The ABCs of SBC

SBC in Community Delivery Platforms

• UNICEF SBC

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What if healthcare systems weren't just centralized services but dynamic partnerships rooted in trust, relevance, and equity? 

That’s the driving vision behind Community Delivery Platforms. In this episode we talk about collaborations among governments, local communities, UNICEF, and partner organizations to make essential health and nutrition services accessible to every mother, child, and household, no matter where they live. 

Join host Qali Id as we unpack the strategies, struggles, and successes of community delivery platforms, with insights from:

  • Afrika Mukaneto, SBC Specialist, UNICEF Regional Office for South Asia
  • Waqas Shafi, SBC Specialist, UNICEF Pakistan
  • Bridget Job Johnson, Chief of SBC, UNICEF Bangladesh

Want to learn more about how SBC can be used to strengthen systems? Check out episode 5, on SBC in Support of Systems Strengthening. We’ll also have another episode coming out soon on Community System Strengthening - stay tuned. 

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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.

Check out UNICEF’s latest publication on Social and Behaviour Change, Why don’t you just behave! For more information about UNICEF SBC, check out the programme guidance.

We care about what you think — you can share your thoughts on the podcast using this feedback form. For all other inquiries, please contact sbc@unicef.org.

Afrika:

the vision you're talking about is every community member, every child, no matter where they live, they have access to services, right? So this is not something that you can do alone. You need a joint effort, joint advocacy from different partners to elevate community health nutrition as a priority within national agenda and policies.

Qali Id:

Welcome to the ABCs of SBC, where we dive into how social and behavior change is reshaping systems and lives.. I'm your host, and today What happens when healthcare is out of reach, not culturally relevant, costly, or simply not working? It doesn't have to be this way. Around the world, governments, local communities and organizations like UNICEF are coming together to change this through the Community Health Delivery Partnership or CHDP. The CHDP is a collaboration of global, regional, and national stakeholders committed to supporting country led efforts to expand access to equitable, high quality, essential health services. It does this by working with countries to strengthen community-based primary healthcare with community health workers at the heart of the system. At the core of this effort is a powerful truth. Investing in community health just makes sense. It has eased the burden on overwhelmed health facilities, expanded access to reproductive health services, strengthened health literacy and built trust and resilience in communities. In this episode, we'll explore how this collaboration is helping countries deliver health services, and how social and behavior change is helping make that vision a reality. We'll from Africa Muto, SBC specialist for UNICEF's Regional Office for South Asia, who you heard at the beginning of this episode. Waqas Ali Sah, SBC specialist in unicef, Pakistan. And Bridget Job Johnson, chief of SBC for unicef Bangladesh. Let's hear from Africa. Who describes CHDP and its wide reaching Mission

Afrika:

CHDP is a platform that can. Significantly increase,, the reach and impact of community-based, , service,, across key sectors, not only in health, but health, nutrition, but also other key social sectors which have a role in contributing to. Health, nutrition and wellbeing of children, , across the world.

Qali Id:

That collaborative cross-sector approach is at the heart of CHDP, and as Africa puts it, what really drives change at the community, household, and individual levels is social behavior change.

Afrika:

We are fostering continuous dialogue with the communities participation, engagement of not only families household, but also community leaders and community structures, right? That's 1, area. The other area is. Facilitating community's ownership of children health and wellbeing. Because the community knows better than anyone where the vulnerable families and the vulnerable children, the mothers who need who at the highest risk, right? another example I can give, is, . The health system, health providers do need evidence that cannot be found without us talking to the community. So community voices are important to ensure that we are providing evidence-based programs, evidence-based health services, , and also ensuring that we are. Hearing from the community so that the health services that we're providing are addressing the specific needs of the communities where the services are being provided. Because it's not a one size fits all.

Qali Id:

This highlights how important community feedback is and how that feedback loop strengthens the links between communities, providers and policy makers. It's not just about listening, it's about acting on what's heard. In fact, this kind of responsive, people-centered approach is exactly why community-based primary healthcare is such a powerful tool. Now let's turn to Bridget, job, Johnson and Bangladesh, to hear how improving health services for urban slum populations in Dakar began with a service first approach. Unfortunately, and perhaps predictably, these efforts fell short.

Bridget:

The attempt by the government over the years to provide good primary healthcare services, especially to the urban slum dwellers has been challenge, at different phases. They had implemented the first face of the project, which was really based on input, which was really based on people coming to utilize the services and the services were there. So it was let's establish the services. let's staff the clinic and the people will come. And people were not coming.

Qali Id:

And with that, a second phase began focusing on community structures, but also collaboration with the CSO, implementing partners, the Department of Health, ward leaders, and unicef, to try to diagnose the problem and build better on existing community networks and collaboration to design services that worked for everyone.

Bridget:

Starting from really trying to understand the problem together to identify the role that each of the parties could play. And when I talk about these parties, I'm talking about the religious leaders. I'm talking about community volunteers. And then we have We have the world leaders who has responsibility, of course, politically for the world and for their people. And so we've been able to bring these elements together and the youth groups in some of these urban slums, and bringing all of them together has really changed the status quo the status quo in terms of really, the ownership of the health services within the location that this is been implemented.

Qali Id:

The result of this collaboration was the Allo Clinic program. Six Allo clinics were established so that the underserved could have convenient quality access to health services in places, and at times of the day that met their unique needs.

Bridget:

So we have what we call the Allo clinics. The allo clinics are clinics in the urban slums. There is a very strong collaboration between the community and, the health services. Also because these health services are organized in a way that. It is a C that is looking at what happens at the community up to the health facility level, and then back to the community in terms of feedback, in terms of dialogue and being on the same page. And those who are benefiting from this is really the urban population is really the women, the children, and of course the rest of the population in the urban locations. Another benefit that has come from this is the increased willingness of the population to use the services because now they know what to expect and they know that their opinion counts

Qali Id:

That sense of ownership is a game changer. What Bridget describes isn't just better communication, it's social accountability and action. When people see their voices reflected in how services are designed, when opening hours fit their lives, when they're invited in services improve, people return, and everything shifts. And this is the kind of transformation the CHDP aims to support by promoting collaboration across national, regional, and global levels. The CHDP works to optimize the efficient use of resources, reducing duplication of efforts, shared expertise, and multi-sectoral partnerships to expand the reach and impact of services like these Allo clinics, especially for underserved urban populations. Trust is at the center of health systems. It determines the use of available health services, in particular among underserved or marginalized communities who tend to be more at risk for SBC specialist Waka Isha in Pakistan, some of the most at risk are mothers. Here he paints a vivid picture of the obstacles women face when trying to access care.

Waqas:

I think there are multiple factors, , that prevent her from accessing medical care. One of one of them could be, geographical barriers. Planning areas are quite far located from the health facilities with limited or no transport facilities. So that prevents the mother or the female caregiver from accessing the medical services. The other could be financial constraints that we have seen even when the services are free. So we have seen at the basic health units, the services are free. Of course, the services are available. But due to financial constraints they do not have cost of means to bear the transportations cost for medicines and others indirect costs that may be associated with seeking healthcare. So financial constraint is also one of the key barrier. The other barrier that I would like to mention here is. The gender and cultural norms. So in many households, women need permission from their husbands or from their mother-in-laws to visit a health center, which often leads to either a delayed or a denied care. The other barrier would be around, the low awareness and misinformation. Many mothers, they rely on traditional healers or home remedies, because they have either lack of knowledge or they have misconceptions about modern treatments.. Other thing that I would like to mention here as well apart from the demand side, the healthcare workers which in this case are mostly over burdened. So the lady health workers or the midwives or the other front end workers that they have are quite overburdened and which often leads to long waiting times and inconsistent service delivery. These are some of the barriers especially for a mother or a female caregiver that she passes through each day in order to access medical care.

Qali Id:

So there's a lot going on here. We have access, long distances, financial challenges, social and gender norms, misinformation and mistrust, overworked healthcare workers, and long waiting times. And these are just a few of the barriers that women must overcome in rural Pakistan. It's a complex mix, and in many ways these issues are deeply interconnected. This is where partnerships like the CHDP can add real value by working alongside governments to ensure that community health strategies are not only responsive to the existing barriers, but that the solutions are properly costed, prioritized, and included in national health budgets. Let's hear more from Wakas.

Waqas:

So in order to address the barriers we are working on, empowering play health workers as trusted providers. So we are training them on the counseling skills on providing maternal and child health services. And we are also providing them with basic essential supplies as well to to equip them with necessary supplies so that they can also deliver basic services at their health houses. In areas where we have, we don't have LHW coverage, we have hired couple counselors as well to reach out to these communities and to serve as lady health workers . I think that strategy is working very well, in Balochistan, in Raja, where we have lower LHW coverage. In addition to that, I think what is actually working and what we have put in place these mother support groups involves mothers from the communities. Some of the mothers are accessing the health services. They are the ones that are following all the desired behaviors within their households. But then there are also mothers that are not accessing services due to to misinformation, misconceptions due to lack of support from their families. It, it serves as a peer support network where the mothers then often engage their mother-in-laws, , to, to address their concerns.. Qali Id: So in areas where workers, couple counselors were hired and trained to reach families and women's champion networks and mother support groups were established. These are invaluable spaces for peer support, sharing information, and raising awareness about healthy practices. But of course, women can't drive this change alone, especially in more conservative areas of Pakistan where social norms restrict women's autonomy. Something powerful is happening. Wakas reflects on how male engagement in communities has evolved, particularly through the creation of father support groups. These groups provide a platform for men to discuss health and nutrition practices, connect with peers and foster supportive environments within their families and communities. This shift didn't happen overnight. It began with the interest and initiative of a single father. So it all started, with one father in, , in one of the district in Balochistan,, who reached out, , to our teams, , and . Whose wife was basically part of the,, women champion network. He suggested that he would like to be part of, the same network as well, where he can also, , mobilize other men within the community to be part of the men champion network. So that's how the initiative started. They had a curiosity in the beginning on why these women champion networks are being created and what's their role and what are they doing? So the curiosity basically led them to understand the effectiveness and the objective of these networks, and that's where the interest was created. So one of the father then reached out and based on his suggestion and based on the interest and the motivation that we saw, we had to create, . A men champion network in one of the district first, , that men champion network, not only engaged fellow other champions as well who were fathers, who were husbands, who were brothers, who can then bring about the required support that is needed for these women to access healthcare services. But they also reached out to, some of the, community influences as well. Religious leaders were involved., other community elders was involved who had a say,, within these communities and who can shape up traditional beliefs and practices. So that's how by the demand and in the trust of one father, we were able to replicate that in the entire districts. Now we are thinking to replicate the same in other locations where we are implementing the CHDP program.

Qali Id:

In SBC, we call this a positive deviant. Someone who, despite facing the same challenges and limited resources, as everyone else in their community, still manages to adopt healthier, more positive behaviors. In short, they figured out what works right there in their own context, and they can show others the way forward. That one father's action created a ripple effect reshaping how men see their role in health and caregiving today in Pakistan. Mother and father support groups are a growing network of local champions. They're not outsiders, they're neighbors, role models and positive deviance. Now let's hear from Bridget about how community volunteers and community leaders were used during major outbreaks like dengue.

Bridget:

In 2023, there was a very big dengue outbreak in Bangladesh. And for the first time, almost all the districts were reporting cases and Dhaka was top on the list of cases and community engagement there was a lot of work that was done because the community volunteers and the community leaders really pulled together. Typically in the urban slum since are not very organized. You have all the open drains, you have the refuse all over the place. And I remember going out to see some of those what they call cleanup campaigns where you know, several people in the community comes together. They identify locations where mosquitoes could be breathing and then they go together. Really community efforts. Young people, women, men, they clean up these places. And make sure that there is no room for community for mosquitoes to breed in those locations. There was very intensive work at the community level, especially to encourage. Those who might be presenting with the dengue fever symptoms to quickly seek medical care and not just go to the pharmacies. And the number of people who actually were sick and came to the health facility to seek care was really unprecedented.

Qali Id:

The success of the Allo Clinic program extended beyond acute phases of outbreaks and health emergencies. It demonstrated something deeper that when communities are engaged, not just as beneficiaries, but as partners and leaders, systems begin to shift.

Bridget:

Yes, it's not only for disease outbreak, but the significant increase between 2022 and 2023 we're here to see the 20, 24 figures. There was a very. Steep increase from 19% usage of the Allo Clinic to 37% that is more than a hundred percent doubling , in one year. And that is a very significant. So I think that engagement between community, I think that partnership of the different elements at both the health service and the community level definitely is bringing a very good results.

Qali Id:

What Bridget illustrates here is how CHDP is designed to support a people-centered approach that builds on community strengths and promotes local leadership, trust and accountability. These are the building blocks of resilient health systems, especially in times of crisis. The ambition is significant. And for Africa, the insights gained from Bangladesh and Pakistan suggests that CHDP could pave the way for a more equitable and inclusive global health landscape.

Afrika:

It's a world where every mother and child have access to and receive high quality, essential health, nutrition, social services. At the community from community workers who are fairly paid, skilled, supplied, and supervised, it means that what, where a million of children, mothers, and community member no longer suffer or die from preventable death due to the lack of access to timely equitable in quality healthcare.

Qali Id:

Better coordination, policy and investments by all partners is essential to achieving universal healthcare and global health security. Saving lives, improving equity and building trust between our social systems and people. And it's the people who are driving change with SBC as a catalyst helping to facilitate conversations and meaningful participation. For Bridget, the future is about building on the Allo Clinic and its key feature relevance.

Bridget:

Giving me, rice, which I might like to eat very much is a very good beginning, but giving me rice in the mood that I prefer to eat it and at the right time of the day makes a lot of difference. So again, it's really about the relevance. If CHDP and SBC achieves their goal in 10 years, it'll be fully community owned and community driven. And that is because capacity for the community to address issues that relates to health, to be accountable more and more for the health of the community will be enhanced. There is no alternative to it.

Qali Id:

I asked Waqas about the future of CHDP in Pakistan

Waqas:

if we succeed in,, the CHDP and, , the SBC interventions, there will be demand from the communities.. I would see an improved service design where,, women have better access to, , healthcare services where women have, , access to female service providers,, at the healthcare sites., we would be able to see that there are less cases of, mother and child health,, illnesses,, within the communities. And there's more support, , to the health service systems,, within the communities.

Qali Id:

When systems listen, they change, and when communities lead, they are more likely to thrive. CHDP is showing that with the right support, health systems don't just serve people, they partner with them. Creating systems that are more trusted, more equitable, and better prepared for whatever comes next. And across South Asia, it's already reshaping the way healthcare works for families.

Bridget:

I've seen it in many elements of work that I do, that when the private sector, the public sector, and the community work together, there is always a win-win.

Qali Id:

This is what happens when you reimagine healthcare, not just as a service, but as a partnership. Thank you to our guests, Africa Muto, Bridget job Johnson, and Waqas Ali Sha for sharing their stories and insights. You can learn more about the Community Health Delivery Partnership by visiting the link in our show notes. Thank you for joining us on the ABCs of SBC. If you like this episode, share it with a colleague, or better yet, with someone working on the front lines of community health. I'm Qali Id. Until next time.