Type of Material: Reports and Studies

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West Africa Breakthrough ACTION Experiences

Breakthrough ACTION leverages social and behavior change (SBC) approaches to increase modern family planning (FP) access and informed, voluntary use in Burkina Faso, Côte d’Ivoire, Niger, and Togo. This technical brief, available in English and French, shares promising, proven, or innovative program approaches that can yield FP results in the West Africa region by providing a deep dive into three distinct activities:

  • Community dialogues and facility site walkthroughs, a multi-sectoral and community engagement approach to improve FP service quality via community-driven solutions.
  • FP provider behavior change tools to respond to regional and country-specific challenges identified to offer quality FP services.
  • The Confiance Totale (Total Confidence) radio campaign, which fostered trust in FP services and methods during the COVID-19 pandemic.

Expériences de Breakthrough ACTION en Afrique de l’Ouest

Breakthrough ACTION s’appuie sur des approches de changement social et de comportement (CSC) pour accroître l’accès à la planification familiale moderne (PF) et son utilisation volontaire et informée au Burkina Faso, en Côte d’Ivoire, au Niger et au Togo. Ce résumé technique, disponible en anglais et en français, présente des approches prometteuses, éprouvées ou innovantes qui peuvent produire des résultats en matière de PF dans la région de l’Afrique de l’Ouest, en fournissant une analyse approfondie de trois activités distinctes :

  • Dialogues communautaires et visites de sites, une approche multisectorielle et d’engagement communautaire visant à améliorer la qualité des services de PF par le biais de solutions communautaires.
  • Outils de changement du comportement des prestataires de PF pour répondre aux défis régionaux et nationaux identifiés pour offrir des services de PF de qualité.
  • La campagne radiophonique Confiance Totale qui a permis de renforcer la confiance dans les services et les méthodes de PF pendant la pandémie de COVID-19.

Source: Johns Hopkins Center for Communication Programs

Date of Publication: March 17, 2026

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Factors Influencing Community Health Worker Behaviors

Community health workers (CHWs) are essential to a strong primary health care system and play a critical role in service provision. Uplifting CHW programs can bring further confidence to the health system, especially given CHWs’ ability to build trust with the communities they serve. It is, therefore, important to understand the many factors influencing CHWs and how to best support them in their work.

Breakthrough ACTION conducted a global literature review to identify and explore factors influencing CHW behavior. The project also conducted supplemental interviews with CHWs and others working with them in four countries to ensure a more holistic understanding of CHWs’ lived realities. Finally, Breakthrough ACTION held a virtual consultation to summarize the synthesis of the literature and interviews and gather additional insights into the multitude of factors that influence CHW behavior.

These factors were then mapped into categories against the Provider Behavior Ecosystem domains and are summarized in the Factors Influencing Community Health Worker Behaviors: Literature Review Synthesis.

Last modified: March 16, 2026

Language: English

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Using Social and Behavior Change to Address Tuberculosis in Nigeria: Implementation Stories

In 2021, Nigeria accounted for 4.4% of the world’s tuberculosis (TB) cases, ranking sixth among nations with the highest case rate. About 500,000 Nigerians are infected with TB annually.  Moreover, Nigeria struggles to identify TB cases; in 2018, the country’s National TB, Leprosy, and Buruli Ulcer Control Programme (NTBLCP) only was able to track 24% of cases.

Decisions on if, when, and where to seek testing and treatment for TB are influenced by a multitude of social and behavioral factors, such as knowledge of TB, how likely a person is to think they are to contract the disease (perceived susceptibility), how serious they think it would be if they were diagnosed with TB (perceived severity), their perception of the available health services, their confidence in their ability to seek those services, and TB-related stigma and discrimination, among others. To deepen its understanding of why TB cases were hard to find and what influenced a person’s TB care-seeking behavior, Breakthrough ACTION worked with the NTBLCP in 2019 to learn about community members’ experiences with TB-related behaviors using a human-centered design approach.

This process uncovered deep insights about what Nigerians with TB experience in their journey to get tested and treated. Four key insights emerged from this process:

  1. Individuals take a long journey, literally and figuratively, before they attain proper treatment for TB.
  2. While testing is free, sick individuals incur indirect costs.
  3. Stigma is a barrier to case-finding and care-seeking.
  4. Myths and misconceptions about TB are prevalent.

Breakthrough ACTION-Nigeria, NTBLCP, and partners, and community members used these insights as springboards to generate ideas for solutions.

Four stories detail how Breakthrough ACTION-Nigeria placed community members’ needs at the center of its work and collaborated to design and implement solutions using SBC approaches—and since their activities began, case detection has steadily increased. These implementation stories also include lessons learned in the process and recommendations:

Last modified: March 16, 2026

Language: English

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Cover page of document titled Digital Mental Health Landscaping in Low- and Middle-Income Countries
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Digital Mental Health Landscaping in Low- and Middle-Income Countries

The aim of this project was to map the landscape of who is doing what and where in digital mental health, and to provide recommendations that may assist in targeting communication efforts and funding calls. To address this, the project consisted of three studies:

  1. Social Media Review
  2. Systematic Literature Review
  3. Focused Consultation with experts.

This report presents the comprehensive results of digital mental health interventions across academic and commercial landscapes in LMICs. The findings highlight the diverse range of interventions, technologies, and mental health conditions addressed, as well as the geographical distribution and stakeholder involvement in the development and testing of these interventions.

Source: University College London

Date of Publication: August 26, 2024

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The Mission to Stop Ebola: Lessons for UN Crisis Response
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The Mission to Stop Ebola: Lessons for UN Crisis Response

This report analyzes the creation, structure, and impact of UNMEER, the UN’s emergency response to the 2014-2016 Ebola outbreak. The report assesses UNMEER’s effectiveness in coordinating the UN system’s response, scaling up logistical capacity, and mobilizing international support. It also identifies lessons for future UN crisis responses, including the need for flexible mandates, diverse partnerships, and a people-centered approach. The report concludes by highlighting the importance of integrating UN entities to effectively respond to multidimensional crises. The International Peace Institute (IPI), an independent, international think tank, published the report with a mission to promote peace, security, and sustainable development through policy research and analysis.

Last modified: August 12, 2024

Language: English

Source: International Peace Institute

Year of Publication: 2017

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COVID-19 Coordination Report - Consultation Findings and Case Studies
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COVID-19 Coordination Report – Consultation Findings and Case Studies

This resource focuses on the coordination and leadership structures that emerged during the COVID-19 pandemic response. The report explores how non-governmental organizations (NGOs) working in humanitarian settings engaged with these structures. It presents findings from a desk review of existing literature on COVID-19 coordination mechanisms and 46 semi-structured interviews. These interviews were conducted with policymakers, practitioners, and individuals with experience working with COVID-19 coordination structures. The report highlights key themes such as opportunities for effective NGO engagement, the role of coordination mechanisms in advocating for community-centered response approaches, and considerations for future outbreak preparedness. Finally, it provides case studies of Indonesia and the Democratic Republic of Congo, illustrating the successes and challenges encountered in coordinating COVID-19 response efforts.

Last modified: August 12, 2024

Language: English

Source: READY Initiative

Year of Publication: 2021

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Ebola Outbreak, Liberia: Communication: Challenges and good practices
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Ebola Outbreak, Liberia: Communication: Challenges and Good Practices

This report, based on the ACAPS Ebola project in Liberia, examines the role of communication in containing the 2014 Ebola outbreak. The authors analyze communication challenges and good practices, emphasizing the importance of community engagement in disseminating information and promoting behavior change. Key findings highlight the effectiveness of radio as a communication channel, the importance of involving anthropologists to tailor messages to cultural contexts, and the crucial role of faith leaders in influencing community behavior.

Source: Assessment Capacities Project (ACAPS)

Date of Publication: August 12, 2024

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Lassa fever: the Guinean context and social and cultural determinants
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Fièvre Lassa : Le contexte Guinéen et les déterminants sociaux et culturels

Ce document est un dans une série des courts documents sur les zoonoses prioritaires dans le contexte Guinéen, et a pour but fournir les informations sur la connaissance et les comportements de risque et prévention autour des zoonoses prioritaires. Il document était rédigé par l’équipe de Breakthrough ACTION Guinée pour passer en revue la littérature sur la fièvre Lassa en Guinée, et d’intégrer dans la littérature existante les résultats d’une étude qualitative sur les maladies zoonotiques réalisée par Breakthrough ACTION. Il a pour but d’aider les responsables de la mise en œuvre des programmes à mieux comprendre le contexte social et culturel de cette zoonose, et il fournit les recommendations pour aider les activités de prevention de la fièvre Lassa.

Lassa fever: the Guinean context and social and cultural determinants

This document is one in a series of short papers on priority zoonoses in the Guinean context and aims to provide information on knowledge and risk behaviors and prevention around priority zoonoses. It was put together by the Breakthrough ACTION Guinea team to review the literature on Lassa Fever in Guinea, as well as to incorporate into the existing literature findings from a qualitative study on zoonotic diseases undertaken by Breakthrough ACTION. This brief is intended to help program implementers better understand the social and cultural context around this zoonotic disease and offers recommendations for Lassa Fever disease prevention efforts.

Source: Johns Hopkins Center for Communication Programs

Date of Publication: June 21, 2024

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Anthrax or Anthrax Disease: The Guinean Context and Social and Cultural Determinants (2020)
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Anthrax ou la maladie du charbon : Le contexte Guinéen et les déterminants sociaux et culturels (2020)

Ce document est un dans une série des courts documents sur les zoonoses prioritaires dans le contexte Guinéen, et a pour but fournir les informations sur la connaissance et les comportements de risque et prévention autour des zoonoses prioritaires. Il document était rédigé par l’équipe de Breakthrough ACTION Guinée pour passer en revue la littérature sur l’anthrax, ou la maladie du charbon, en Guinée, et d’intégrer dans la littérature existante les résultats d’une étude qualitative sur les maladies zoonotiques réalisée par Breakthrough ACTION. Il a pour but d’aider les responsables de la mise en œuvre des programmes à mieux comprendre le contexte social et culturel de cette zoonose, et il fournit les recommendations pour aider les activités de prevention de la maladie du charbon.

Anthrax or Anthrax Disease: The Guinean Context and Social and Cultural Determinants (2020)

This document is one in a series of short papers on priority zoonoses in the Guinean context and aims to provide information on knowledge and risk behaviors and prevention around priority zoonoses. It was put together by the Breakthrough ACTION Guinea team to review the literature on Anthrax in Guinea, as well as to incorporate into the existing literature findings from a qualitative study on zoonotic diseases undertaken by Breakthrough ACTION. This brief is intended to help program implementers better understand the social and cultural context around this zoonotic disease and offers recommendations for Anthrax disease prevention efforts.

Source: Johns Hopkins Center for Communication Programs

Date of Publication: June 21, 2024

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Survey on Knowledge, Attitudes and Practices (KAP) for Ebola Prevention in Côte d'Ivoire
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Enquête sur les Connaissances, Attitudes et Pratiques (CAP) dans le Cadre de la Prévention contre Ébola en Côte d’Ivoire

La grande épidémie d’Ébola qui a débuté dans les zones rurales de la Guinée en décembre 2013 a démontré le besoin urgent de communication des risques et d’engagement communautaire (CREC) afin d’identifier et de contenir rapidement les épidémies de maladies infectieuses. Après s’être propagée à Conakry, la capitale de la Guinée, à la mi-2014, l’épidémie s’est répandue en Sierra Leone et au Liberia en juillet 2014. En fin de compte, on a recensé 28 616 cas au total dans les trois pays, dont 3 814 cas et 2 544 décès pour la seule Guinée. La récente réémergence d’Ébola en Guinée a rendu la réponse à COVID-19 plus complexe et a nécessité une réponse intégrée.

Le Centre de Programmes de Communication (CCP) de Johns Hopkins est le principal responsable de la mise en œuvre du projet Breakthrough ACTION. Breakthrough ACTION est un accord de coopération quinquennal de l’Agence américaine pour le développement international (USAID) visant à diriger la programmation de l’USAID en matière de changement social et comportemental dans le monde. En Côte d’Ivoire, CCP, par le biais de Breakthrough ACTION, s’emploie à améliorer l’adoption de pratiques sanitaires bénéfiques afin de contribuer à l’objectif plus large d’amélioration des résultats en matière de santé et de développement dans les domaines d’intervention du programme. L’USAID a chargé Breakthrough ACTION-Côte d’Ivoire de soutenir le gouvernement (de CDI) à travers le GTT pour la préparation à la prévention et la réponse contre la maladie à virus Ebola (MVE). Cela se traduit par la reconnaissance des symptômes par la population, la recherche des soins et l’acceptation de la vaccination. Les interventions de CREC visent à répondre aux craintes de la population, à instaurer la confiance et à promouvoir des attitudes et des normes positives pour favoriser des comportements spécifiques. Pour réussir la CREC, il est essentiel d’avoir une compréhension actualisée des connaissances, des attitudes, des croyances, des intentions et des normes spécifiques au contexte qui précèdent et favorisent les comportements.

Survey on Knowledge, Attitudes, and Practices (KAP) for Ebola Prevention in Côte d’Ivoire

The major Ebola epidemic that began in rural Guinea in December 2013 demonstrated the urgent need for risk communication and community engagement (CREC) to rapidly identify and contain infectious disease outbreaks. After spreading to Guinea’s capital Conakry in mid-2014, the epidemic spread to Sierra Leone and Liberia in July 2014. Ultimately, a total of 28,616 cases were recorded in the three countries, including 3,814 cases and 2,544 deaths in Guinea alone. The recent re-emergence of Ebola in Guinea has made the response to COVID-19 more complex and necessitated an integrated response.

The Johns Hopkins Center for Communication Programs (CCP) is primarily responsible for implementing the Breakthrough ACTION project. Breakthrough ACTION is a five-year cooperative agreement of the U.S. Agency for International Development (USAID) to lead USAID’s social and behavioral change programming around the world. In Côte d’Ivoire, CCP, through Breakthrough ACTION, is working to improve the adoption of beneficial health practices to contribute to the broader goal of improving health and development outcomes in the program’s focus areas. USAID has commissioned Breakthrough ACTION-Côte d’Ivoire to support the government (of CDI) through the TWG in preparing for Ebola Virus Disease (EVD) prevention and response. This translates into the population recognizing symptoms, seeking care, and accepting vaccination. CREC interventions aim to address people’s fears, build trust, and promote positive attitudes and norms to encourage specific behaviors. To succeed in CREC, it is essential to have an up-to-date understanding of the context-specific knowledge, attitudes, beliefs, intentions, and norms that precede and promote behaviors.

Source: Johns Hopkins Center for Communication Programs

Date of Publication: June 10, 2024

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