Hidden in Plain Sight: Strengthening Social and Behavior Change Systems

A year and a half ago, a group of us linked to the Health Communication Capacity Collaborative (HC3) gathered in a common room in the apartment building of an HC3 colleague. The task we set for ourselves was to develop, based on our past experience and that of others in this field, a model that described the key elements of social and behavior change (SBC) capacity strengthening. Over a series of lively meetings in that room over a period of a few months, we crafted what we came to call the Capacity Ecosystem. It was one of the more satisfying professional experiences I’ve had in recent years. The discussions were lively. Opinions and experience were diverse.

We made progress.

But I’m not writing this to describe that Ecosystem, which I encourage you to read. Rather, I’m moved to write by one set of insights that emerged during its development. There was a component of the model that I felt was “hidden in plain sight.”

As we began our discussions about what was meant by SBC capacity strengthening, stock images came to my mind: a group of trainees on their graduation day; students in a university lecture hall; a mentor in deep consultation with their mentee. Maybe at a particularly reflective moment I’d think of a teacher with a headset on, speaking into her computer mic and interacting with students in a distance learning program. These became the elements of the individual-level interventions in the model.

Similarly, we thought about the well-developed tools and processes to build the SBC capacity of organizations, such as participatory assessments, strategic planning, team building and even operational systems development.

Then things got really interesting. We began to grapple with what else is important to capacity strengthening beyond smart, capable individuals and efficient organizations. At first, we couldn’t describe it, but we knew there were important elements that didn’t fit into the “individual” or “organizational” categories: technical working groups of organizations working in common purpose; national strategies that guide multiple organizations; policies; even something as nebulous as the spirit of coalition action and collaboration. SBC projects worldwide have been involved in these types of activities for many years, but we didn’t have a common language to describe them. We came to describe them as elements of the SBC “system.” The analogy that came to mind was that these were components of the “connective tissue” that was linking and supporting these organizations.

That’s what was hiding in plain sight.

The more we discussed elements of the system, the more we realized that, just as with individuals and organizations, it was possible to define the competencies of a well-functioning SBC system and the interventions that might affect those competencies.

On March 23, 65 people gathered at the National Press Club to discuss what was meant by the systems-level issues in capacity strengthening. The nine elements of a “healthy” SBC system formed the heart of our discussion as we looked into not only the Ecosystem but also a series of country case studies from HC3’s programs in Bangladesh, Nigeria, Ethiopia and Nepal that described how these nine elements work on the ground. It was certainly an initial step in articulating the important role systems thinking has to play in SBC capacity strengthening.