Improving health outcomes by strengthening public sector capacity in social and behaviour change programming in Nigeria

Abstract

Abstract Background: Capacity building aids sustainability of SBC programming, encompassing planning, implementation, monitoring, and evaluation of activities. USAID-funded project, Breakthrough ACTION/Nigeria is currently implementing interventions to increase the capacity of public sector stakeholders for social and behavior change (SBC) programing, as part of a broader, integrated health SBC project. This paper examines the outcomes of the PSCS approach and how they contribute to the promotion of maternal, newborn, and child health, and nutrition (MNCH+N)-related outcomes. Methods: The qualitative study used outcome harvesting and most significant change methodologies to evaluate project outcomes over five years. Data collection included key informant interviews and most significant change stories in Sokoto, Kebbi, Nasarawa, Bauchi, and Ebonyi states of Nigeria. Data was collected from 45 participants between July and August 2022. Thematic analysis approach was used to analyze data. Ethical approvals and informed consent were obtained before data collection. Findings: The PSCS approach empowered stakeholders at the individual level to disseminate health messages, monitor health and SBC activities, and increase the demand for health services. At the organizational level, the approach facilitated coordination of SBC activities, enabled training cascades, and promoted adherence to health service guidelines. At the system level, it strengthened ward development committees to address health challenges. Challenges hindering stakeholders' application of PSCS-acquired skills include inadequate workforce, negative attitudes of health workers, funding constraints, cultural barriers, lack of government ownership, and limited accessibility. Conclusion: This study shows that the PSCS approach is an effective model to scale up capacity for SBC in health programs. In response to documented supply-side challenges impeding the application of gained knowledge, we recommend inclusive health worker recruitment, sensitization programs for health workers, government ownership, improved security, healthcare infrastructure and transportation systems. Implementing these recommendations will complement stakeholder capacity for improved health outcomes.