Social and behavior change (SBC) is an approach that applies insights about why people behave the way they do and how behaviors change to affect positive outcomes for and by specific groups of people. In behavior-centered programs, all program interventions are designed to empower individual and collective changes and create enabling social, physical, market, and policy environments. Within the context of strengthening health systems, SBC activities shape the demand for accountable, affordable, accessible, and reliable care. They can also address and support the behaviors of people, communities, and organizations within the health system to promote the equitable provision of quality care.
As a part of USAID’s Health Systems Strengthening Learning Agenda, a panel of SBC experts from USAID, ICF, and PSI, with support from The Accelerator, hosted an interactive knowledge exchange on how HSS and SBC efforts can complement each other and the initial steps that can be taken to integrate SBC into HSS programming. Participants engaged in a robust knowledge exchange on improving the linkages between SBC and HSS.
What did we learn? Key themes and takeaways
The key themes and takeaways included:
Tips on “how to get started” and sustainably scale and institutionalize SBC within HSS programming:
- Get key stakeholder perspectives informally, and if possible, through research
- Build in strong mechanisms for community engagement
- Take time to understand both the system aspects (e.g., policies, supervision tools, opportunities in existing job descriptions) and the behavioral drivers (e.g., what motivates people to change behavior)
- Analyze the patient experience through methods such as patient pathways analysis, journey mapping, and empathy analysis
- Consider how to address providers’ emotional and social needs before focusing on other types of behavior change
Anticipated challenges of bringing an SBC focus into HSS:
- Distal nature of results (it may take several months or years to see behaviors change)
- Engaging policymakers (shifting their thinking to apply an SBC lens to the health system)
- Need for time and opportunities for reflection and collaborative learning (to adjust and improve approaches during implementation)
What resources were identified?
Panelists and participants shared the resources below during the webinar:
- USAID: Social and Behavior Change and Health Systems Strengthening
- This document identifies the ways in which the behavior of health system actors has a direct impact on the strength of the overall health system and on health outcomes. It highlights how SBC may be integrated into HSS programs to strengthen HSS program implementation and measurement and improve the system’s ability to support the practice of healthy behaviors.
- Breakthrough Action: Increasing the Use of Social and Behavior Change in Health Systems Strengthening
- This technical brief summarizes the findings of a literature review conducted in September 2022: The Effects of Integrating SBC within HSS in Low- and Middle-Income Countries. It also includes the results from three working sessions with global SBC and HSS experts. This brief provides concrete recommendations and identifies promising opportunities and entry points to increase the use of effective SBC in HSS programming.
- Accelerator:
- Improving Linkages between Social Accountability and Social and Behavior Change: A Preliminary Report of Country Data Collection for Cote d’Ivoire, Ghana, and Guinea (acceleratehss.org) The SA-SBC linkages study seeks to address the under-considered linkage of social accountability and behavior change within health systems strengthening (HSS) work, including work that aims to increase equity and efficiency through UHC.
- Application d’une optique de changement de comportement pour faire progresser la mobilisation citoyenne en faveur de la couverture sanitaire universelle au Togo. Here is a blog about the workshop with the UHC task force in Togo
- WHO: Engaging the private health service delivery sector through governance in mixed health systems: strategy report of the WHO Advisory Group on the Governance of the Private Sector for Universal Health Coverage. This strategy is focused on governance to support effective private sector engagement for UHC. The strategy report is intended to set the norms and goals for private sector engagement and provide evidenced support for WHO and Member States to invest appropriate resources in private sector health service delivery governance.
- JSI: Think | BIG Behavior Integration Guidance: A suite of tools and resources to help apply behavior integration, which is an approach to design and implement programs that defines outcomes as specific behaviors required to achieve the development goal, ensuring that the strategy, project and activity design are behavior-led, not intervention-driven.
- PSI: Map the Consumer Journey. A resource to walk through developing journey maps.
- The Framework for Engaging the Private Health Service Delivery Sector through Governance in Mixed Health Systems: Summary brief outlining the 6 governance behaviors: deliver strategy, align structures, enable stakeholders, build understanding, foster relations, and nurture trust.
- USAID: Social and Behavior Change and Health Systems Strengthening
Moving ahead
Health system actors have barriers and facilitators to their behaviors, their decision-making, and their actions which impact both the performance of the health system and the health of communities. Gathering social and behavioral insights from health system actors may help stakeholders design locally contextualized policy and local solutions that are key to successful behavior change and potentially sustainable systems change. The webinar can be viewed here or below.
