Strengthening Social and Behavior Change Programming Through Application of an Adaptive Management Framework: A Case Study in Tanzania

"[I]ntegration of a systematic adaptive management approach can lead to greater scale, saturation, and quality execution of activities, contributing to measurable improvements in key behaviors and their determinants."

Large-scale integrated social and behaviour change (SBC) programmes seek to leverage facilitators and address barriers to achieve a range of behaviour change objectives focused on health and development. Measurement of change, including the adoption or maintenance of particular behaviours and the social conditions that facilitate or hinder them, is challenging, as is the identification of factors for programme successes or gaps. In response to these challenges, FHI 360 developed the SBC Adaptive Management Framework, which provides a roadmap and tools to facilitate the routine use of near real-time data alongside participatory analysis approaches for project design and evaluation. This paper examines how the United States Agency for International Development (USAID)'s flagship programme USAID Tulonge Afya applied FHI 360's SBC Adaptive Management Framework in Tanzania. A particular focus is on the similarities and differences between the responsive feedback (RF) approach and the SBC Adaptive Management Framework; to that end, the paper shares lessons that may strengthen and expand the application of RF and similar approaches within future SBC programmes.

FHI 360 developed the SBC Adaptive Management Framework specifically to: (i) inform strategy design and evaluation, including understanding and elucidating pathways to behaviour change; (ii) identify SBC programme successes and challenges against performance indicators; (iii) measure performance and understand implementation fidelity and quality across programme sites; (iv) strengthen SBC programmes to enable responsive shifts, as needed; and (v) adapt programmes to meet contextual needs and/or replicate or scale up successful strategies. Both RF and the framework: include meaningful engagement with an array of stakeholders throughout project design, implementation, monitoring, and evaluation (M&E); require close collaboration between M&E and programmatic staff to ensure data collection and use are informed by and contribute to refinement of the project's theory of change; and incorporate purposeful, routine opportunities for learning and course correction. Accompanying the framework is a suite of tools and activities to facilitate systematic collection, analysis, and application of data for project design, improvement, and evaluation.

As detailed at Related Summaries, below, FHI 360 under the USAID Tulonge Afya project (Kiswahili for "Let's Talk about Health") delivered (from 2017-2022) integrated activities that aimed to catalyse opportunities for Tanzanians to improve their health status by transforming sociocultural norms and supporting the adoption of healthier behaviours. Through use of a participatory, evidence-based, and theory-informed approach, the project developed 2 integrated, branded SBC platforms: Naweza (Kiswahili for "I Can"), which reached adults at key life stages (pregnancy and caregiving for a child aged younger than 5 years, with a focus on the first 1,000 days); and Sitetereki ("Unshakeable"), which engaged youth to increase uptake of positive sexual and reproductive health behaviours. These integrated platforms were supplemented by a long-running HIV-focused campaign, Furaha Yangu ("My Happiness"). Beginning in 2019, the project implemented comprehensive packages of SBC activities under these platforms, including: national-level mass and social media; mid-media (e.g., community theatre, radio, and events); community mobilisation; and interpersonal communication activities in collaboration with local civil society organisation (CSO) partners in 29 focal districts.

The article describes the application of the SBC Adaptive Management Framework within USAID Tulonge Afya and explores how it improved implementers' ability to address emerging priorities and achieve greater scale, saturation, and quality execution of activities. It provides examples of how it facilitated significant input from local communities and stakeholders through shared data analysis and feedback loops, thereby ensuring project activities reflected their strengths, needs, and preferences rather than the perspectives and biases of programme implementers. Selected contributions of the framework to programme results include:

• The USAID Tulonge Afya project met with stakeholders to review service delivery and campaign data and identify recommended changes to the SBC campaign's strategic approach that could increase HIV testing yield. Continued monitoring of service data after implementation of these adaptations showed a rebound in HIV testing positivity yield, steadily increasing to levels greater than before the campaign.
• Because of the larger array of activities for which the community volunteers were responsible compared to peer champions, in many districts, reach targets for Naweza and Furaha Yangu were not met compared to reach targets for activities under the Sitetereki platform. The result of this adaptation was improved reach among young parents and caregivers.
• By engaging stakeholders as active participants, the framework supported the gaining of hands-on experience in participatory data collection methods, data analysis and interpretation, and quality assurance of SBC activities. (However, a limitation of the approach used under USAID Tulonge Afya was that the framework was not used systematically as a capacity-strengthening tool.)

Key lessons learned include:

• Both donors and programme implementers should ensure sufficient allocation of time and resources to adaptive management approach activities throughout the entire project life cycle.
• Effective implementation of an adaptive management approach requires programmes to have strong relationships with government and donor counterparts.
• Stakeholders should collaborate and coordinate activities to optimise effort, time, and resources.
• Creating a culture of testing and learning requires programme implementers to be open to diverse perspectives and have their assumptions challenged, recognising that doing so has tangible benefits for project delivery and broader learning.
• Prioritize Indicators and Develop Tools Guided by a Theory of Change
• SBC programmes should: (i) use evidence to develop a theory of change for the project; (ii) use the project's theory of change to directly inform the selection of indicators that are tracked over time; (iii) prioritise a core set of priority or sentinel indicators for routine tracking; and (iv) select or develop adaptive management tools that are accessible and meet the skill level of the entire project team.
• The way in which projects apply adaptive management approaches needs to be flexible and responsive.

In conclusion: "Learning from the USAID Tulonge Afya experience can contribute to an improved understanding of the conditions necessary to facilitate effective integration of an adaptive management approach within complex SBC programs and the benefits of such an approach for improved implementation and impact."