Behavior Change Communication: If You Build It, They May Not Come

In Bangladesh, some project beneficiaries were wary of free healthcare services.
In Bangladesh, some project beneficiaries were wary of free healthcare services.

By Pinky Serafica

Fields of dreams should be based on project communication to fully achieve development outcomes.

They looked really good on paper. Peer reviewers blessed the solid technical specs. Specialists praised the innovations. Governments lauded the economic and political viability of the financing.

And so we built these cutting-edge road grids and traffic management schemes, water supply and treatment systems, toilets, solid waste management plants and networks – only to find that they are either not used at all, used for other purposes, or not used in the optimal way we calculated.

Toilets are not used for number one or number two, but rather for what might be called number four. Because they are thought to be too clean and separated from the rest of the usual one-room house, they are perfect for storing grain.

Footbridges are not used to survive the crossing from one end of a long highway to another. Since they are built away from natural convergence points like markets, schools and community entrances, they quickly become extended living areas for informal settlers. Overpasses built smack in dense areas often become spaces for playgrounds or mini bazaars, limiting pedestrian movement.     

Rural roads are used partly to ferry goods and people, but as they are sealed and smooth, a part of the lane is quite good for drying beans, chili and grains. Clinics that offer “free” services are ignored by pregnant mothers that urgently need health care; the reason being that anything “free” is equated with low quality.

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Kevin Costner didn’t quite complete the picture in the film Field of Dreams, when he was told in a dream: “If we build it, they will come.”

Even if they are the field of our dreams, people do not necessarily come if it’s not evident that there is something for them there. We get high scores for outputs of miles and meters of infrastructure and systems, but we don’t perform as well on the outcomes of better sanitation and hygiene, improved road safety, or lower maternal and child mortality.

This is where behavior change communication (BCC) steps in as a critical element in ADB’s due diligence work.

Communication is often done to report on the good stuff near the finish line, when everything’s been built and project stakeholders are ready to sing the praises of a new faucet or try out that new electric bus. BCC however works best when integrated during project conceptualization, as it adds on to ADB’s processes of getting stakeholder feedback about project benefits and impacts.

With a BCC program, projects get off on the right foot by considering user behavior and actual needs. Key stakeholders are engaged because they know more about what they need and, when involved, can provide innovative and pragmatic solutions.

BCC approaches

After supervising an ADB-supported urban solid waste management project in Mandalay, Myanmar, project officer Andrew McIntyre recalled how one of the interventions was to supply automated garbage trucks to collect domestic waste from designated spots. The problem was that while the trucks addressed a fragment of the collection problem, they could not navigate the inner cities where streets are too narrow.

The affected households suggested a simple innovation – use skip bins distributed strategically where residents can dispose of waste, and which can then be used to ferry garbage to the truck stops.

So, who changed whose behavior? The BCC program facilitated the engagement of the key players in Mandalay—households and garbage collectors—so they could identify small, pragmatic steps that they can do themselves. This is the opposite of big, complicated solutions that will possibly work for the entire time a project is there, but fizzle as soon as ADB considers the project completed.

People will not change their behavior if there is no concrete, practical return. In Mandalay, they were faced with garbage that can only be collected maybe once a week. But if they cooperated and daily disposed of their waste at designated skip bins, citizens would enjoy fresh air and cleaner streets.

It doesn’t stop there. Individual behavior, even if successfully negotiated, can slide over time. BCC programs ensure that individual behavior changes are reinforced by support networks or community systems, so stakeholders can address emerging issues. In Mandalay’s case, such systems might involve village rituals that promote and celebrate cleaner streets. 

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BCC approaches are not one-size-fits-all. The communication needs of projects are highly contextual, and with different stakeholders successful BCC programs require different strokes.

The team involved in an ADB-supported primary health care project in Bangladesh initially thought that since most people love discounts, free services are even better. But promoting maternal and child health services as “free” was not particularly attractive for moms in urban poor communities in the capital, Dhaka. They shied away from the brand new, state-of-the-art clinics located near them.

Formative research under the BCC program of the health project confirmed that mothers drew on their personal experience to equate “free” services with low-quality care. This was notwithstanding that health indicators pointed to high rates of maternal and infant mortality, and surveys verified that mothers themselves said they urgently needed the services.

The BCC program tapped trusted community members like health workers and religious leaders to influence urban poor communities, targeting households with pregnant women and children to promote the clinics. As there is not one best way to reach these women, the BCC program used a media mix of interpersonal communication, courtyard sessions, folk singing, films, and a TV drama serial to encourage women to have safe pregnancies and deliveries and to adopt better childcare practices.

Clearly, without communication project outcomes will not be fully achieved. But when fields of dreams are based on project communication, the (people) really will come.