Agency for All Project

The project defines 'agency' as "the capacity of a person, or group of people, to create and accomplish the goals they set for themselves, with full autonomy to make decisions about their own health or well-being." To better understand how agency works in different cultures, strengthen evidence on approaches to develop agency within SBC programmes, and increase the agency of local partners to generate and use that evidence, the project works across three workstreams: 

Evidence Generation
The project employs implementation science activities layered onto ongoing SBC efforts (that are implemented by partners) to discover: the nature of agency, how agency develops, how agency affects health behaviours, and how different SBC interventions can be utilised to promote agency to improve health. The project examines the agency of individuals and communities in a broad range of outcomes, modalities, and contexts, leveraging existing capacities and resources wherever possible.

Measuring, Monitoring, and Adaptive Management
Agency for All applies adaptive learning strategies to foster critical reflection and analysis across all evidence results. Using complexity-aware monitoring (CAM) and collaboration, learning, and adapting (CLA) tools and practices, the project seeks to:
 

• Develop and rigorously test measures of agency and social dynamics across contexts;
• Promote adaptive management, including testing and integrating validated sets of SBC monitoring indicators for different domains;
• Support the integration of these new approaches through the project's Learning Collaboratives and partner networks (see more information about this below); and
• Provide a toolkit of agency-related measures, indicators, and monitoring, evaluation, and learning (MEL) approaches to support the adoption of these new approaches.

Research Utilisation
The project seeks to shift culture and practice to promote equitable partnerships throughout the research cycle, using a systems approach to facilitate uptake of research knowledge. Research utilisation (RU) focuses on four functions: complexity awareness, collaboration, capacity-building, and communication to ensure that new evidence impacts practice and policy. The project actively explores power dynamics in partnerships and between stakeholders to understand the interrelationships driving organisational agency in research-to-practice partnerships in the SBC global health and development sector and, based on the findings, develops and tests strategies to improve RU and build equitable researcher-implementer-donor partnerships through, for example, capacity-strengthening activities.

Across all the workstreams, locally led, equitable partnerships are key. Agency for All works to ensure that local consortium partners lead the research agenda and implementation through their diverse voices, perspectives, and expertise. This goal is also facilitated by their participation in the Social Norms and Agency Learning Collaboratives based in East Africa, West Africa, and South Asia, which are existing regional communities of practice made up of implementing organisations, researchers, community representatives, and others with a stake in promoting positive social norms and increasing individual and community agency to improve health.

Activities: 
In 2023, the project launched and completed eight research studies. It collaborated across USAID Missions and other sectors of USAID to conduct additional studies on the intersection of agency and vaccine hesitancy, adolescent childbearing, reproductive coercion, gender norms, and more. Agency for All also rolled out emerging insights from the evidence, literature reviews, and various research and programme recommendations. In addition, the project held workshops, webinars and conversations focused on translating research into practice.  

Click here to access research shared by the project to date, which includes Research-at-a-Glance publications on issues such as the impact of SBC media on youth agency in Kenya, developing a measure of contraceptive acceptability, COVID-19 vaccination communication in Nigeria, and reductig infertility stigma and improving reproductive agency in Cameroon and Kenya, as well as Technical Briefs and Programme Assessments.  

The following are two examples of projects being implemented with local partners in Cameroon and Kenya: 

Agency for All consortium member EVIHDAF is working with partners to conduct a twin research study on contraceptive acceptability and infertility in Cameroon and Kenya. Partners include the UCSD-GEH, Makerere University, Matchboxology, and Save the Children. The work consists of two main activities. The first seeks to develop a reliable and valid measure of contraceptive acceptability in different contexts across Africa to inform the design of future interventions and policies to effectively meet the needs of women and men throughout the reproductive life cycle. It uses mixed methods to explore acceptability, including rapid qualitative formative research, fertility life history maps, human-centred design approaches, and a literature review. The second activity seeks to design an SBC intervention that supports women and couples to build agency to achieve their self-determined reproductive goals by increasing fertility-related knowledge and decreasing infertility-related stigma. Qualitative formative research will explore individual, community, contextual, and programmatic factors related to infertility, as well as the influence these factors have on the reproductive agency.

In Kenya, consortium member Shujaaz Inc. is designing a multi-year norm-changing mass media campaign that will build young people's agency and enable them to take control of their sexual and reproductive lives. Shujaaz Inc. will be working in close collaboration with Makerere University in Uganda to track, research, and provide evidence of the impact of the media campaign and to better understand the crucial steps that are required to put young people in control (build agency) around family planning, health, and well-being.

Agency for All is also working in Niger, Nigeria, Uganda, Ethiopia, Madagascar, Bangladesh, India, Cambodia, and Indonesia.

More information can be found on the Agency for All website; see also the video, below.

Rationale for the project:

As explained in the technical brief "Advancing Shared Conceptualizations of Agency: Emerging Insights" [PDF], "There are significant gaps in our understanding of agency and its impact on social and behavior change (SBC) program outcomes. While emerging evidence suggests that empowerment-focused SBC programs can create sustained impacts on a wide range of health outcomes across contexts, they rarely address issues of individual and collective empowerment. Agency is situated at the heart of the empowerment process, and is the engine through which people work to achieve their self-determined goals. Concepts of agency in health and development are often defined in high income contexts and applied to low-and middle-income contexts. This pathway impedes conceptual clarity and contextualized understanding of the role (and measurement) of agency across diverse settings. It also creates and sustains evidence gaps on the role of agency in health, on the ways that individual and community agency influence one another, on optimal means of assessing the impact of agency, and on identifying strategies that are most effective in fostering agency. While there have been advances in conceptualizing empowerment as a process influenced by the social environment, encompassing critical consciousness, choice, efficacy and action, we lack reliable, validated measures to study these processes. A primary constraint is the lack of validated measures for the multiple constructs embedded in agency and empowerment (e.g., collective capacity, social norms and social accountability) that are feasible for use by SBC practitioners in different communities around the world. This gap severely hinders the comparability of agency and empowerment research across contexts, and the ability of researchers, implementers, and policy makers to understand and support shifts in these phenomena."