Breakthrough ACTION Nepal 2018 Social and Behavior Change Capacity Assessment Report Submitted by: Johns Hopkins Center for Communication Programs Cooperative Agreement #AID-OAA-A-17-00017 In collaboration with: Government of Nepal Ministry of Health and Population National Health Education Information Communication Center Family Welfare Division Table of Contents Acronym List ..................................................................................................................................... iv Acknowledgements............................................................................................................................ v Executive Summary ............................................................................................................................6 Background .......................................................................................................................................8 The Emerging SBC Health System ............................................................................................................. 8 Overview of SBC Capacity Assessment Exercise ................................................................................. 11 Objectives ............................................................................................................................................... 11 Participants ............................................................................................................................................. 11 Approach ................................................................................................................................................. 12 Process .................................................................................................................................................... 13 SBC Capacity Assessment at the Central Level ................................................................................... 14 Visioning Exercise .................................................................................................................................... 14 Preliminary Discussion about the Self-Assessment ................................................................................ 15 Small Group Discussion ........................................................................................................................... 15 Assessment Results for the Central Level .......................................................................................... 16 Program Management (Indicators 1.1–1.2) ........................................................................................... 16 SBC (Indicators 2.1–2.10) ........................................................................................................................ 16 Mobile Technology (Indicators 3.1–3.4) ................................................................................................. 18 Social and User-Generated Media (Indicators 4.1–4.5) .......................................................................... 19 Knowledge Management, Coordination, and Communications (Indicators 5.1–5.6) ............................ 20 Monitoring and Evaluation (Indicators 6.1–6.4) ..................................................................................... 21 Insights from Key Informant Interviews at the Central Level .............................................................. 21 Major Gaps Identified at the Central Level ........................................................................................ 23 Recommendations for the Central Level ........................................................................................... 25 SBC Capacity Assessments at the Provincial and Local Levels ............................................................. 26 Visioning Exercise .................................................................................................................................... 27 Capacity Skillsets ..................................................................................................................................... 28 Small Group Discussion ........................................................................................................................... 28 2018 Social and Behavior Change Capacity Assessment Report | i Assessment Results for the Provincial and Local Municipalities Level ................................................ 29 Program Management (Indicators 1.1–1.2) ........................................................................................... 29 SBC (Indicators 2.1–2.10) ........................................................................................................................ 30 Mobile Technology (Indicators 3.1–3.4) ................................................................................................. 32 Social and User-Generated Media (Indicators 4.1–4.5) .......................................................................... 33 Knowledge Management, Coordination and Communications (Indicators 5.1–5.6) ............................. 33 Monitoring and Evaluation (Indicators 6.1–6.4) ..................................................................................... 34 Advocacy (Indicators 7.1–7.10) (see Appendix 2: SBC Capacity Assessment Tool) ................................ 35 Key Informant Interviews Insights at the Local Level ......................................................................... 35 Major Gaps Identified at the Local Level ........................................................................................... 38 Province-level gaps ................................................................................................................................. 38 Local municipality gaps ........................................................................................................................... 38 Short- and Long-term Priorities at the Local Level ............................................................................. 38 Action Planning for Implementation and Monitoring ............................................................................ 38 Recommendations for the Local and Provincial Levels ....................................................................... 39 Appendix 1: SBC Capacity Self-Assessment Scores (2018) .................................................................. 41 Appendix 2: SBC Capacity Assessment Tool ....................................................................................... 42 Appendix 3: Interview Guidelines for Internal Use ............................................................................ 69 Appendix 4: Interview Guidelines for External Partners ..................................................................... 72 Appendix 5: Summary Findings from the 2014 National Health Education Information Communication Center Self-Assessment* ................................................................................................................ 745 Appendix 6: Participant Lists .......................................................................................................... 746 2018 Social and Behavior Change Capacity Assessment Report | ii Figures Figure 1: Ministry of Health and Population health promotion structures .................................................. 9 Figure 2: Health system structure of provincial Ministry of Social Development in Karnali Province . 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Figure 3: Health system structure at the local municipality level .............................................................. 10 Tables Table 1: Aggregate scores of SBC Capacity Assessment 2018 ...................................................................... 7 Table 2: List of participants in provincial and local capacity assessment workshops ................................ 26 2018 Social and Behavior Change Capacity Assessment Report | iii Acronym List DHO District Health Office DPHO District Public Health Office FCHV Female Community Health Volunteer HD Health Directorate IEC Information, Education, and Communication M&E Monitoring and Evaluation MOHP Ministry of Health and Population NHEICC National Health Education Information and Communication Centre PMP Project Managing Plans SBC Social and Behavior Change SBCC Social and Behavior Change Communication SMS Short Message Service TOR Terms of Reference USAID United States Agency for International Development 2018 Social and Behavior Change Capacity Assessment Report | iv Acknowledgements This report was written by Pranab Rajbhandari, Shreejana KC, TrishAnn Davis, Caroline Jacoby, and Sanjanthi Velu who led workshops, collected data, drafted and reviewed content, and edited the report. Shreejana KC and TrishAnn Davis conducted the SBC Capacity Assessment Workshop at the central level. Shreejana KC and Lokesh Bhatt conducted the workshops at the provincial and local levels. The Breakthrough ACTION Nepal team graciously thanks the many stakeholders who contributed their time and energy to participate in the SBC Capacity Assessment Workshops at the central, provincial, and local levels. This activity was supported by the United States Agency for International Development (USAID) through Cooperative Agreement #AID-OAA-A-17-00017. Suggested citation: Rajbhandari, P., KC, S., Davis, T.A., Jacoby, C., and Velu, S. Breakthrough ACTION Nepal. 2018. Nepal Social and Behavior Change (SBC) System: