The ABCs of SBC

SBC in Support of System Strengthening

UNICEF SBC Season 1 Episode 5

Systems - you may not see them or feel them but they’re there. When vaccines feel out of reach or voting too arduous a task, it means our systems may need some TLC, R&D and perhaps, SBC?

If you’ve ever wondered about the systems that get vaccines to your arm, mail to your door, and food on your plate - this episode is for you. Qali speaks with Vincent Petit, Global Lead of Social and Behaviour Change (SBC) at UNICEF on why SBC is key to strengthening our systems and preparing for the crises to come. 

Resources (in order of mention)

Keep an eye our for the launch of UNICEF SBC’s upcoming magazine on sbcguidance.org or follow Vincent on LinkedIn for updates.

The views and opinions expressed by the contributors are their own and do not necessarily reflect the views or positions of UNICEF or any entities they represent. The content here is for information purposes only.

The ABCs of SBC is hosted by Qali Id and produced and developed by Helena Ballester Bon in partnership with Common Thread. To learn more about UNICEF SBC, click here.

Have a question, comment or story idea, please contact sbc@unicef.org


Vincent Petit:

A colleague of mine, Karen, has this

restaurant analogy:

if customers don't go in a restaurant, you don't blame the customers. You try and think about what's wrong with the restaurant itself, right? During the pandemic, when we had issues with COVID vaccine uptake, colleagues were asking us to build demand and to fight this vaccine hesitancy. But in reality, what makes the majority of reasons for not being vaccinated, wherever we study, is supply side barriers. It's like the health center being too far, opening hours being inappropriate, profile of the health workers being inappropriate, cost of going there and getting the vaccine being too high. Participation must become the new normal, if you want the system to operate in a different way.

Qali Id:

Hello and welcome back to the ABCs of SBC, your podcast on social and behaviour change or SBC. If you've followed the journey this far, you will have heard me speak to experts about what SBC is, what it looks like at UNICEF and beyond, and specifically what it can and can't do for communities who are facing the world's most complex challenges. In this episode, we'll be talking about system strengthening. You may have heard this term tossed around in past episodes, but now we're doing a deep dive into what it means and what it has to do with improving outcomes and responding to challenges that may arise in the future, such as climate catastrophe, disease outbreaks, political turmoil, economic challenges, and more. Let's go to Vincent Petit, who has spent the last 12 years working in social and behaviour change at UNICEF, starting back when it was still known as Communications for Development, or C4D, and has overseen and played a big role in the shift to SBC. We're going to start off with the basics. What do we mean when we say system strengthening? What are these systems?

Vincent Petit:

So when you look at the system, it has a few pillars, traditionally like policy, governance, planning, financing, and then more public-facing ones like the workforce or the commodities or the services. So typically, if you are able to send your daughter to school, it's because there's a system behind it, right? There are trained teachers. You have approved curricula, you have a national administrative and, uh, supervisory backbone, you have funding allocations, buildings, and so on. Similarly, if you live in a rural area in Congo or in Bangladesh or Canada or Romania or wherever, and if you can get a tetanus or diphtheria shot, it's because there are vaccine manufacturers, there are boats and planes and warehouses and a cold chain system and some people overseeing dispatch and you have health centers and fridges and doctors, nurses and records and so on. These are systems by definition, sectoral ones. Yes, they are upstream, but they go from upstream to downstream. And at the end of the day, they define the conditions in which we behave in quite an extensive way. What people call system strengthening is basically building the capacity of these different pillars so that these systems can perform better. And performing better in that sense means developing better policies, delivering services with a higher rate of uptake, delivering commodities and goods that are more adapted to the needs of the people and so on. So I guess at a basic level, that's what I think system strengthening is.

Qali Id:

So a lot of the system from the administration, the logistics, the cold chain, and so on, behind receiving an education or a vaccine, as you described, is all around us and invisible to us. These elements obviously play a crucial role in the system they support, but why does this all matter when we talk about social and behaviour change?

Vincent Petit:

The reason SBC is critical is because these systems interact with people directly at the downstream level, even if they are conceived at the upstream level. They exist to serve people. One could say that they're only as good as their ability to do that. They depend on people's use, on people's satisfaction, or even people compliance sometimes. I mean, all of that is SBC business. So that's why SBC as a function is critical to strengthen public systems.

Qali Id:

We've talked a lot in the series about how SBC focuses on people understanding their context, culture, history, and working with them and letting them lead. So for any system designed to serve people to not involve these principles seems quite wrong. Is there a barrier to bringing SBC into strengthening our systems?

Vincent Petit:

It's kind of the technocratic worldview of many decision makers. The idea that experts know better, right? Experts design in their corner, in their offices, and they roll out to the masses. And I've worked with a lot of doctors and technical professionals in ministries of health, for example, and those who truly believe that communities have valuable contributions to offer in improving the way the health system operates are very few. But the people we're trying to serve, they have an expertise, which is the expertise of their daily lives of their daily realities. And this is kind of irreplaceable. And the further you are from them, the harder it is to, you know, think on their behalf. It's the decision makers ability to recognise that they don't necessarily know better, regardless of their, you know, privileged education or their graduate degrees. It's a tricky thing to navigate. I think we need to socialize examples of success and convince these decision makers that there is something in it for them, you know, if they change the way they work traditionally, which is not easy because it can feel like a hassle to work with people. You know, it takes longer. It requires considering other options and different views. But at the end of the day, it should affect the results and make them look good, right?

Qali Id:

Well, I'm not sure. You tell me. Is there an example that comes to mind when you think about successfully strengthening systems with SBC?

Vincent Petit:

Recently, I was discussing with the, our team in the Latin America office, and they were explaining how in Bolivia, our SBC colleagues and the national partners had kind of developed their own take on HCD on human-centred design, which is traditionally rooted in Northern perspective, right in Western perspective, but they adapted the methodology with indigenous population to incorporate elements that were central to the Quechua and Guarani communities and cultures they were working with. And they made a larger space for considering their cosmovision in relation to the task at hand, which was to improve immunisation service delivery. So, you know, they were managed to stick to the principle of collaborating with the people to design a service better. And yet make it relevant to the people they were working with. So I don't think context is an issue. At the end of the day, I think adapting our interventions to a local context is easy. It's not a problem. But again, it's the whole culture of experts versus beneficiaries that is the main barrier in my opinion.

Qali Id:

So what is at risk here? Beyond creating systems that are not conceived with the ideas and values of real people and communities, which is already major when you think about the big systems you mentioned, like education and vaccination. If these systems don't account for us, what do you see happening?

Vincent Petit:

Systems are a key determinant in social trust. I think trust is everything in what we do. It's kind of the condition for any collective action. To do something together, people need to trust each other, right? We had that intuitive understanding for a long time, but now there is pretty hard data to show how dramatic the influence of trust is on everything we do in cooperation and humanitarian action. There's a study that was published in the Lancet during the COVID pandemic in 2022, where they analysed the contextual factors of transmission in almost 180 countries, I believe. And they looked at one or two years of data from all over the world and their conclusion was that the countries that curbed the pandemic the best weren't really those with the strongest health systems. They were those with the higher level of trust. None of the, what we call,"health security capacity indices", which is like measures of how strong the health system is and how prepared it is - none of these were meaningfully associated with infection rates. It's the measure of trust in the government, so vertical trust, but also trust interpersonally, so horizontal trust, and both of these had very statistically significant association with the spread of the virus and with the uptake of the vaccine as well. So less trust, more death in a nutshell. And I was shocked when I saw this study because it was the first time I was seeing a quantitative confirmation of something that I had believed for a long time. And I think this sheds a quite a different light on the importance of system strengthening for crisis preparedness. And you'll hear a lot of my colleagues talking about that, and rightly so. But what they mean by that is usually stockpiling masks and stockpiling vaccines and aquatabs and so on and Plumpy'nut. We never talk about stockpiling trust. And at the end of the day, it's social cohesion that we're talking about. And that is important to adapt to the crisis to come.

Qali Id:

That COVID example is really striking, and you mentioned having this inkling about trust even before this research confirmed it. I'm curious to hear where else you've seen this in your work.

Vincent Petit:

I'm gonna try and give you a concrete example, which is one I explained in an article in a magazine that we are about to release fairly soon. I was in Basra, in Iraq, last year in the southeastern part of Iraq. Basra used to be an area called the Venice of the East because of its canals. And nowadays it's an area that's already devastated by the climate crisis. It's one of these places where we're not talking about future impacts. We're talking about already navigating through a daily reality that temperatures are through the roof. Water scarcity is tremendous. You can literally see pastoralist communities being displaced from the marshlands on a real time basis because of that. It is a very shocking context for climate. And so I was there working with the UNICEF colleagues from the field office on water conservation. One of their programmes was to organize meetings in local communities and local neighborhoods of the cities. They had very skilled local facilitators that, honestly, I have a lot of respect for these people. They were doing an amazing job and they were asking the participants, you know, what can you do at your level to help conserve water given the dire situation that we're in, and given that the prospect is not so great. And people immediately responded that they wouldn't do anything until the government would do its share, which was basically fixing pipes and improving the governance and improving the service. And so the facilitators, uh, they pushed and they asked again, they said, okay, we hear that you want the government to do a better job. But in the meantime, what is it that you can do at your level to conserve water and contribute to reducing the problem? The response was the same. The response was nothing because the government is not playing ball, so we're not doing it. And it was just a clear example of people who had enough. I think the social contract was broken. Basra is also an area where oil production is enormous. We're talking millions of barrels a day. I assume people understand what that means financially. So not seeing a local government taking care of basic services. Yeah, trust was broken. That's why you need a basic level of trust, mutual understanding and collaboration to be able to face the crises, including climate, that are to come.

Qali Id:

So if I'm following correctly, that social contract starts with making sure our systems are designed for the people, with the people, and remain accountable to the people. Try saying that three times fast. That is what builds trust between people and institutions. So where do we begin using SBC to strengthen these systems?

Vincent Petit:

The first objective, I guess, is to define our ability to go through difficult times and to maintain the level of social cohesion that will help us work hand in hand and make it through the crises that are coming. And unfortunately, there are a lot of them coming up. So all of the system pillars that are, you know, policy, governance, workforce, and services, and so on, they can all be reshaped to be more people centred. We have built a lot of community feedback and social accountability mechanisms to improve the governance. We are pushing for HCD, Human-centred Design, to help craft better services and overall user-focused products development. Recently, my team was involved in redesigning wash dignity kits, like these kits that we give in humanitarian situations to help families maintain good hygiene so that they better match their needs. So that's what people-centred systems look like. The trick, I guess, is to constitute system strengthening, these tactics or these programmatic approaches should not be run as projects, but really institutionalised in the day to day. So if you do an HCD workshop, it can support what you're doing. It could be a good thing, but an HCD workshop is not a default way of working, right? It needs to be brought into the core processes of the institution. Similarly, if you do a civil society consultation, it's a good thing, but it's not enough. Participation must become the new normal if you want the system to operate in a different way. If we increase this partnership between the right holders and the duty bearers, if we manage to bring together the communities we're supposed to serve with those who have the power, the decision and the financial power to change something, we're going to increase the perception of inclusiveness, of equity, of active partnership. And at the end of the day, we're going to improve the relationship with the population. This is key to increase the trust. So what is getting in the way of institutionalizing SBC to strengthen systems? I know you mentioned this culture of experts knowing better. But is that all? I think it is pretty tricky to get support for system strengthening because it is long term. Trust is easily broken, but it takes time to earn and to earn back. That doesn't make people-centred system strengthening very bankable from that perspective. If we are to sell the immediate results for uptake of vaccines or number of girls registered in schools, that could increase because we work more closely with communities. I guess that that's a way of doing it, but the long term perspective is difficult to fund because everything that takes time doesn't match the pace of political agendas, it doesn't match the pace of development funding and are very programmatic cycles in our organizations. You know, everything is so short term. So every time you talk about multi-year processes and the perspective of having results that are not immediate, uh, not even guaranteed at times, it's extremely difficult to get funding. But once we integrate these people-centred approaches into systems, then it happens on a routine basis. You don't necessarily need to fund it anymore. And it also serves the emergency response. So balancing is difficult, mostly because we're lacking resources. And when we're lacking resources, we're focusing on responding and not on preventing and not on preparing. Similarly with the expert-based culture that I mentioned before, we live in a world dominated by a supply culture. I think supply versus demand is, it's something very widespread in UNICEF and typically my SBC colleagues are asked to build demand. That's the standard ask that we receive from anyone who is willing to collaborate with us. Supply versus demand is a valid economic principle when it comes to markets, but it's a pretty bad framework for public sectors. And I actually think it goes against system thinking. The immunisation example is once again the most striking one because during the pandemic when we had issues with COVID vaccine uptake, what was in every mouth was vaccine hesitancy. Colleagues were asking us to build demand and to fight this vaccine hesitancy. But in reality, what makes the majority of reasons for not being vaccinated, wherever we study, is supply side barriers. It's like the health center being too far, opening hours being inappropriate, profile of the health workers being inappropriate, cost of going there and getting the vaccine being too high. And yet we are asked to create demand when demand is first and foremost, created within supply when you design this supply, and it's that same culture that underpins and generates the idea that SBC is about communication, right? It's about selling something to people after the fact, rather than working with them.

Qali Id:

I'm sure there'll be people listening to this who still won't be sold on why there needs to be investment in SBC for our systems, for all of the reasons you described. What would you tell them?

Vincent Petit:

A colleague of mine, Karen, has this restaurant analogy, which is if customers don't go in a restaurant, you don't blame the customers. You try and think about what's wrong with the restaurant itself. And so, you know, SBC could bring supply and demand together in a real systems approach and recreate the link between Public services, policies and the people they're trying to serve when we build consultation processes, when we build platforms to engage with local leaders, with religious leaders, when we build partnerships with women-based organizations for the purpose of development work. All of these assets can be easily repurposed when the crisis hit, and they are. We've done that, uh, including with social listening mechanisms in the past. And we've seen that with some long-existing, people-centred, systemic approaches I mentioned earlier. You know, micro planning has been a long proven effective strategy where in health districts, you have staff who rally a few local influencers, community members, village chiefs, and they work together to map out where people are and what has changed since the last immunisation campaign and where our service is not available or where are the people that, you know, didn't get covered last time and they try and reconcile admin data with the, the experience of these communities and of these people. It's a very low tech intervention. It's been all around the world for a very long time. Um, classic example is with pastoralist communities. This helps tailor the delivery of vaccines to their movements. We have seen vaccine delivery points being built around water holes and things like that. Once you have a proper micro planning in place, if there is a crisis, you can immediately leverage that to respond to the crisis, right? So again, here, I think the long term needs and the short term needs align. If we manage to sell some short term goals, and we try and achieve these short term goals the right way, then this right way of working is going to be extremely useful when we respond to emergencies in the future.

Qali Id:

What would you like to see at UNICEF?

Vincent Petit:

I think I'd like to see UNICEF make the people-centred way of working its default way of working across all system strengthening efforts, I would say, instead of having a projectized or issue specific way of dealing with a problem. I wish we as organizations and the governments we work with could invest in creating the foundation for preventing these issues in the first place.

Qali Id:

That's our show. Thank you so much to Vincent Petit for joining us and sharing his wisdom on system strengthening. You can read more about stockpiling trust in UNICEF's upcoming magazine. I've gotten a sneak preview of it and it is such a colorful compendium of social and behaviour change at UNICEF and beyond. Whether you're a seasoned pro or new to these approaches, there's something in it for everyone. As always, those details will be in the show notes along with other research and resources mentioned in the episode. If you're craving more on system strengthening, you can check out UNICEF's tool on system strengthening in their online programme guidance, which has tons of other quick guides to SBC tools and approaches. Stay tuned for more episodes this Fall.

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