Mzansi Agriculture Talk

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Knowledge, a Pre-requisite for Social Behaviour Change for Better Nutrition Outcomes

1. Introduction
FANRPAN’s nutrition-sensitive agriculture (NSA) programme is about making sure that agriculture delivers better on nutrition outcomes, especially for society’s most vulnerable.  These include women of child-bearing age and young children in farming households, where the high nutritional demands of pregnancy, lactation and early childhood development must largely be met through own food production. One of the key nutrition-sensitive interventions is behavior change, which takes place when households and communities acquire knowledge on basic nutrition, nutritional value of different food groups and how best to utilize the different foods. FANRPAN promotes behavior change among the vulnerable groups such as women caregivers, men and associated communities in its programmes. The targeted behaviours include the need to improve dietary diversity; infant and child feeding practices; hygiene and sanitation practices; participation of women in decision making on resource use; and gender dynamics at household and community levels. 

2. The Social Behavior Change Communication (SBCC) Package
FANRPAN’s Social Behaviour Change Communication (SBCC) package comprises the application of three pathways for achieving positive nutrition outcomes from agriculture, that is production, income and women empowerment pathways.  The SBCC interventions related to these pathways are as follows: 

  1. Nutrition and hygiene education to improve consumption of diverse foods from own production, including animal source foods, fruit and vegetables; 
  2. SBCC for influencing income expenditure from sale of agricultural produce for use in purchasing other nutritious foods to improve household diets; 
  3. SBCC for women empowerment and gender equity in agricultural value chains to improve the women’s participation in joint household production and their time use.

These SBCC interventions were successfully applied in the field among communities in Ethiopia and Tanzania through the FANRPAN ATONU project.

3. Delivery of the SBCC Package 
It is important that the promoters of any SBCC intervention select appropriate households to target, which in this case were households that had children under the age of five and women of child-bearing age. The targeted households would normally be participating in an agricultural development project, which may be aimed at improving productivity, production and value chain development of a specific commodity, for example poultry, cereal or horticulture production. In all cases, the objective is to improve nutrition outcomes of the associated agricultural development programme in which the targeted households would be participating.

The delivery of the SBCC package follows various steps as follows:

  1. Preparation of the community for engagement

This step entails mobilization of local community leaders and the targeted households.  Project implementing practitioners, such as public and NGO staff, would introduce themselves and the SBCC intervention project to local government, community leaders and targeted households to secure their buy-in. This would then be followed by implementing practitioners taking a familiarization tour (transect walk) through the participating villages, collecting all the necessary context-specific information on agriculture production, routines, seasons, productivity information, available foodstuffs, dietary practices, child care and feeding practices, status of health services, local food markets and availability of water sources.

In addition, practitioners prepared their community mobilization plan, listing all key talking points to build the case for support and participation of all stakeholders, including highlights of the malnutrition situation at all levels in the community. Posters with images of malnourished children were developed to enhance communication. They then consulted and set dates for mobilization of the communities, identified the target audience and the local leadership who would accompany the process.

b) Preparation of SBCC materials 
The preparation of SBCC materials was informed by baseline and formative research findings from studies that would have been conducted in the same communities or those with similar conditions. The SBCC materials include facilitation aids for practitioners delivering messages, such as playing cards with images of different food groups; meal-planning and budgeting exercise templates; seasonal food calendars based on foods that are locally available in the area; forms for monitoring attendance and delivery of SBCC sessions, and key messages for each intervention. 

c) Pre-session arrangements at the training venue
It is important that the site used for community training sessions be conducive and should normally be equipped with the following:

  • A toilet with hand washing facility (a demonstration of hygiene).
  • A safe water point in close proximity.
  • Cooking shelter with energy saving stove and clean cooking utensils supplied by participating families.
  • Appropriate learning shelter.
  • A demonstration site, for example a vegetable garden.
  • Presence of supporting government, agriculture, and community health extension staff. 

d) Implementing the interventions
Three approaches are generally used to deliver the SBCC interventions. These are selected for their complementarity and suitability for engaging adult learners. FANRPAN promotes behaviour change, not only amongst the primary target groups, but whole communities, including men. The interventions are implemented through group sessions, individual home visits and community theatre.

i) Group sessions
Sessions would normally be delivered twice a month at the start, followed by once a month once it was noted that the desired behaviours and habits had taken root. It is important to limit the numbers of participants to a maximum of 40, dividing them into two or more groups to ensure active participation by all. The knowledge dissemination sessions include a practical session or demonstration, for example, a cookery session, to reinforce the knowledge. Group sessions bring participants together, creating a basis for them to support and inspire each other and discuss pertinent issues on food, nutrition and hygiene they experience daily in their communities.

ii) Home visits
Home visits enable the implementing field practitioners to focus on those participants who would have missed group sessions by visiting their homes at convenient times. This also facilitates household members to ask questions and follow up on issues they may not be comfortable discussing in a group setting.  The home visits allow the field practitioners to understand the challenges that the households experience and any assistance they may require as they work on changing behaviours to apply the new knowledge on nutrition and hygiene.  This is an opportunity for practitioners to observe household hygiene practices, dietary diversity, food production and consumption and data collection for monitoring purposes. 

iii) Theatre for nutrition behaviour change sessions
Relevant content and key messages were packaged into a 30-minute theatrical performance. Performances were targeted at the whole community, including participating households.  This allows community members to appreciate the SBCC messages and identify some of their behaviours from characters depicted in the theatre performance. Theatrical skits allow for the surfacing of issues that would otherwise be treated as taboo or culturally sensitive amongst community members, but which are necessary to bring out in order to remove barriers to desirable behavior change.

4. From Theory to Practice
Experiences from the ATONU project that FANRPAN implemented among communities in Ethiopia and Tanzania showed some notable behaviour and attitudinal changes due to the SBCC messages. Some of the attitudes and perceptions captured from some participating households are recorded below. 

“My family is illiterate but the new knowledge we get from ATONU is easy to understand and follow.” Asmarech Alamrew, Ethiopia

“Before the ATONU project, we had no toilet. Now we have a toilet and a tippy tap for washing hands after using the toilet. I have also learnt the importance of bathing the kids regularly. Before ATONU, the kids used to bath once a month.” Desta Demlew, Ethiopia.

“After attending cooking demonstrations, I went home to teach my wife the new recipes. I also taught my family about the food groups and the importance of a diverse diet” Jumane, Tanzania.

“When I heard that ATONU would be teaching us about how to eat for better health, I decided to attend to hear for myself. When Mommina taught us about budgeting, I knew I would not miss a session. The best thing that I learnt from ATONU is that, as a man, I can do everything that my wife can do, except give birth and nurse a child” Yayaw Tarekegun, Ethiopia.

Bahati said she had learnt how important it was to “eat for health and not for hunger.”

“Before ATONU, whenever I thought of cooking chicken, I would think of how expensive it is to make Doro wat (chicken stew). At the ATONU cookery sessions, I learnt how to cook chicken in an inexpensive way. By substituting some of the expensive spices with vegetables such as carrots, now I can cook chicken every two weeks when we are not fasting.” Haregwoyin Fereja, Ethiopia.

5. Lessons for Scaling Up
The following lessons are noteworthy for scaling up SBCC messages:

  1. Community engagement and involvement is key when delivering interventions that are meant to influence behavior change.
  2. Local leadership involvement creates accountability on the part of the leaders, the people and the service providers.
  3. Diverse and complementary methods of knowledge dissemination are important as this addresses the gaps created when only one approach is used.
  4. Behavior change is not an overnight outcome, it requires continuous reinforcement and consistent support to the targeted population until new habits take root.
  5. Do not assume that the targeted people know nothing; their indigenous knowledge and methods provide a strong foundation for engagement of new approaches and knowledge.
  6. For projects that involve educating people, an understanding of the local community’s way of doing business is key as this will inform the approach to consider when designing social behavior change communication strategies.

Disclaimer: The views and opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of Mzansi Agriculture Talk or its members.

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