Introduction
In fiscal year 2017, the Independent Evaluation Group (IEG) incorporated Strategic Engagement Areas (SEAs) into its work program, selecting three key areas: Sustained Service Delivery for the Poor, Inclusive Growth, and additional topics that align with the World Bank Group’s overarching goals.
Environmental sustainability is a key focus of the World Bank Group's efforts towards achieving sustainable development The Strategic Environmental Assessments (SEAs) enable the Independent Evaluation Group (IEG) to gain deeper insights into various evaluation topics, helping to identify effective strategies and their contextual relevance.
The Sustained Service Delivery for the Poor SEA aims to enhance the understanding of evidence-based solutions for consistently delivering services to impoverished communities It has established common frameworks to identify, describe, and evaluate various approaches and interventions that facilitate service delivery and encourage behavior changes to boost service utilization This paper, alongside another focused on service delivery, will create frameworks and tools to support IEG evaluations in urban transport, water and sanitation, and basic health services The SEA teams have actively collaborated with the World Bank Group to foster dialogue and leverage ongoing initiatives in these critical areas.
The working paper aims to create an evaluative tool for assessing the impact of behavior change activities on service delivery outcomes across various sectors It distinguishes between supply-side issues related to effective service delivery and the challenges of service uptake Both papers converge at the diagnostic stage, considering user demands and constraints Following the pilot of these two frameworks in IEG’s evaluations, a subsequent paper will integrate them, highlighting their differences and complementary aspects.
This paper aims to define behavior change in a way that aligns with World Bank operations, explore applicable theories of human behavior for international development interventions, and introduce an evaluative framework for assessing the integration of behavior change concepts throughout the intervention lifecycle It also highlights examples of the World Bank's support for behavior change in sectors such as water and sanitation, urban transport, and nutrition within basic health care.
2 the paper does not draw conclusions on the types or effectiveness of these interventions, it simply presents them as illustrative
The main audience for this work is the staff within IEG, although it may also be useful for evaluators from other agencies and personnel within the World Bank Group However, it is important to note that the content is not tailored to meet the operational needs of Bank Group staff.
Behavior reflects how an individual externally responds to a situation, stemming from their decision-making process, which can be either automatic or deliberate (Kahneman, 2011) This response is influenced by various factors, including economic, psychological, and social mechanisms (Pawson and Tilley, 1997).
Behavior change activities focus on specific choices and behaviors that lead to desired outcomes (Pawson, 2006; 2013) These changes can manifest as increases, decreases, enhancements, improvements, or maintenance of behaviors (Morra-Imas and Rist, 2009).
In international development, individual behavioral responses to project activities are influenced by specific contexts and mechanisms, with a primary focus on the demand for goods and services While behavioral change often starts at the institutional level, it is crucial to understand the factors that facilitate or inhibit service uptake at the individual level For instance, the use of a newly built latrine signifies a behavior change, but merely providing resources is not enough to ensure service use Other barriers, such as economic, psychological, and social factors, may hinder latrine usage, necessitating targeted project activities that address these demand-side behavior changes Successful interventions must consider individuals' decision-making processes and the trade-offs they face, ensuring sustained service delivery for the poor.
Figure 1.1 Behavior Change Results Chain
Graphically illustrating the definitions and distinctions of behavior change and behavior change activities can be effectively achieved using standard economic tools such as supply and demand In this context, "behavior change" is also referred to as an "outcome."
Behavior change outcomes refer to the shift in the equilibrium quantity of a good or service, illustrated by the movement from Q1 to Q2 in figure 1.2 These activities aim to influence the demand curve for various goods and services, leading to significant changes in consumer behavior.
A shift in the demand curve can occur due to various factors such as changes in the relative price of a good, fluctuations in income, or new information regarding the true price or value of a product Additionally, alterations in the shape of the demand curve are generally driven by shifts in consumer preferences for the good or service.
Figure 1.2 Behavior Change As Understood Through Supply and Demand
Note: The first panel represents a shift in the demand curve The second panel is a change in the shape of the demand curve
The third panel illustrates a shift in the supply curve, while changes in its shape are not depicted All three scenarios lead to changes in behavior outcomes, specifically affecting the equilibrium quantity However, only the first two scenarios are classified as behavior change activities, as they directly influence the demand curve.
Provision of additional resources or changes in production technology can shift the supply curve, while alterations in productivity factors can modify its shape Supply-side interventions, such as constructing latrines or roads, may influence behavior if utilized by individuals However, these changes are not deemed "behavioral" unless they also impact the demand curve For a more comprehensive analysis of supply-side considerations, refer to the companion working paper on service delivery (IEG 2016).
The World Bank Group has been dedicated to improving access to services for the poor for decades, but access alone may not suffice for poverty eradication Despite progress, challenges persist, and targeting beneficiaries' behavior to ensure service usage can enhance the Bank's effectiveness By evaluating projects through a behavior change perspective that emphasizes demand-side factors, the World Bank can gain valuable insights into improving service utilization, especially when resources are not the primary limitation.
Literature Review
To effectively assess how the Bank has utilized behavior change to meet project goals, it is essential to grasp the theoretical foundations of behavior change models This literature review explores key concepts from economics, sociology, and psychology that pertain to behavior change, highlighting the relevant theories that inform development work.
It includes a discussion of four existing frameworks for designing behavior change interventions
The literature on behavior and behavior change can be categorized into three main areas: standard neoclassical economics, psychology and sociology, and a blend of economics, psychology, and sociology, along with other social sciences like anthropology While this classification is not flawless due to significant overlaps among the ideas, it serves as a valuable framework for understanding the foundational elements of behavioral interventions developed over the past century.
Policy makers often utilize standard neoclassical economic theory, which is based on the assumption that individuals act as economically rational agents, driven by self-interest to maximize their utility within given constraints This model posits that individuals can process information accurately, even under uncertainty, and identifies incentives (such as prices and regulations) and information as key factors influencing behavior change While this approach has proven effective in various domains, as noted by Rodrik (2015), it falls short in areas like public health To enhance and sustain positive outcomes, integrating additional techniques alongside traditional economic models is essential.
Psychological and sociological theories of human behavior are diverse, including the theory of reasoned action, which emphasizes persuasive communication, and social cognitive theory, which posits that individuals learn by observing the behaviors of others Additionally, the transtheoretical model outlines a multi-stage process of behavior change, highlighting the importance of social and temporal factors This model is particularly relevant in disease prevention, as it requires not only access to preventative medicines but also individuals' commitment to taking the correct medication at the appropriate time and dosage, with each stage incorporating crucial behavioral components.
The literature on behavior change project design, influenced by psychology and sociology, is primarily focused on public health, which has explored behavior change for many years Due to the diversity of health issues, populations, cultures, and contexts, no single theory is predominant While interventions based on various theories share similarities, the implementation of behavior change activities has often been inconsistent Recent studies have sought to create a theory-linked taxonomy of behavior change techniques, identifying common themes among intervention types and aligning them with foundational theories such as the theory of reasoned action and social cognitive theory This research has led to a unified framework of behavior change techniques, promoting standardization in the field and facilitating comparisons between health interventions A total of twenty-six behavior change techniques have been identified, applicable to various policy objectives beyond health, including barrier identification, self-motivation, rewards, prompts, and communication Additionally, simpler taxonomies of behavior change techniques have been developed to classify a variety of activities in development interventions.
Communication strategies informed by psychology and sociology represent a significant evolution from earlier behavior change efforts that primarily focused on raising awareness through information, education, and communication (IEC) campaigns This shift has led to the development of Behavior Change Communication (BCC), which adopts a more holistic approach by acknowledging a wider range of behavioral determinants BCC goes beyond mere awareness to consider practical constraints, social norms, and cultural perceptions, and emphasizes the importance of interaction and emotional connections with beneficiaries.
Behavioral economics integrates insights from psychology, sociology, anthropology, and neuroscience with traditional economic theories to enhance the predictive accuracy of the neoclassical model This interdisciplinary approach helps to elucidate behaviors that deviate from purely rational decision-making.
Some experts believe that economics is returning to its foundational principles, referencing influential thinkers like Smith, Keynes, and Hayek, who examined the psychological and social factors affecting human decision-making.
Contemporary researchers highlight that individuals frequently struggle to optimize their choices, leading to systematic errors in judgment and decision-making This results in decisions that ultimately prove more harmful than beneficial, even when individuals possess the necessary knowledge to make better choices.
Moreover, they use mental frames to interpret their environment, which shape their perception and understanding of the world
Behavioral economics applies theories from psychology and sociology to understand individual decision-making processes It utilizes "behavioral insights" from non-economic fields to create projects aimed at changing behaviors, particularly addressing cognitive biases like loss aversion and procrastination.
Confirmation bias can hinder individuals from optimizing their behavior change activities These activities, based on behavioral insights, typically manipulate psychological and social factors in decision-making Strategies include setting defaults, simplifying information, emphasizing social norms, and leveraging interpersonal interactions and social support.
O VERLAPS IN B EHAVIOR C HANGE T HEORIES
The paper categorizes approaches to behavior change in social science and public policy, highlighting the overlaps in theories and techniques across disciplines that seek to understand similar constructs A notable example is social cognitive theory, which emphasizes that individuals learn behaviors by observing role models and has been widely applied in health communications (Bandura 2004) Recently, economists have also recognized the significance of role model effects in areas such as fertility and gender empowerment (Jensen and Oster 2009).
La Ferrara, Chong, and Duryea 2012) It is notable that early papers by La Ferrara did not cite Bandura, but a recent review paper has, which suggests convergence
Several frameworks have been developed to design interventions aimed at changing individual behavior, building on existing theories Defra’s 4E framework focuses on promoting sustainable lifestyles and waste prevention, and it can be adapted to various policy contexts Although the COM-B framework is primarily used in public health and lacks behavioral insights, it is flexible enough to incorporate such interventions Key elements like Messenger, Incentives, Norms, and Defaults play a crucial role in these frameworks.
The MINDSPACE and EAST frameworks highlight key factors that affect decision-making, utilizing mnemonic devices to simplify the understanding of behavioral influences.
2.8 The World Bank has developed behavior change frameworks of its own Building on the work of Kahneman (2011), the 2015 World Development Report (WDR) entitled Mind,
The article discusses the processes of behavior change in society through the perspective of behavioral economics, as highlighted by the World Bank in 2015 It introduces the Focus, Opportunity, Ability, and Motivation Model in Sanitation (SaniFOAM), a framework created by the World Bank to effectively design water and sanitation projects.
The CrI 2 SP Framework and Coding Template
3.1 The existing behavioral frameworks already in use–MINDSPACE, EAST,
SaniFOAM, COM-B, and similar frameworks categorize behavioral constructs in diverse ways, yet they share common limitations These frameworks are primarily either abstract or diagnostic, outlining thought processes that influence behaviors, or they serve as preemptive tools for policy design However, they lack an evaluative component, as none assess the behavioral implications of interventions after they have been implemented.
IEG created a new evaluative framework aimed at assisting sector evaluations in evaluating the integration of behavior change concepts throughout the entire intervention life cycle, from the diagnostic phase to project closure The design of this behavior change framework required careful consideration to ensure its effectiveness.
The evaluation should focus on descriptive analysis rather than prescriptive guidance, examining projects retrospectively to detail not only the original designs but also the actual implementations and any modifications made during the process This approach enables evaluators to identify potential trends in outcomes based on different types of interventions and behavioral activities.
be relevant It should allow the full range of the World Bank’s portfolio to be evaluated
be flexible The framework should be applicable across World Bank sectors (GPs, CCSAs)
be “user friendly” to sector experts or evaluators who may not have a behavioral background
be easy It should build on frameworks already familiar to IEG evaluator staff
To effectively assess behavior change, it is essential to adopt a beneficiary-focused approach, using the end beneficiary as the primary unit of analysis This perspective allows for a clearer understanding of whether an activity is deemed "behavioral" and how it impacts outcomes Ultimately, the evaluation should center on the behaviors of individual beneficiaries to accurately measure the effects of various activities.
be comparable It should use World Bank Group projects, components or subcomponents as the unit of coding
be relatively simple and concise It should be CRISP!
IEG recognized that existing frameworks did not fully satisfy their criteria, prompting the development of a new framework tailored to meet these requirements This framework was crafted in collaboration with authors from the 2015 World Development Report (WDR) and refined through discussions with the Bank's behavioral hubs, including the Global Insights Initiative (GINI) in the Development Economics department and the Behavioral Insights Team in the Poverty and Equity Global Practice.
The Change Community of Practice engaged individuals from the Transportation, Water and Sanitation, and Nutrition sectors, along with IEG evaluators and evaluation leads Additionally, 30 participants from an interactive session at the 2016 Results Measurement and Evaluation Stream events contributed to brainstorming and providing feedback on the framework.
T HE C R I 2 SPF RAMEWORK AND C ODING T EMPLATE
Finally, early iterations of the resulting framework were discussed with the United
Kingdom’s Behavioral Insights Team (the “nudge unit”)
Understanding Behavior Change ex post: The CrI 2 SP Framework
In response to the outlined requirements, IEG created the CrI 2 SP framework, which encompasses five key categories to identify barriers and interventions that drive behavior change: Communication, Resources, Incentives and Information, Social Factors and Activities, and Psychological Factors and Activities This framework is central to the IEG approach for assessing behavior change in practice.
Figure 3.1 The CrI 2 SP Framework of Barriers and Intervention Types that Can
Note: CrI 2 SP = Communication, resources, Incentives and Information, Social Factors, and Psychological Factors
3.5 Communication serves as the backdrop to activities that intend to change behavior
Effective communication channels are essential for delivering behaviorally-informed messages to the target audience Evaluating these communications involves assessing whether the intervention successfully conveyed the intended behaviors and understanding the methods used Insufficient, misleading, or untrusted information can hinder the uptake of services A well-crafted communication strategy can alleviate informational barriers and promote desired behaviors.
Supply-side interventions are not classified as behavioral activities within this framework, as indicated by the lower-case “r” in a grayed box However, resources can influence behavioral outcomes by expanding opportunities for individuals to engage in activities or by reducing costs through increased supply, which can lead to movement along the demand curve These aspects are further examined in the accompanying IEG working paper on service delivery Additionally, the category of resources encompasses policies, regulations, and other elements that shape the environment for these activities.
T HE C R I 2 SPF RAMEWORK AND C ODING T EMPLATE
13 enabling environment Moreover, it also includes interventions that improve general capabilities but do not have a direct effect on outcomes 10
While the provision of resources is not classified as a behavior change activity since it does not directly alter the demand curve, insufficient resources, regulations, and capabilities can hinder behavior change Although resources alone do not constitute behavior change activities, they are essential for achieving behavior change outcomes Monitoring the relationship between resource allocation and behavioral elements can offer valuable insights into the structure of the Bank’s portfolio.
To support the desired behavior change, it is essential to implement sufficient incentives and information, which are key motivators in neoclassical economics This encompasses both financial and temporal incentives, which can be either positive, like subsidies for mass transit, or negative, such as fuel taxes Additionally, the information provided can vary in completeness and may be subject to uncertainty or asymmetry This information translates into two types of knowledge: "knowledge that," which includes insights on expected benefits or costs, such as the advantages of washing vegetables.
"Knowledge how" encompasses the essential skills and techniques required to perform specific tasks or behaviors This includes 11 projects designed to enhance individual abilities and capabilities, offering targeted training in areas like water purification, as well as broader educational incentives and information.
Incentives and information are key factors driving shifts in the demand curve, as illustrated in figure 1.2 Together with resources (supply), they form the foundation of the standard economic model of consumer theory, where rational actors aim to maximize utility within a budget constraint while assuming fixed preferences This concept aligns with Kahneman's (2011) notion of "thinking slow."
Social factors significantly shape individual behavior by influencing perceptions and adherence to social norms, which are shared beliefs about expected group conduct Projects may either align with, challenge, or enhance these norms, while also addressing moral considerations like fairness and responsibility Effective interventions often leverage social networks for monitoring and recognition, fostering a sense of group identity and encouraging social change For instance, a soap opera could be used to destigmatize public transportation or promote a group identity with positive attributes, ultimately leading to improved behavioral outcomes.
3.11 Psychological factors account for ways in which a project influenced individuals’ behavior through their nonrational or bounded-rational perception of the world around them
T HE C R I 2 SPF RAMEWORK AND C ODING T EMPLATE
This category encompasses cognitive stress and hassle, highlighting the role of mental models, including stereotypes, causal narratives, and heuristics It also addresses cognitive biases and limitations, as detailed in appendix C Additionally, design elements like nudges and defaults are included, aiming to correct faulty mental models, as illustrated in the WDR 2015, which emphasizes framing diarrhea as a consequence of germ contamination rather than other interpretations.
“leaking baby” that has had too many fluids and needs to stop having water), or making a targeted behavior easier, attractive, salient, or timely
Conclusion
Causal evidence indicates that behavior change initiatives in sectors such as water and sanitation, urban transport, and basic health services can be highly cost-effective The 2015 World Development Report highlighted various impact evaluations of non-Bank activities, including a project in Kenya that provided free chlorine dispensers at water sources, leading to a 50% increase in water treatment among the population (Kremer et al., 2009) Additionally, in Kenya, the introduction of stickers encouraging bus passengers to confront unsafe drivers successfully altered social norms, resulting in a 50% reduction in accidents (Habyarimana & Jack, 2011) Furthermore, in India, immunization rates more than doubled when vaccines were accompanied by small nonfinancial gifts, such as dahl and dinner plates, which resonated with mothers' immediate needs, compared to offering vaccines alone (Banerjee et al., 2010).
The effectiveness of the World Bank’s Global Scaling Up Handwashing Program in Vietnam was evaluated, revealing no significant impact on handwashing practices, health, or productivity despite efforts through a behavior change communication campaign This highlights that behavioral strategies may not always lead to improved outcomes Utilizing a behavioral framework and evaluative coding can offer valuable insights for enhancing the design and effectiveness of the Bank's initiatives.
In its new Strategic Engagement Area focused on Sustained Service Delivery for the Poor, IEG has developed a framework to integrate behavior change principles into the Bank's operations The paper defines behavior change in a way that aligns with the Bank's objectives and outlines various theories and frameworks that can be utilized to understand human behavior in the context of development interventions Rather than providing an early analysis of the portfolio or assessing the effectiveness of these interventions, the paper serves to introduce a tool for understanding these concepts illustratively.
The paper introduces a tool for sector evaluations designed to assess the integration of behavior change concepts throughout the intervention life cycle, from diagnosis to monitoring and evaluation The Independent Evaluation Group (IEG) aims to create an ex post evaluation tool for behavior change in World Bank projects, developing a framework to analyze interventions from a behavioral perspective and a coding template to evaluate projects based on behavior change criteria It is expected that the CrI 2 SP framework and the behavior change coding template will be refined during the execution of three pilot evaluations in water, transport, and basic health.
Abraham, C., and S Michie 2008 “A Taxonomy of Behavior Change Techniques Used in Interventions.”
Bandura, Albert 2004 Health Promotion by Social Cognitive Means Health Education & Behavior, Vol 31
Banerjee, A., E Duflo, R Glennerster, and D Kothari 2010 “Improving Immunisation Coverage in Rural
India: Clustered Randomised Controlled Evaluation of Immunisation Campaigns with and without Incentives.” BMJ 340: 2220
Banerjee, A., and S Mullainathan 2010 “The Shape of Temptation: Implications for the Economic Lives of the
Poor.” NBER Working Paper 15973, National Bureau of Economic Research, Cambridge, Mass Becker, Gary S 1976 The Economic Approach to Human Behavior Chicago: University of Chicago Press
Behavioral Insights Team 2014 EAST: Four Simple Ways to Apply Behavioral Insights London: Cabinet
Bengson, J., and M A Moffett, eds 2011 Knowing How: Essays on Knowledge, Mind, and Action New York:
Boulding, Kenneth E., and George J Stigler 1952 Readings in Price Theory London: George Allen and
Cane, J., M Richardson, M Johnston, R Ladha, and S Michie 2015 “From Lists of Behavior Change
Techniques (BCT) to Structured Hierarchies: Comparison of Two Methods of Developing a Hierarchy of BCTs.” Br J Health Psychol 20 (1): 130–50
Chase, C., and Q Do 2012 “Handwashing Behavior Change at Scale; Evidence from a Randomized Evaluation in Vietnam.” Policy Research Working Paper 6207, World Bank, Washington, DC
Devine, J 2009 “Introducing SaniFOAM: A Framework to Analyze Sanitation Behaviors to Design Effective
Sanitation Programs.” Water and Sanitation Program Working Paper, World Bank, Washington, DC
Favin, M., and M Griffiths 1999 Communication for Behavior Change in Nutrition Projects—A Guide for
World Bank Task Managers Washington, DC: World Bank
Friedman, M 1962 Capitalism and Freedom Chicago: University of Chicago Press
Habyarimana, J., and W Jack “Heckle and Chide: Results of a Randomized Road Safety Intervention in
Kenya.” Journal of Public Economics 95 (11): 1438–46
Hoff, Karla, and Joseph Stiglitz 2016 “Striving for Balance in Economics: Towards a Theory of the social
Determination of Behavior.” Journal of Economic Behavior & Organization 126 (2016): 25–57
IEG (Independent Evaluation Group) 2013 Delivering the Millennium Development Goals to Reduce Maternal and Child Mortality Washington, DC: World Bank
——— 2016 “Introducing a Framework for Evaluating Service Delivery in Sector Evaluations: Urban
Transport, Water and Sanitation, and Nutrition.” IEG Working Paper, World Bank, Washington, DC
Institute for Government 2010 MINDSPACE—Influencing Behavior through Public Policy London: Cabinet
Jensen, Robert and Emily Oster 2009 The Power of TV: Cable Television and Women's Status in India
Quarterly Journal of Economics Volume 124, Issue 3Pp 1057-1094
Kahneman, D 2011 Thinking, Fast and Slow New York: Farrar, Straus and Giroux
Kremer, M., Edward Miguel, Sendhil Mullainathan, Clair Null, and Alix P Zwane 2009 “Making Water Safe:
Price, Persuasion, Peers, Promoters, or Product Design.” Unpublished manuscript http://www.academia.edu/12590170/Making_water_safe_Price_persuasion_peers_promoters_or_prod uct_design
La Ferrara, Eliana, Alberto Chong, and Suzanne Duryea 2012 Soap Operas and Fertility: Evidence from
Michie, Susan, Maartje M van Stralen, and Robert West 2011 “The Behaviour Change Wheel: A New
Method for Characterising and Designing Behaviour Change Interventions.” Implementation Science 6: 42 http://doi.org/10.1186/1748-5908-6-42
Morra-Imas, L., and R Rist 2009 The Road to Results: Designing and Conducting Effective Development
Evaluations Washington, DC: World Bank
Rodrik, D 2015 Economics Rules: The Rights and Wrongs of the Dismal Science New York: W.W Norton
Service, Owain, Michael Hallsworth, David Halpern, Felicity Algate, Rory Gallagher, Sam Nguyen, Simon
Ruda, and Michael Sanders 2012 EAST Four simple ways to apply behavioural insights The
Behavioural Insights Team London: Cabinet Office
Storey, Douglas, Katherine Lee, Caitlin Blake, Peggy Lee, Hsin-Yi Lee, and Nicole Depasquale 2011 Social and Behavior Change Interventions Landscaping Study: A Global Review Baltimore: Johns Hopkins
Bloomberg School of Public Health
Thaler, R., and C Sunstein 2008 Nudge: Improving Decisions about Health, Wealth, and Happiness New
World Bank 2003 World Development Report 2004: Making Services Work for Poor People Washington, DC:
World Bank https://openknowledge.worldbank.org/handle/10986/5986
——— 2014 Landscape Study of Behavior Change Interventions in Sustainable Development Projects
Behavior Change Community of Practice Washington, DC: World Bank Group
——— 2015 World Development 2015: Mind, Society, and Behavior Washington, DC: World Bank Group
Case Study: Improving Hygiene Behaviors of Rural People in Nepal
The Rural Water Supply and Sanitation Project in Nepal, approved in 1996 and closed in 2003, significantly enhanced hygiene practices among rural communities This initiative included a health and sanitation education subcomponent, which represented a modest investment of $1.5 million out of the total project budget of $18.3 million.
The identified target groups for behavior change initiatives include diverse community leaders and elders, recognized for their significant influence on individual actions Additionally, women are highlighted as a vital demographic, as they often impact behavioral shifts, especially in their children, despite men typically managing finances Women also play essential roles in promoting family hygiene and sanitation.
The project aimed to transform key hygiene and sanitation behaviors through community education, training of trainers for effective message delivery, and social marketing via various media channels, including radio, posters, leaflets, and engaging songs and games Emphasizing community education was crucial, as previous experiences demonstrated its effectiveness in mobilizing women in communities lacking cooperative action The project appraisal document (PAD) highlights that nonformal education has enhanced receptiveness to new ideas, facilitated mobilization, boosted self-confidence, and encouraged individuals to embrace new responsibilities.
The project’s design integrated essential elements for effective behavior change interventions, emphasizing the importance of incorporating insights from previous initiatives and recognizing the necessity for technical support, such as a program development officer for HSE and Women’s Technical Support Services A crucial takeaway from earlier projects is that HSE programs employing a participatory approach have proven to be more successful than those that solely focus on disseminating health messages.
The project successfully identified outcome indicators, such as handwashing before eating, to measure results and established baselines through knowledge, attitudes, and practices (KAP) studies However, it did not set targets for all indicators Despite this, the project effectively supported health, hygiene, and sanitation education, leading to improved hygiene behaviors.
To ensure the long-term sustainability of these personal sanitation practices and behaviors, the project has relied primarily on community participation Additionally, the Project
Performance Assessment report notes women said the main reasons they stuck to improved health behaviors were the direct benefits to their families and reduced medical costs
Case Study: Behavior Change Communication in Senegal Improves Mothers’ Nutrition and Childcare Practices
In Senegal, the phase two of the Nutrition Enhancement Project (P097181), approved in 2006 and closed in 2014, contributed to improved nutrition behaviors, including breastfeeding for
25 the first six months, adopting appropriate feeding practices for young children, and providing children with vitamin A supplements
The project’s community-based nutrition component implemented various activities to promote behavioral changes related to nutritional practices Key interventions included monthly growth monitoring for children under two, counseling for mothers, and home visits, alongside a behavior change communication (BCC) campaign focused on infant feeding, disease prevention, and care for sick children The BCC messages also encouraged support from husbands for their pregnant wives and aimed to empower women Additionally, the project recognized the influence of social factors and the respect afforded to elderly women in Senegal by adopting the Grandmother Strategy, which engages grandmothers' networks to integrate new child survival and maternal health practices with positive traditional behaviors.
The project successfully met its behavior-related targets, with exclusive breastfeeding rates for infants under six months rising to 65 percent from a baseline of 34 percent Additionally, the percentage of children aged 6-59 months receiving vitamin A supplements increased to 94 percent, surpassing the target of 90 percent, up from a baseline of 79 percent Furthermore, the proportion of pregnant women attending at least four prenatal care visits grew to 61 percent, exceeding the target of 60 percent from a baseline of 40 percent.
Case Study: Promotion of Bicycle Use in Santiago, Chile
The Sustainable Transport and Air Quality for Santiago GEF Project (P073985), approved in 2003 and concluded in 2008, significantly boosted bicycle usage in Santiago, with a 12 percent increase in spring and a 23 percent rise in winter Notably, the percentage of women cycling rose from 8 to 20 percent during this period.
Drawing from insights gained from a previous project in Lima, Peru, this initiative implemented a comprehensive promotional strategy alongside the construction of new bikeways While the Lima project included essential activities such as building bikeways, offering bike maintenance training, encouraging employers to provide shower facilities and bicycle parking, and organizing promotional events, it failed to tackle the cultural barriers that hindered bicycle use, especially among women, for whom cycling was perceived as a deviation from societal norms.
Interventions in Santiago focused on social factors alongside information dissemination Key initiatives included partnering with community groups to foster grassroots support for nonmotorized transport, launching publicity campaigns to enhance the bicycle's image as a viable transport option, conducting bicycle riding and safety training in schools, implementing traffic safety campaigns for both drivers and cyclists, and creating a dedicated website to share valuable information.
The promotional campaign for cyclists, despite being shorter than expected due to consultant hiring delays, played a crucial role in successfully increasing bicycle usage.