This SBC package is a skill-based job aid for how to use local social and health data to plan, implement, mentor and monitor SBC for health programs. This locally owned SBC for health package is now in demand by health and non-health government sectors, non-government partners and academia who have requested the package for adaptation and use. The Package will soon be available for users in a closed Facebook group, online, and with a bot.

Background/Objectives

Nepal has recently changed to a federalized system, where 753 local political entities each now make independent decisions about health. Though this new system has enormous potential, currently local decision makers have not realized the importance or value of evidence-based SBC programs and do not have the skills to use local data for developing, implementing, or monitoring programs. This abstract describes how a team used state-of-the-art design approaches with the Nepal Government to co-design a locally owned SBC for health platform that is now being used by government at all levels, academia and implementing partners.

Description Of Intervention And/or Methods/Design

The integration of evidence-based SBC into local systems included a human-centered design (HCD)-informed, co-designed and pilot tested process of an SBC package for the local level, a skill based job aid for how to use local data to plan and implement, mentor and monitor SBC for health programs. Local government staff were substantially involved in baseline and endline SBC self-assessments, co-creation and pilot testing all aspects of this program. They were also central to mapping government annual program planning process, roles and responsibilities, and capacity strengthening on SBC through orientations, training, monitoring/mentoring, advocacy visits. A learning-by-doing approach was used. Self-assessment at the onset of the intervention and the conclusion were central to assessing changes while the baseline self-assessment also acted as the stepping stone for the local municipalities to buy-into the local evidence-based SBC system strengthening process.

Results/Lessons Learned

Key informant interviews with stakeholders at the local level have highlighted an increase in knowledge and understanding of SBC for health, improved practice of collaboration during the planning process, greater prioritization of SBC in annual plans and commitment to SBC for health programs in annual budgets through fund allocation. Acknowledgement of the importance and use of local data and especially community interactions to understand local community needs was also identified. Programmatic efforts to encourage governmental buy-in and collaboration with partners have been vital to the success of this SBC for health package. The package has been endorsed by National Association of Urban and Rural municipalities of Nepal. The Ministry of Health and Population's National Health Education Information and Communication Center (NHEICCC) is using the package to develop trainers in all provinces, in coordination with UNICEF. USAID-funded project Suaahara II has integrated the package across 42 districts of Nepal.

Discussion/Implications For The Field

Decentralization is a reality in many countries. Strengthening local entities to make data-based decisions and incorporate essential evidence-based SBC for health into their local budgets and activities is a persistent challenge. This audience-centered development process and skills-based package of SBC tools that keeps the intended audience the government staff at the center could be adapted and applied to any context or issue.

Abstract submitted by:

Pranab Rajbhandar - JHU CCP

Shreejana  K.C. - JHU CCP

Caroline Jacoby - JHU

Sanjanthi Velu - JHU

Zoe Hendrickson - JHU

TrishAnn Davis - JHU

Thaneswor Koirala - JHU CCP