Interventions that aim to ensure and increase quality service delivery require behavior change plans designed to meet the needs of health care providers.
There are three broad categories of factors that influence provider behavior:
- Opportunity – providers have sufficient resources and a supporting environment
- Ability – providers have the required skills and knowledge to provide quality services, and understand the performance expected.
- Motivation – providers are sufficiently motivated.
These four factors act across various levels of the ecosystem within which the health provider lives and works. Opportunity factors, such as supportive guidelines and policies or a consistent supply of commodities, could be addressed at the health systems or organization level. Likewise, motivational factors, such as adequate pay or supportive norms, might be addressed at the organization or community levels, respectively.
It can be challenging, however, to address motivational factors at the provider level because these involve issues intrinsic to the person, such as personal values and attitudes. The usual interventions here (e.g., trainings, supportive supervision, etc.), are better suited for addressing ability factors, not necessarily motivational ones. To influence motivation, PSI uses provider behavior change communication (PBCC).
PBCC takes place during ongoing and regular one-to-one conversations with providers. During these conversations, trained PSI staff use PBCC techniques to identify individual motivators and barriers to performing the desired behavior and provide solutions to address them. PBCC can be used in conjunction with classroom and field-based trainings.
PSI’s PBCC approach is modeled on medical detailing – the most effective marketing tool employed by the private sector pharmaceutical industry to influence provider behaviors. PSI’s PBCC approach was co-designed with one of the largest pharmaceutical companies in the world and based on their proven best practices.
PSI builds capacity in PBCC among its network members through our PBCC Associate Program. This program takes field staff from network member offices, trains them for more than a month on PBCC and program design and assessment, and then sends them to another network member for five months of long term technical assistance. The result is a team of in-country PBCC specialists as well as a “backbench” of PBCC experts who can deliver technical assistance throughout the PSI network.
PSI segments and prioritizes providers to maximize efficiency. Segmentation is based upon two factors. The first is the provider’s potential health impact, which considers such things as the burden of disease in the provider’s catchment area and client volume. The second factor is the degree to which the provider has adopted the promoted behavior. PSI is also experimenting with tele-detailing, which supplements the face-to-face visits with telephone or other electronic-based interactions, reducing overall costs.
Rapid prototyping and continuous feedback loops are designed to refine messages that allow PBCC interventions to be nimble. These adapt quickly to the needs of providers and their clients without the need for traditional, and often cumbersome, formative surveys so that scale and impact can be quickly maximized. Instead, PBCC agents develop personalized plans for each provider that address specific barriers, moving her or him along a behavior change continuum towards the desired behavior.
PSI’s PBCC programs produce results. At Population Services Khmer (PSK), PSI’s local implementing partner in Cambodia, the use of PPBC techniques by medical representatives helped them to positively influence the quality of counseling provided by pharmacists to their clients on short-acting family planning methods.
More than 25 PSI countries use PBCC to change provider behaviors in the areas of reproductive health, malaria control, HIV prevention and treatment, and youth friendly services.
Making a Difference
Tears Wenzira, is an unlikely health worker. A hairdresser by trade, Tears also teaches her clients about female condoms, explaining their benefits and how to use them. Tears sells about 100 female condoms per month, making enough extra money to buy basics like bread and milk for her family. She is one of more than 2,000 hairdressers in Zimbabwe who work on the PSI/Zimbabwe HIV prevention program, co-funded by the United States Agency for International Development (USAID) and the U.K. Department for International Development.