Building Behavioral Design Skills: Conversations with Breakthrough ACTION Innovators
Written by: Mamina Herizo, ideas42
This is part of a series of conversations with members of the National Innovations Team (NIT), a group of 54 health professionals across government and non-profit sectors in Burkina Faso and Niger. NIT members engage in a hybrid online and in-person applied learning curriculum developed by ideas42, which includes an introduction to behavioral design and hands-on coaching from our behavioral economics experts.
Through the course, members develop and refine innovative solutions based on feedback from end users to address behavioral challenges across a range of health areas. The NIT was established in 2020 by Breakthrough ACTION, the U.S. Agency for International Development’s flagship SBC program.
This spotlight features Bouraima Gnanou, who is part of a group working to increase the rate of antenatal care (ANC) visits in rural communities in Burkina Faso. In this interview, Bouraima discusses the effects of this training on his daily work as a communicator and Technical Advisor in the Department of Communication at the Ministry of Health (MOH) Burkina Faso.
How did you learn about the Burkina Faso NIT?
I heard about the NIT when Breakthrough ACTION started to create this program here in Burkina Faso. I was working in the communication department at the MOH. I wanted to discover something new, to do something else to allow me to act differently, and I wanted to learn about best practices from other countries. I participated in the NIT for two cycles [in 2020–21 and 2021–22].
What did you learn by participating in the NIT?
Before joining the NIT, when there was a problem, we thought about scenarios to tackle the problem, created messages, adapted the solution, then broadcast [those messages to the public]. We were satisfied with the messages that we broadcast. At that time, we were not engaging beneficiaries to provide feedback on the messages beforehand.
With the NIT, we learned new skills—really brand new! We would start with an idea and end up with a prototype of that idea. We analyzed the problems we were seeking to address, prioritized among these problems, considered the determinants of the problem, and then proposed ways to address these problems to implement. [This was all] very different from what I was used to doing. We went beyond messages and went as far as making prototypes that would be used by the beneficiaries and tested these prototypes to take into account the opinions of health workers, husbands, mothers-in-law, women of childbearing age, and the beneficiaries. This was really new for me.
What surprised you the most?
In the beginning, I did not know that I could have an idea and that my idea would be used throughout the process to create solutions and prototypes to test. My idea went to a certain level, to make sketches to implement [the solution] and [be] used by the beneficiaries. I also enjoyed the interactivity within the group, which allowed us to exchange opinions and develop the best ideas. It was a great formula for collaboration. The trip to the communities was also a great exercise, to be in contact with the beneficiaries and to have their opinion.
In the NIT course, I can say there was a lot of discovery. Now, I have learned all the processes and am able to make proposals for an innovative intervention to bring change. Recently, we developed health communication strategies. We came up with many proposals of ideas that could feed into innovative behavior change strategies. We have already made a proposal for a National Health Communication Strategy that includes innovative interventions and workshops to allow the development of prototypes to address certain issues.
During [COVID-19], we tried to use innovative methods to solve problems. The course we completed served us well to improve our work and now innovative interventions have been introduced in the strategy.
When I joined the NIT I had expectations, but I feel that I got more than I expected. I feel capable of making innovative proposals [for interventions]. I really received a lot of support, I learned a lot, [and] I feel fulfilled. Today, if I am asked to make an innovative proposal, I will be able to make it because of the course.
How did you apply what you learned at work?
There has been a change today—we are working with many technical departments. Now, when there are problems to solve and we have to develop public health messages, I always think of using innovative approaches. I ask myself, “What can we do?” Whenever there is an opportunity, I give updates and inform the team about the innovation, and I [take] into account the different steps for an innovative intervention. Planning innovative activities in the communication strategy comes automatically to mind. This is a big change.
Recently, when we worked on [our] five-year strategy, we included innovative activities and interventions in the health strategy from 2022 onwards to solve problems.
Can you share with us how you practiced applying innovative methods during the course?
The ANC rate in Burkina Faso is low. For our group, our work was to determine how to bring the women from rural areas to complete all their ANC visits, which is usually four visits.
For this exercise, we challenged ourselves with the new World Health Organization guideline, which is eight ANC visits. In Burkina Faso, pregnant women usually come for their first ANC visit at the end of the first trimester or in the second trimester. Therefore, having a full four ANC visits becomes challenging due to that delay. The rate of one ANC visit is between 70% and 80%, but fewer than 30% of women have four ANC visits and we wanted to work upstream. From our analysis, women do not know the benefits of ANC, forget about appointments, and listen to taboos about pregnancy that are related to culture and beliefs. Hence, we identified four solutions to overcome these barriers.
First, [we] involved the key actors, such as husbands [and] mothers-in-law, who are very influential to the women. We thought that the contribution of the husband and mother-in-law in a voluntary and official way can help to tackle the problem related to benefits and the delay for the ANC. They were involved in encouraging women from the first month of pregnancy to start the ANC.
[For our] second solution, we put women in groups of two or three, so they go to ANC together. [This] will encourage discussion and also break the taboo of attending ANC. Since they are in a group, at least one or two can remember the next appointment so they can remind each other of the date of the appointment
[Our] third solution was the commitment card. The pregnant woman or husband or mother-in-law will encourage women to go and register with a community health worker (CHW). Then, the group will be formed, and the woman will take the commitment with the CHW to follow the ANC.
Finally, as a fourth solution, we have provided stickers that show the development of the fetus, which will encourage the woman to go for the next appointment. The health worker who does the checkup will put the sticker on the card. If she comes to the next appointment, she will get another sticker. We thought she didn’t want to miss out on knowing her child’s developmental level. During user testing, [women] said, “Ah, we’ve never seen this before, and we’re going to go to the care visit.” With that pretest, we think it will really enhance the outcome.
Implementing [these solutions] will increase the rate of ANC and compliance with ANC appointments. We were comforted when we did the pretest. A midwife said, “No woman wants to miss her appointment for ANC. They will all make it all the way and come here to make sure they get the sticker.” With the women in the community, we feel that there is already an attachment to the sticker.
Do you have any projects or suggestions related to what you have learned?
I suggest the [Burkina Faso] MOH formalize the NIT. Annually, the MOH determines the priority issues and could request the support of the NIT to help solve the problems. The NIT should be given the technical support to work on the analysis [of problem determinants] and propose innovative solutions. The ownership of NIT by the MOH is important. Having a formalized NIT would help improve the whole process and achieve great results.