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. 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. 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. 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. The DBC Framework
Behaviour Priority and Influencing Group
Description
Significant Determinants Bridges to Activities Activities
Outcome
Indicators:
Process Indicators:

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. The Behaviour
 Women in REFLECT Circles in Kutum are
contributing to decision making concerning health
seeking behaviour.

8. The Priority Group

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. 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. 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

13. 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

14. 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

15. 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

16. 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

18. 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

19. 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

20. Acknowledgements

21. Questions?