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Step 1: Understanding the Social Problem

Rationale

• Know how the program team defines the problem they want to solve
• Know what the program team thinks are the causes and solutions to the problem
• Know what the scientific literature says about the problem you are targeting, its causes and consequences, and effective interventions

Analyzing the rights-based social justice considerations together with the program team, you may prioritize new SRHR problems or see them differently.

Tips: Sensitive Issues You May Need to Consider
Tips: Is Your Agency Walking the Talk?

Task 1: Be clear about the SRHR problem the program seeks to help solve

Group Exercise: Meet with your M&E team and clarify what problem you are seeking to address with your work.

Task 2: Specify the underlying factors that determine the SRHR problem the program addresses

• Collect information on the determinants of the addressed SRHR problem in some or all of the following ways:
  • Review published literature.
  • Talk with colleagues in programs that address similar SRHR issues.
  • Consult with local researchers
  • Involve knowledgeable people from the community and beneficiaries at this point. But keep the discussion focused on the causes of SRHR problem you are addressing. Tips: Can Stakeholders Help You Understand the SRHR Problem?
  • Carry out a needs assessment. See Tips listed below for help deciding if you can carry out a needs assessment.

Tips::What Is a Needs Assessment?
Tips: Why Carry Out a Needs Assessment?
Tips: How Can You Carry Out a Needs Assessment If You Don’t Have Funds Set Aside for It?

• If the program is already underway, review all program documents to find out how the program planners or staff visualized the underlying determinants of the program’s target SRHR problem. Look closely at:
  • the background sections of any proposals you have written
  • rationale and introduction sections of program reports
  • Program planning tools that have been used when developing your program

Diagram: Complexity of Social Problems

SRHR problems (like all social problems) are influenced by factors at the individual, family, community and broader institutional levels (as shown in the diagram below).

By reflecting on factors at all levels you can:

• Have a more complex understanding of the problem you are trying to impact
• Develop a group understanding of the problem you are targeting and its components
• Help articulate at which levels you want to and can impact the problem with the intervention

Individual level: each person’s own

Family level: a person’s intimate relationships with family, spouse and/or partner(s)

• how family decisions are made
• who has power within these relationships
• degree of sexual, physical and emotional violence or support
• emotional tone of the relationships
• values and messages transmitted in these relationships

Community level: a person’s geographic community and/or community of identification; culture and social norms

• social boundaries
• norms and taboos
• peer pressure
• physical barriers, obstacles, risks
• opportunities and facilities

Institutional level: laws, administrative procedures, policies and programs in relevant spheres

• health care
• transportation
• education systems
• religious institutions
• police
• government and political institutions
• the economy and job opportunities
• civil society organizations

Group exercises for Understanding your SRHR problem

There are two group exercises that can help you understand your SRHR problem:

Information to Review before doing these Exercises:

• The scientific evidence for what can impact your target problem
• Refer to the extensive programmatic experience of people engaged in solving this problem
• Any needs assessments that are relevant to your work (the problem you are targeting and the population you are interested in)
• Relevant program materials
• Any other information relevant to your program, your target problem, or your population

When to use these exercises:

• When you are helping to plan a new program.
• When an ongoing program needs greater clarity in its Theory of Change
• When you want to make sure a rights-based social justice perspective has been applied to your target problem

Who you might want to involve:

• Stakeholders, especially clients and beneficiaries and community leaders. Tips: Can Stakeholders Help You Understand the SRHR Problem?
• Local researchers, particularly anthropologists, sociologists, or public health specialists.
• Partner agencies who work on similar issues and in similar populations.

Print and use the Target SRH Issue Diagram and/or The Five Why’s exercise for each of the SRHR issues you want to address with your work and that are related to your M&E priorities.

Worksheet: Target SRH Issue Diagram

How to proceed:

1. For each of the “outer circles” (individual, family, community, institutional) brainstorm all of the factors that contribute to the problem in your community. Keep in mind: culture, including if relevant, the culture of the specific population you are working with; economic status (what economic or financial resources does this person or group of people have); social position and power; and stigma.
2. Ask yourselves the following questions to make sure you are including all the relevant factors

2. 1. Are there any rights issues you have left out? Are people’s rights being violated at any of these levels?
   2. Have you considered all issues related to quality of SRHR services? What about unmet needs or barriers to services?
   3. How do these factors affect males and females differently? What gender roles and norms shape the way men and women (boys and girls) are treated and behave in certain ways. How might those roles and norms place their health at risk?
   4. What are the beliefs, norms or values related to sexuality that are influencing the SRHR problem? And how do they shape the sexual practices that may be contributing to the problem?
   5. Have you considered factors that are relevant throughout the life cycle and that might influence youth or older men and women in particular?
   6. Are there factors related to the lack of participation of certain groups or tensions among different sectors that limit access to services or create obstacles to sexual and reproductive health and rights of the population?
   7. Have you considered the special needs of marginalized or particularly vulnerable groups?
3. As you answer the questions, fill in the additional factors that you agree are influencing the target SRHR problem
4. Mark those factors that the group feels are the most important ones with one color.
5. Mark the factors that your program is addressing or wants to address with a different color.
6. Compare the two colors of marked items to identify important factors your program may have left out.
7. Analyze why certain important factors were left out. If they are beyond the mandate of your agency, think about ways you can encourage partnerships with other agencies that are working on those factors. If they are within the mandate of your agency, discuss ways of addressing such factors.
8. Identify important factors that your program is addressing. You should refer to these when working on your program’s causal pathway (Causal Pathways are covered in Module 3: Your Objectives)
9. Identify important factors that your program is not addressing that could interfere with the success of the program and therefore with your M&E findings. Keep these in mind when you design your data collection instruments, you may want to collect a small amount of information about them to help you better understand and interpret your findings.

Tips: What If There Are No People on Staff Familiar with Gender Sensitivity, Sexuality, HIV, Vulnerable Populations
Tips: Sensitive Issues You May Need to Consider
Tips: Filling Gaps Through Partnerships

The user may want to refer to the rights-based social justice considerations in the introduction for more information.

Group Exercise: The Five Why’s

To make sure that the program addresses the true nature of the determinants of the SRHR problem the program addresses, you need to understand the root causes of the problem. In the same way that a doctor tries to make a diagnosis of an illness rather than merely treating the symptoms, as a group you are going to ‘diagnose’ the causes of the problem.

The Five Why’s technique involves asking “Why?” at least five times in a row to uncover the root cause of the factor that is being discussed.

• Identify the factor or influence to be discussed.
• Ask “Why?”this particular factor or influence exists.
• Each time the question is answered, ask “Why?”again.
• Continue to ask “Why?” until the group is satisfied they have arrive d at what they feel is the root cause.

An Example:

Imagine the SRHR problem you are interested in

changing has to do with girls dropping out of school once they reach adolescence. The factor you have chosen to delve into is negative parental attitudes towards girls’ education.

So first, ask “Why do parents hold negative attitudes towards girls’ education?”

When you receive an answer, ask why, and then

why again.

You can draw out the responses on a paper or chalkboard. For example:
Why #1: Why do parents hold negative attitudes towards girls’ education?
Answer: Because they feel like education is wasted on girls.
Why #2: Why do they feel education is wasted on girls?

Answer: Because girls become wives and wives do not need to be educated.

Why #3: Why do girls only become wives rather than also having jobs or professions?
Answer: Because women are supposed to only be interested in getting married.

Why #4: Even if they get married, why isn’t it important for women to be well educated?
Answer: Because men make all the decisions and women are supposed to obey men.
Why #5: Why should women only obey men and why should women only be interested in getting married?
Answer: Because that is the way boys and girls have been brought up but things are changing and need to change.

Aha! Now it is clear that parental attitudes toward girl’s education come from very deep-rooted causes of how girls and boys are educated to behave, in other words, the gender roles in that culture.

This idea could form the seed of what would eventually become a gender educational program for parents and young men and women.

Worksheet: The Five Why’s

Use this Five Why’s Worksheet for each SRHR problem of interest:

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