Adapting and Implementing the Beyond Bias Model: Solutions to Reduce Provider Bias in Contraceptive Service Delivery for Youth and Adolescents

"Decades of training and supervision have been insufficient in addressing biases held by sexual and reproductive health providers. Recognizing this reality, the Beyond Bias project was conceived with a mandate to disrupt the status quo..."

Several studies cite provider bias - such as a belief that young, unmarried people should not be sexually active or that young, married women should prove fertility - as a driver of judgmental and poor quality sexual and reproductive health (SRH) care. Led by Pathfinder International, in collaboration with Camber Collective, YLabs, and RAND and supported by funding from the Bill & Melinda Gates Foundation, the Beyond Bias project was implemented in Burkina Faso, Pakistan, and Tanzania to understand what drives provider bias and to introduce scalable solutions that address it. ​This publication is a step-by-step guide to the Beyond Bias model. It shares opportunities available for adapting and institutionalising the model in other contexts, while offering lessons from the field and examples of and links to adaptable tools and materials.

In brief (see Related Summaries, below), Beyond Bias used human-centred design (HCD), psycho-behavioural segmentation, behavioural economics, and social and behaviour change (SBC) principles in designing, testing, and implementing solutions to provider bias, culminating in a 3-step process:

• Summit: a story-driven, in-person, one-day event meant to activate providers' awareness of their own biases and their empathy for young people's needs;
• Connect: an ongoing peer-support and learning forum - conducted either virtually via WhatsApp, in person, or with a hybrid model - in which providers problem-solve together to apply unbiased practices in their daily work; and
• Rewards: a growth-oriented incentive system whereby facilities receive report cards with performance data and recommendations for improvement, and those with high improvement scores get public recognition for their progress.

The how-to guide's two main sections include:

1. Is the Beyond Bias Model Right for My Setting?
   • Why is Provider Bias a Problem?
   • Why Should I Adopt the Beyond Bias Approach?
   • Introduction to Beyond Bias
   • What Drives Provider Bias?
   • The Beyond Bias Behavior Change Strategy
   • The Three Pillars: Summit, Connect, Rewards
   • The Six Principles of Unbiased Care
   • What Does Success Look Like?
   • Designed for Scale-up
   • Adapting and Institutionalizing the Beyond Bias Model in Your Setting
   • Evidence of Improved Outcomes: How Participants Changed Post-Intervention
2. How Do I Implement the Beyond Bias Model?
   • Overview of the Process: A Map to the How-To Guide
   • Key Lessons We've Learned About Effectively Addressing Provider Bias
   • Step 1: Conducting a Situational and Segmentation Analysis
   • Step 2: Strengthening the Capacity of the Resource Team
   • Step 3: Implementing Summit
   • Step 4: Implementing Connect
   • Step 5: Implementing Rewards
   • Step 6: Performance Monitoring, Evaluation, and Learning

For those seeking additional resources on Beyond Bias, a list of supplemental readings have also been included in the annexes.

Editor's notes:

• This how-to guide was launched on May 11 2022 during Part 2 of a 2-part end-of-project webinar series, available by clicking on the video below (click here to watch it in French.) In addition to providing an overview of the resource, this webinar features a panel discussion with the Beyond Bias implementation team, who explore key lessons learned from the Beyond Bias project and provide practical tips for using the Beyond Bias model (and this guide) in adolescent and youth sexual and reproductive health (AYSRH) programmes.
• Click here for the 45-page PowerPoint slides for the Part 2 webinar in PDF format.
• To view Part 1 of the webinar series, which is focused on the Beyond Bias evaluation, visit the second item under Related Summaries, below.