Evaluation of the RISE II integrated social and behavior change approach in Niger: A contribution analysis

Objective: Niger faces a myriad of health challenges and development efforts are complicated by persistent poverty, high population growth rates, and climate change. Integrated social and behavior change (SBC) addresses health outcomes through collective action and approaches at the limited points of entry individuals have with the health system. Methods: We conducted a mixed-methods study to evaluate the effectiveness of an integrated SBC program in the Maradi, and Zinder regions of Niger. We applied contribution analysis, a theory-based plausibility analysis, to assess contributions of the intervention. Results: We found the program contributed to improved behavioral determinants. Male engagement and income generating activities provided further support for women to practice health behaviors. However, increases in male partner out-migration was negatively associated with health outcomes. While the program did not generate statistically significant improvements in health outcomes in the intervention area, exposure to health messages and participation in women’s groups were positively associated with health outcomes suggesting sustained implementation of the integrated SBC approach at scale may achieve improved health outcomes. Conclusion: Programs should continue to invest in health promotion efforts that include gender sensitive interventions. Further research is needed to understand how women’s agency and autonomy evolves as household composition changes through male out-migration.