Understanding Social Science and Behavior Change for Disease Outbreak Response

Social Science (SS)/ Social Behavior Change (SBC) Capacity Assessment READY Initiative

Why are we doing this assessment? As the 2014-2016 West Africa Ebola outbreak and the current DRC outbreak demonstrates, capacity to address behavioral determinants that drive spread of a disease is critical to containing and stopping it. Not doing so can result in a proliferation of rumors and misconceptions, mistrust of messages (and messengers), conflict, and poor linkages between communities and services, to name some. Ultimately, this means the outbreak progresses beyond projections.

READY Capacity Assessment Tool Helps you identify priorities for building organizational capacity to address social and behavioral drivers that impact the effectiveness of major outbreak responses. Allows you to measure changes in organizational capacity overtime by establishing a baseline for programmatic capacity planning and identifying goals.

What are Behavioral Drivers? People generally don t just consider pros and cons to make a rational decision on the best path of action: providing them with the right information will rarely automatically translate into the logical choice . People are also emotional, influenced by their context, and by those they live and interact with. This is especially so in an emergency context when stress and fear can be high, and people tend to be less receptive to complex messaging. Behavioral drivers are those multiple factors in our own psychology, socially and in our environment that influence our decisions. This could include anything from personal values, beliefs and self image to peer pressure and family power dynamics to policies and constructs such as racism, gender, and religion, to name just some examples.

What do we mean by Social Science (SS)? In this context, social science refers generally to the discipline and study of the social, cultural, economic and political variables that can humanize an outbreak response, and mitigate the disruptive socio- economic and psychosocial burdens associated with outbreaks, epidemics and pandemics.

What is SBC? Social behavior change (SBC): SBC is a strategic design process to develop solutions tailored to each unique behavioral challenge by understanding individual, social, environmental and structural determinants that drive them, to achieve positive health and development outcomes. SBC activities include risk communication and community engagement (RCCE).

What is Risk Communication? Risk communication: Defined by WHO as the real- time exchange of information, advice and opinions between experts, community leaders, officials and the people who are at risk of a disease outbreak. This means disseminating critical messages to allow people most at risk to understand and adopt protective behaviors, while allowing officials to understand and address people s concerns. Channels typically used for risk communication include traditional media, social media, mobile technology, and forums with trusted spokespeople and influencers.

What is Community Engagement? Community engagement: In the context of the READY project, it is a participatory process for working with traditional, community, civil society, government and opinion groups and leaders to protect them from disease while addressing other health and humanitarian needs. Community engagement empowers social groups and social networks, builds upon community capacities and improves local participation, ownership, adaptation, and communication.

Instructions Instructions: For each question in the tool, there are four possible answers that range from stage 1 to stage 4. Please select the one that best represents the stage your organization is in by putting the number in the individual score column. If you do not know the answer to a question, please write Do not know in the comments section.

1.0 OPERATIONS

1.1 Surge roster Does your surge mechanism include social science competencies, with experience working in public health emergencies? Response guidelines Competencies include anthropology, social science, social behavior change, community engagement or risk communication. Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not have these competencies Is in the process of including these competencies Has some of these competencies, but no experience in emergency settings Has these competencies and experience working in emergency settings Notes:

1.2 Staff Social Science Competencies Aside from surge, does [the organization] have sufficient staff with relevant Social Science competencies for public health emergency response? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not have any staff with relevant social science competencies for public health emergency response. Does not have staff with relevant social science competencies for public health emergency response but is actively planning to hire or train in these competencies. Has some staff with social science competencies for a public health emergency response but skills are limited and roles are not clearly defined. Has sufficient staff with social science skills and experience in public health emergency response. Roles and responsibilities for public health emergency response are clear. Notes:

1.3 Interpersonal Communication and Community Engagement Trainings Are staff working in emergency response trained in interpersonal communication, engaging communities, or developing or disseminating messages? Response guidelines Key elements include: 1. INTERPERSONAL COMMUNICATION: Approaches to build trust between frontline workers and community members, patients and other humanitarian service recipients. 2. MESSAGING: Approaches to develop messaging that follow the 7Cs of communication with consideration to perceived threats and self-efficacy (confidence to adopt the behavior and perceive the behavior is effective; benefits outweigh the risks). 3. COMMUNITY ENGAGEMENT: Participatory, two-way conversation that fosters community ownership of their part in controlling and ending an outbreak. Level of Capacity Individual Score Consensus Score 1 2 3 4 No such training occurs. Is in the process of establishing this type of training for staff. Staff are trained in a limited number of key elements but these are not applied consistently in the field. Staff are trained in many of these key elements and these are applied consistently in the field. Notes:

1.4 Safety and Orientation Trainings Do you provide safety or emergency operations orientations for SBC/RCCE staff identified to respond in emergencies? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not provide orientations or safety trainings. Is in the process of establishing orientations and safety trainings. Provides one but not both; neither are implemented systematically or as needed before deployment. Provides orientations and safety trainings, which are easily accessible and provided regularly and/or as needed before deployment. Notes:

1.5 Financial Policies & Procedures Do you have documented financial policies and procedures that supports the deployment of SBC/RCCE specialists in public health emergencies? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not have these financial policies and procedures. Has ability to rapidly deploy through financial mechanisms but procedures are not documented, or they need to be updated. Has these written financial policies and procedures, but staff practices are not in accordance with the policies and procedures. Has policies, procedures, and systems that guide deployments, which are up- to-date, readily available and are consistently used. Notes:

1.6 Budgeting for Social Science Interventions When designing a budget for a social science intervention in public health emergency, how do you develop a budget? Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not develop a budget for this type of intervention. We do not develop a budget prior to the start of the intervention but keep track of costs as we go along. We develop a budget based on assumed costs but do not always keep track of costs along the way. We develop a realistic budget based on previous experience and periodically adjust it based on actual costs. Notes:

2.0 TECHNICAL CAPACITY

2.1 Coordination with Social Sciences At country/regional level, to what extent do you coordinate with communication mechanisms in emergencies, and harmonize data, messages, and interventions? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not coordinate with communication mechanisms in emergencies. Is not aware of such mechanisms. Is aware of relevant communication coordination mechanisms in emergencies but does not currently coordination with them. It has a plan for coordination. Is aware of communication coordination mechanisms and sometimes coordinates with them to harmonize data, messages and interventions. Is aware of communication coordination mechanisms. It regularly / consistently coordinates with them to harmonize data, messages and interventions. Notes:

4.1 Mobilization & coordination Organization follows specific steps to mobilize and coordinate with partners Q: When implementing your interventions, which steps does your organization follow when working with partner organizations? Response guidelines 1. Make sure each partner understands their role. 2. Identify a program lead whose responsibility is to facilitate the process. 3. Identify partner needs and conduct trainings as necessary. 4. Keep partners updated. 5. Share credit for good work. 6. Monitor activities. 7. Prepare for future evaluation activities. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use any of the key steps We use 2-3 of the key steps but cannot clearly describe them We use 4-5 of the key steps and can clearly describe them We use 6-7 of the key steps and can clearly describe them Notes:

2.1 Data Harmonization To what extent do you consider social science data when planning an public health emergency response activity? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not consider or harmonize SS data with epidemiological data when planning an emergency response activity. Is aware of relevant social science data but does not regularly consider it before planning a response activity. Is actively planning to harmonize this data in future responses. Is aware of communication coordination mechanisms and sometimes coordinates with them to harmonize data, messages and interventions. Is aware of communication coordination mechanisms. It regularly / consistently coordinates with them to harmonize data, messages and interventions. Notes:

2.1 Community Engagement Approaches Do you have and use a documented approach for engaging communities in addressing social and health issues? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not routinely engage communities to improve social and health issues. Consults community leaders to ensure planned activities are acceptable. Engages communities in some of the planning processes and implementation of activities. Engages communities in identifying issues and communities take the lead in planning, implementing on monitoring. Organization promotes community ownership and decision-making while building their knowledge and skills to take action. Notes:

2.1 Community Feedback Loops Do you have and use a documented approach for feeding information back to communities and families you served who are affected by an emergency? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not routinely feed information back to communities affected by an emergency. Have this documented approach but do not regularly adhere to it. Have this documented approach, and sometimes adhere to it. Have this documented approach and always adhere to it. Notes:

2.1 Interpersonal Communication Approaches Do you use a documented interpersonal communication approach for building trust between community members/patients and humanitarian responders? Response guidelines Key elements include: !. LISTENING: Active listening and reflection. 2. MESSAGING & MANAGING CONVERSATIONS: Navigating conversations and using language. 2. BUILDING TRUST: Understanding what makes or breaks trusting relationships. Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not use interpersonal communication approaches when working with patients or community members at risk. Has an interpersonal communication approach that includes a few of the key elements but doesn t include trust building exercises. Has an interpersonal communication approach with some of the key elements but doesn t include trust building exercises. Has an interpersonal communication approach that includes most or all of the key elements, including trust- building exercises. Notes:

2.1 Situation Analysis/Rapid Needs Assessment Organization systematically conducts situation analysis/rapid needs assessment that includes social science or behavioral factors Q: When conducting a situation analysis or rapid needs assessment, which SS factors do you consider? Response guidelines Knowledge, Attitudes (beliefs, values, etc.), Perceived risks and benefits, Social norms, Cultural/religious contexts, Self-efficacy, Collective efficacy, Intent, Structural barriers, Gender, power dynamics Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use any of these factors. We a few of these factors and can clearly describe them We some of these factors and can clearly describe them We most or all of these factors and can clearly describe them Notes:

2.2 SBC Theory Organization uses SBC theories or models to understand stakeholders and their experience Q: During the discovery process, how does your organization use SBC theory to guide analysis and develop an explicit theory of change? Response guidelines A theory is an explanation of how and why certain social or behavioral outcomes happen. The simplest theory typically consists of an outcome behavior and 2 or more predictor variables. Different theories emphasize different predictors. Some theories do not describe a social or behavioral outcome (e.g., epidemiological theory about disease agents). Theories can be used to guide questioning during a discovery phase or to understand information that emerges during discovery. The best theory is one you make yourself, based on evidence and understanding of stakeholder experience. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use theory to guide discovery or program design We sometimes use theory to guide discovery or program design, but do not link it to specific outcomes We sometimes use theory to guide discovery or program design, but do not describe that theory explicitly We always use theory or theories to guide discovery and program design and can articulate it clearly Notes:

3.1.1 Design Process (Ideation & prototyping) Organization follows specific steps for development of prototypes Q: When designing prototype solutions, which key steps does your organization follow? Response guidelines A prototype is a rough idea or concept for a solution; it can be the outline of a process, a message concept, a model of a product or other solutions to the design challenge. Steps include: 1. Conduct inventory of existing solutions, reflecting on results of discovery process. 2. Host a participatory process that facilitates agreement on design approach. 3. Develop creative options through an iterative ideational process. 4. Create prototype concepts/materials/solutions for stakeholder pretesting. 5. Test concepts/materials/solutions with stakeholders and key decision-makers. 6. Share results of pretest with the creative team and stakeholders. 7. Revise/reject prototypes based on feedback. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use any of the key steps We use 2-3 of the key steps but cannot clearly describe them We use 4-5 of the key steps and can clearly describe them We use 6-7 of the key steps and can clearly describe them Notes:

2.3.2 Prevention and Treatment Messaging How do you develop, coordinate and deliver messaging on protective and treatment behaviors and actions? Response guidelines 1. Identifies context-specific data on barriers and facilitators to prevention and treatment of the disease 2. Uses data and coordinates with stakeholders to tailor messaging for optimal adherence 3. Pretests messaging and adjusts based on results; shares with other stakeholders. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not do any of these things We do a few of these things some of the time We do some of these things often We do all of these things all of the time Notes:

2.3.1 Rumors and Misinformation When engaging a community, how does [your organization] collect and respond to rumors and misinformation? Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not collect and/or respond to rumors or misinformation. We collect and respond to rumors and misinformation on an ad hoc basis. We We systematically collect data on rumors and misinformation; we do not always rapidly analyze and adjust interventions or advocate for adjustments to interventions. systematically collect data on rumors and misinformation; we regularly rapidly analyze and adjust interventions, or advocate for adjustments to interventions. Notes:

2.3.2 Audience Analysis Do you use audience analyses before engaging with communities and patients in a response? Response guidelines Audience analyses are based on data and beneficiary input to better define target audiences and identify barriers and facilitators to address for each audience. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use an audience analysis before designing interventions. We have a rough audience analysis, but it is not based on primary/second ary data to inform interventions. We have an audience analysis based on primary/second ary data, but we do not use it consistently to inform interventions. We have an audience analysis based on primary/second ary data, and use it consistently to inform interventions. Notes:

2.2 Gender When designing an intervention how does [your organization] consider gender? Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not consider gender in the design of interventions. We consider gender, but not always in terms of potential risk factors for disease transmission. We consider gender in the design of interventions, including gender-related risk factors for disease transmission. We consider gender in the design of interventions including gender-related risk factors. Interventions are designed to change harmful gender norms. Notes:

3.3 Implementation planning Organization bases intervention plans on a previously-defined (written) strategy Q: How are Social Science interventions planned and implemented within your organization? Response guidelines Consider how systematically your organization plans for implementation activities. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not have implementation plans; activities are decided on short notice or in reaction to external demands We develop a rough implementation plan for some activities in order to meet funding or political considerations We develop an implementation plan for all activities, but the individual plans do not always link to the SBC strategy We develop an implementation plan for all activities and the plans link to a larger strategic plan. The plans are reviewed and adjusted on a routine basis Notes:

3.4 Budgeting Organization sets social science intervention budgets based on actual costs Q: When designing an intervention, how does your organization develop a budget? Consider the process you follow when developing a project budget. Response guidelines Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not develop a budget We do not develop a budget prior to the start of the intervention but keep track of costs along the way We develop a budget based on assumed costs but do not always keep track of costs along the way We develop a realistic budget based on previous experience and periodically adjust it based on actual costs Notes:

3.0 TECHNOLOGY/ COMMUNICATION CHANNELS

3.2 Complementary mechanisms/channels Strategy uses multiple engagement mechanisms in a complementary way Q: When designing an intervention, how does your organization use multiple ways to reach and engage with stakeholders? Response guidelines Consider how engagement options (e.g., media, ICT, community mobilization, interpersonal communication) are identified and used in your program. Not all channels reach all audiences. Use of multiple channels can help reinforce program effects. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use more than one mechanism/ channel to engage with stakeholders We use more than one mechanism/ channel but they work individually and are not coordinated We use more than one mechanism/ channel but they are not always coordinated We achieve scale through coordination of mechanisms/ channels to optimize reach, engagement, and program impact among multiple stakeholder groups Notes:

3.1.2 Mobile Technology How do you use/plan to use mobile data collection, automated voice technology or text messaging in public health emergency interventions? Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use or do not plan to use any mobile data collection, automated voice technology or text messaging. We plan to use mobile data collection, automated voice technology or text messaging but are not currently using it. We are currently using at least one form of mobile data collection, automated voice technology or text messaging. We use multiple mobile data collection, automated voice technology and text messaging for existing interventions. Notes: Notes:

3.1.2 Mobile Technology If you use mobile platforms in emergencies, which elements does [your organization] use in your assessments? Response guidelines 1. 2. 3. 4. 5. 6. Audiences access and ownership Literacy levels, Mobile literacy levels Current practices, Privacy issues, cost/benefit or user, User perceptions of mobiles Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use the key elements We use a few key elements but cannot clearly articulate them. We use some key elements and can clearly articulate them. We use most or all key elements and can clearly articulate them. Notes:

3.1.2 Web-based & Social Media Platforms How do you integrate the use of Web or social media to inform affected communities or contribute to behavior change strategies? Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use nor do not plan to use the Web or social media tools. We plan to use the Web or social media tools but are not currently using them. We are currently using at least one Web-based or social media tool but it is not linked to an overall strategic communication or behavior change plan. We use one or more Web- based and/or social media tool aligned with an overall strategic communication plan. Notes:

4.0 M&E Scale-up

4.2 Monitoring Do you have assigned staff with relevant Social Science-related M&E competencies for emergencies? Response guidelines Relevant competencies include M&E staff with experience in social and behavioral sciences. Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not have M&E staff or staff assigned to M&E responsibilities. Has M&E staff, but they do not possess relevant competencies for SBC/RCCE in public health emergencies. Has M&E staff or staff assigned M&E responsibilities who have the relevant SBC/RCCE competencies, but responsibilities are not clearly assigned. Has M&E staff or staff assigned M&E responsibilities who have the relevant SBC/RCCE competencies and clearly assigned responsibilities. Notes:

4.2 Monitoring Organization has a system for monitoring social science interventions and providing progress reports on implementation Q: Does the organization have and implement a process for monitoring implementation and using monitoring information for internal and external program review? Response guidelines Consider how your organization tracks the implementation process and progress toward program objectives. Internal review means using monitoring data to track and revise activities. External review means using monitoring data to compare program progress against external standards. Level of Capacity Individual Score Consensus Score 1 2 3 4 The organization does not have a program monitoring mechanism in place or perform internal or external program reviews The organization does not have formal program monitoring mechanisms in place, but does perform occasional of internal and/or external reviews The organization has internal and external program monitoring mechanisms in place, but findings are not used to inform program development and implementation The organization has program monitoring mechanisms in place for both internal and external reviews, and findings are used to improve program development or implementation Notes:

4.2 Monitoring Does [the organization] systematically review/adjust key messages and activities to respond to needs identified through monitoring of information? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not systematically analyze social science data on activities in emergencies. Systematically analyzes M&E data on risk communication and community engagement activities in emergencies but doesn t adjust activities or programs to respond to identified needs. Systematically analyzes M&E data on risk communication and community engagement activities in emergencies, adjusts activities or programs to respond to identified needs, but doesn t share findings with other stakeholders Systematically analyzes M&E data on risk communication and community engagement activities in emergencies, adjusts activities or programs to respond to identified needs, and sometimes shares findings with other stakeholders. Notes:

4.2 Data Collection Does [the organization] have access to and ability to use mobile technologies for rapid data collection and monitoring of activities? Level of Capacity Individual Score Consensus Score 1 2 3 4 Does not use or have access to mobile technologies for rapid data collection and monitoring of activities. Is in the process of establishing mobile technologies for rapid data collection and monitoring of activities. Has access to mobile technologies for rapid data collection and monitoring of activities but data are not routinely analyzed. Has access to mobile technologies for rapid data collection and monitoring of activities, and data are routinely analyzed. Notes:

4.2 Data Collection Are there systems in place to track if and how interventions are reaching marginalized and vulnerable populations? Level of Capacity Individual Score Consensus Score 1 2 3 4 No system in place to track if and how interventions are reaching marginalized and vulnerable populations. In the process of establishing systems to track if and how interventions are reaching marginalized and vulnerable populations. Systems to track if and how interventions are reaching marginalized and vulnerable populations are in place but are not used. Systems to track if and how interventions are reaching marginalized and vulnerable populations are in place but are not fully used. Notes:

4.2 Data Analysis - Gender When analyzing behavioral data, how does [your organization] include gender? Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not consider a gender lens when analyzing data. We We conduct analysis based on gender. We conduct an analysis based on gender and re-examine programs to make changes. disaggregate data based on sex. Notes:

4.3 Training Organization follows specific steps when planning and implementing training of staff and partners Q: If your organization trains others, which key elements of training does your organization use? Response guidelines 1. Establish training session objectives that are SMART. 2. Include relevant stakeholders. 3. Use a participatory process. 4. Use adult learning methodologies. 5.Evaluate the training (for example, using Kirkpatrick's four levels of evaluation - reaction , learning, behavior and results). Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use any of the key elements We use 1-2 of the key elements but cannot clearly describe them We use 3-4 of the key elements and can clearly describe them We use all 5 of the key elements and can clearly describe them Notes:

4.4.1 Data utilization (key indicators) Organization analyzes data about key indicators to inform programmatic decisions Q: How does your organization use indicator data? Response guidelines 1. Key indicators are linked to each strategic objective. 2. Changes (or lack of changes) in key indicators are used to inform workplans. 3. Indicator data is used to set benchmarks and targets. 4. Indicator data is used to assess progress toward benchmarks and targets. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not use indicator data to inform programmatic decisions We do one of these things with indicator data We do 2-3 of these things with indicator data We do all four of these things with indicator data Notes:

4.4.2 Data utilization (coordinated analysis) Organization analyzes data about key indicators together with stakeholders and partners Q: How does your organization engage with partners and stakeholders to review data and analyze results? Response guidelines Consider how you involve other stakeholders and partners in analysis of program data. Level of Capacity Individual Score Consensus Score 1 2 3 4 We do not review data and analyze results We review data and analyze results based on internal/ institutional understanding of the program We review data and analyze results with some of the key stakeholders based on informal conversations and meetings We review data and analyze results with a group of program partners, decision- makers, stakeholders, and technical experts. All stakeholders are involved Notes:

Summary Priorities going forward

What are our capacity building priorities? Year 1 Year 2

What do we need internally to address these priorities? Year 1 Year 2