July 17, 2024 • 22 mins
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)
- Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021
- System Strengthening
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.
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.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Vincent Petit (00:02):
A colleague of mine, Karen, has this
restaurant analogy (00:04):
if customers don't go in a restaurant, you
don't blame the customers.
You try and think aboutwhat's wrong with the
restaurant itself, right?
During the pandemic, when wehad issues with COVID vaccine
uptake, colleagues were askingus to build demand and to
fight this vaccine hesitancy.
(00:25):
But in reality, what makes themajority of reasons for not
being vaccinated, wherever westudy, is supply side barriers.
It's like the health centerbeing too far, opening
hours being inappropriate,profile of the health workers
being inappropriate, costof going there and getting
the vaccine being too high.
(00:45):
Participation must becomethe new normal, if you
want the system to operatein a different way.
Qali Id (01:01):
Hello and welcome back to the ABCs of SBC,
your podcast on social andbehaviour change or SBC.
If you've followed the journeythis far, you will have heard me
speak to experts about what SBCis, what it looks like at UNICEF
and beyond, and specificallywhat it can and can't do for
communities who are facing theworld's most complex challenges.
(01:22):
In this episode,we'll be talking about
system strengthening.
You may have heard thisterm tossed around in past
episodes, but now we're doinga deep dive into what it
means and what it has to dowith improving outcomes and
responding to challenges thatmay arise in the future, such
as climate catastrophe, diseaseoutbreaks, political turmoil,
(01:42):
economic challenges, and more.
Let's go to Vincent Petit,who has spent the last 12
years working in social andbehaviour change at UNICEF,
starting back when it wasstill known as Communications
for Development, or C4D, andhas overseen and played a
big role in the shift to SBC.
We're going to startoff with the basics.
(02:03):
What do we mean when wesay system strengthening?
What are these systems?
Vincent Petit (02:08):
So when you look at the system, it has
a few pillars, traditionallylike policy, governance,
planning, financing, andthen more public-facing ones
like the workforce or thecommodities or the services.
So typically, if you areable to send your daughter to
school, it's because there'sa system behind it, right?
(02:29):
There are trained teachers.
You have approved curricula, youhave a national administrative
and, uh, supervisory backbone,you have funding allocations,
buildings, and so on.
Similarly, if you live ina rural area in Congo or in
Bangladesh or Canada or Romaniaor wherever, and if you can get
a tetanus or diphtheria shot,it's because there are vaccine
(02:53):
manufacturers, there are boatsand planes and warehouses and
a cold chain system and somepeople overseeing dispatch
and you have health centersand fridges and doctors,
nurses and records and so on.
These are systems bydefinition, sectoral ones.
Yes, they are upstream, but theygo from upstream to downstream.
(03:15):
And at the end of the day,they define the conditions
in which we behave inquite an extensive way.
What people call systemstrengthening is basically
building the capacity of thesedifferent pillars so that these
systems can perform better.
And performing better in thatsense means developing better
(03:37):
policies, delivering serviceswith a higher rate of uptake,
delivering commodities and goodsthat are more adapted to the
needs of the people and so on.
So I guess at a basiclevel, that's what I think
system strengthening is.
Qali Id (03:50):
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 playa crucial role in the system
they support, but why does thisall matter when we talk about
social and behaviour change?
Vincent Petit (04:10):
The reason SBC is critical is because these
systems interact with peopledirectly at the downstream
level, even if they areconceived at the upstream level.
They exist to serve people.
One could say thatthey're only as good as
their ability to do that.
They depend on people's use, onpeople's satisfaction, or even
people compliance sometimes.
(04:31):
I mean, all of thatis SBC business.
So that's why SBC as afunction is critical to
strengthen public systems.
Qali Id (04:37):
We've talked a lot in the series about how SBC
focuses on people understandingtheir context, culture,
history, and working withthem and letting them lead.
So for any system designedto serve people to not
involve these principlesseems quite wrong.
Is there a barrierto bringing SBC into
strengthening our systems?
Vincent Petit (04:58):
It's kind of the technocratic worldview
of many decision makers.
The idea that expertsknow better, right?
Experts design in theircorner, in their offices, and
they roll out to the masses.
And I've worked with a lotof doctors and technical
professionals in ministriesof health, for example, and
those who truly believe thatcommunities have valuable
(05:20):
contributions to offer inimproving the way the health
system operates are very few.
But the people we're tryingto serve, they have an
expertise, which is theexpertise of their daily lives
of their daily realities.
And this is kindof irreplaceable.
And the further you are fromthem, the harder it is to, you
(05:40):
know, think on their behalf.
It's the decision makersability to recognise that
they don't necessarily knowbetter, regardless of their,
you know, privileged educationor their graduate degrees.
It's a tricky thing to navigate.
I think we need to socializeexamples of success and
convince these decision makersthat there is something in
it for them, you know, ifthey change the way they work
(06:02):
traditionally, which is noteasy because it can feel like
a hassle to work with people.
You know, it takes longer.
It requires considering otheroptions and different views.
But at the end of the day, itshould affect the results and
make them look good, right?
Qali Id (06:20):
Well, I'm not sure.
You tell me.
Is there an example thatcomes to mind when you
think about successfullystrengthening systems with SBC?
Vincent Petit (06:30):
Recently, I was discussing with the, our team
in the Latin America office,and they were explaining how in
Bolivia, our SBC colleagues andthe national partners had kind
of developed their own take onHCD on human-centred design,
which is traditionally rootedin Northern perspective, right
(06:50):
in Western perspective, butthey adapted the methodology
with indigenous populationto incorporate elements that
were central to the Quechuaand Guarani communities and
cultures they were working with.
And they made a larger space forconsidering their cosmovision
in relation to the task athand, which was to improve
(07:11):
immunisation service delivery.
So, you know, they were managedto stick to the principle of
collaborating with the peopleto design a service better.
And yet make it relevant to thepeople they were working with.
So I don't thinkcontext is an issue.
At the end of the day, I thinkadapting our interventions
to a local context is easy.
It's not a problem.
(07:31):
But again, it's the wholeculture of experts versus
beneficiaries that is themain barrier in my opinion.
Qali Id (07:38):
So what is at risk here?
Beyond creating systems thatare not conceived with the ideas
and values of real people andcommunities, which is already
major when you think aboutthe big systems you mentioned,
like education and vaccination.
If these systems don'taccount for us, what
do you see happening?
Vincent Petit (07:56):
Systems are a key determinant in social trust.
I think trust iseverything in what we do.
It's kind of the conditionfor any collective action.
To do something together, peopleneed to trust each other, right?
We had that intuitiveunderstanding for a long time,
but now there is pretty harddata to show how dramatic
the influence of trust is oneverything we do in cooperation
(08:20):
and humanitarian action.
There's a study that waspublished in the Lancet
during the COVID pandemicin 2022, where they analysed
the contextual factorsof transmission in almost
180 countries, I believe.
And they looked at one or twoyears of data from all over
the world and their conclusionwas that the countries that
(08:42):
curbed the pandemic the bestweren't really those with
the strongest health systems.
They were those with thehigher level of trust.
None of the, what we call,"health security capacity
indices", which is like measuresof how strong the health system
is and how prepared it is - noneof these were meaningfully
associated with infection rates.
(09:03):
It's the measure of trust in thegovernment, so vertical trust,
but also trust interpersonally,so horizontal trust, and both
of these had very statisticallysignificant association with the
spread of the virus and with theuptake of the vaccine as well.
So less trust, moredeath in a nutshell.
And I was shocked when I sawthis study because it was
(09:28):
the first time I was seeinga quantitative confirmation
of something that I hadbelieved for a long time.
And I think this shedsa quite a different
light on the importanceof system strengthening
for crisis preparedness.
And you'll hear a lotof my colleagues talking
about that, and rightly so.
But what they mean by thatis usually stockpiling
(09:49):
masks and stockpilingvaccines and aquatabs
and so on and Plumpy'nut.
We never talk aboutstockpiling trust.
And at the end of theday, it's social cohesion
that we're talking about.
And that is important toadapt to the crisis to come.
Qali Id (10:04):
That COVID example is really striking, and you
mentioned having this inklingabout trust even before
this research confirmed it.
I'm curious to hear where elseyou've seen this in your work.
Vincent Petit (10:16):
I'm gonna try and give you a concrete
example, which is one Iexplained in an article in
a magazine that we are aboutto release fairly soon.
I was in Basra, inIraq, last year in the
southeastern part of Iraq.
Basra used to be an areacalled the Venice of the
(10:37):
East because of its canals.
And nowadays it's an areathat's already devastated
by the climate crisis.
It's one of these placeswhere we're not talking
about future impacts.
We're talking about alreadynavigating through a daily
reality that temperaturesare through the roof.
Water scarcity is tremendous.
(11:00):
You can literally seepastoralist communities
being displaced from themarshlands on a real time
basis because of that.
It is a very shockingcontext for climate.
And so I was there workingwith the UNICEF colleagues
from the field officeon water conservation.
One of their programmeswas to organize meetings in
(11:25):
local communities and localneighborhoods of the cities.
They had very skilledlocal facilitators that,
honestly, I have a lot ofrespect for these people.
They were doing an amazingjob and they were asking the
participants, you know, whatcan you do at your level to
help conserve water giventhe dire situation that
we're in, and given that theprospect is not so great.
And people immediatelyresponded that they wouldn't do
(11:48):
anything until the governmentwould do its share, which
was basically fixing pipesand 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 itthat you can do at your level
(12:12):
to conserve water and contributeto reducing the problem?
The response was the same.
The response was nothing becausethe government is not playing
ball, so we're not doing it.
And it was just a clear exampleof people who had enough.
I think the socialcontract was broken.
Basra is also an area whereoil production is enormous.
(12:36):
We're talking millionsof barrels a day.
I assume people understandwhat that means financially.
So not seeing a local governmenttaking care of basic services.
Yeah, trust was broken.
That's why you need abasic level of trust,
mutual understanding andcollaboration to be able to
(12:57):
face the crises, includingclimate, that are to come.
Qali Id (13:02):
So if I'm following correctly, that social
contract starts withmaking sure our systems are
designed for the people,with the people, and remain
accountable to the people.
Try saying thatthree times fast.
That is what builds trustbetween people and institutions.
So where do we begin using SBCto strengthen these systems?
Vincent Petit (13:23):
The first objective, I guess, is to
define our ability to go throughdifficult times and to maintain
the level of social cohesionthat will help us work hand
in hand and make it throughthe crises that are coming.
And unfortunately, thereare a lot of them coming up.
So all of the system pillarsthat are, you know, policy,
(13:45):
governance, workforce,and services, and so on,
they can all be reshapedto be more people centred.
We have built a lot ofcommunity feedback and social
accountability mechanismsto improve the governance.
We are pushing for HCD,Human-centred Design, to
help craft better servicesand overall user-focused
(14:07):
products development.
Recently, my team was involvedin redesigning wash dignity
kits, like these kits thatwe give in humanitarian
situations to help familiesmaintain good hygiene so that
they better match their needs.
So that's what people-centredsystems look like.
The trick, I guess, is toconstitute system strengthening,
(14:30):
these tactics or theseprogrammatic approaches should
not be run as projects, butreally institutionalised
in the day to day.
So if you do an HCD workshop, itcan support what you're doing.
It could be a good thing,but an HCD workshop is not a
default way of working, right?
(14:51):
It needs to be broughtinto the core processes
of the institution.
Similarly, if you do a civilsociety consultation, it's a
good thing, but it's not enough.
Participation must becomethe new normal if you
want the system to operatein a different way.
If we increase this partnershipbetween the right holders
(15:12):
and the duty bearers, if wemanage to bring together the
communities we're supposedto serve with those who have
the power, the decision andthe financial power to change
something, we're going toincrease the perception of
inclusiveness, of equity,of active partnership.
And at the end of theday, we're going to
(15:32):
improve the relationshipwith the population.
This is key toincrease the trust.
So what is getting in theway of institutionalizing
SBC to strengthen systems?
I know you mentionedthis culture of
experts knowing better.
But is that all?
I think it is prettytricky to get support
(15:53):
for system strengtheningbecause it is long term.
Trust is easily broken,but it takes time to
earn and to earn back.
That doesn't make people-centredsystem strengthening very
bankable from that perspective.
If we are to sell the immediateresults for uptake of vaccines
(16:14):
or number of girls registeredin schools, that could
increase because we work moreclosely with communities.
I guess that that's a way ofdoing it, but the long term
perspective is difficultto fund because everything
that takes time doesn'tmatch the pace of political
agendas, it doesn't match thepace of development funding
(16:34):
and are very programmaticcycles in our organizations.
You know, everythingis so short term.
So every time you talk aboutmulti-year processes and the
perspective of having resultsthat are not immediate,
uh, not even guaranteedat times, it's extremely
difficult to get funding.
But once we integrate thesepeople-centred approaches
(16:55):
into systems, then ithappens on a routine basis.
You don't necessarilyneed to fund it anymore.
And it also serves theemergency response.
So balancing is difficult,mostly because we're
lacking resources.
And when we're lackingresources, we're focusing
on responding and not onpreventing and not on preparing.
Similarly with the expert-basedculture that I mentioned
(17:17):
before, we live in a worlddominated by a supply culture.
I think supply versus demandis, it's something very
widespread in UNICEF andtypically my SBC colleagues
are asked to build demand.
That's the standard ask thatwe receive from anyone who is
willing to collaborate with us.
Supply versus demand is avalid economic principle
(17:39):
when it comes to markets,but it's a pretty bad
framework for public sectors.
And I actually think it goesagainst system thinking.
The immunisation example isonce again the most striking one
because during the pandemic whenwe had issues with COVID vaccine
uptake, what was in everymouth was vaccine hesitancy.
Colleagues were asking usto build demand and to fight
(18:01):
this vaccine hesitancy.
But in reality, what makes themajority of reasons for not
being vaccinated, wherever westudy, is supply side barriers.
It's like the health centerbeing too far, opening
hours being inappropriate,profile of the health workers
being inappropriate, costof going there and getting
the vaccine being too high.
(18:23):
And yet we are asked to createdemand when demand is first
and foremost, created withinsupply when you design this
supply, and it's that sameculture that underpins and
generates the idea that SBCis about communication, right?
It's about selling somethingto people after the fact,
rather than working with them.
Qali Id (18:43):
I'm sure there'll be people listening to this who
still won't be sold on whythere needs to be investment
in SBC for our systems, for allof the reasons you described.
What would you tell them?
Vincent Petit (18:55):
A colleague of mine, Karen, has this restaurant
analogy, which is if customersdon't go in a restaurant, you
don't blame the customers.
You try and think aboutwhat's wrong with the
restaurant itself.
And so, you know, SBC couldbring supply and demand together
in a real systems approachand recreate the link between
(19:15):
Public services, policies andthe people they're trying to
serve when we build consultationprocesses, when we build
platforms to engage with localleaders, with religious leaders,
when we build partnerships withwomen-based organizations for
the purpose of development work.
All of these assets can beeasily repurposed when the
(19:37):
crisis hit, and they are.
We've done that, uh, includingwith social listening
mechanisms in the past.
And we've seen thatwith some long-existing,
people-centred, systemicapproaches I mentioned earlier.
You know, micro planning hasbeen a long proven effective
strategy where in healthdistricts, you have staff who
(19:59):
rally a few local influencers,community members, village
chiefs, and they work togetherto map out where people are and
what has changed since the lastimmunisation campaign and where
our service is not availableor where are the people that,
you know, didn't get coveredlast time and they try and
(20:20):
reconcile admin data withthe, the experience of these
communities and of these people.
It's a very lowtech intervention.
It's been all around theworld for a very long time.
Um, classic example is withpastoralist communities.
This helps tailor the deliveryof vaccines to their movements.
We have seen vaccine deliverypoints being built around water
(20:43):
holes and things like that.
Once you have a propermicro planning in place, if
there is a crisis, you canimmediately leverage that to
respond to the crisis, right?
So again, here, I thinkthe long term needs and
the short term needs align.
If we manage to sell some shortterm goals, and we try and
achieve these short term goalsthe right way, then this right
(21:06):
way of working is going to beextremely useful when we respond
to emergencies in the future.
Qali Id (21:11):
What would you like to see at UNICEF?
Vincent Petit (21:14):
I think I'd like to see UNICEF make
the people-centred way ofworking its default way of
working across all systemstrengthening efforts, I
would say, instead of having aprojectized or issue specific
way of dealing with a problem.
I wish we as organizations andthe governments we work with
(21:37):
could invest in creating thefoundation for preventing these
issues in the first place.
Qali Id (21:46):
That's our show.
Thank you so much toVincent Petit for joining
us and sharing his wisdomon system strengthening.
You can read more aboutstockpiling trust in
UNICEF's upcoming magazine.
I've gotten a sneak previewof it and it is such a
colorful compendium ofsocial and behaviour change
at UNICEF and beyond.
Whether you're a seasoned pro ornew to these approaches, there's
(22:07):
something in it for everyone.
As always, those details willbe in the show notes along with
other research and resourcesmentioned in the episode.
If you're craving more on systemstrengthening, you can check
out UNICEF's tool on systemstrengthening in their online
programme guidance, which hastons of other quick guides
to SBC tools and approaches.
(22:28):
Stay tuned for moreepisodes this Fall.
A colleague of mine, Karen, has this
restaurant analogy (00:04):
if customers don't go in a restaurant, you
don't blame the customers.
You try and think aboutwhat's wrong with the
restaurant itself, right?
During the pandemic, when wehad issues with COVID vaccine
uptake, colleagues were askingus to build demand and to
fight this vaccine hesitancy.
(00:25):
But in reality, what makes themajority of reasons for not
being vaccinated, wherever westudy, is supply side barriers.
It's like the health centerbeing too far, opening
hours being inappropriate,profile of the health workers
being inappropriate, costof going there and getting
the vaccine being too high.
(00:45):
Participation must becomethe new normal, if you
want the system to operatein a different way.
Qali Id (01:01):
Hello and welcome back to the ABCs of SBC,
your podcast on social andbehaviour change or SBC.
If you've followed the journeythis far, you will have heard me
speak to experts about what SBCis, what it looks like at UNICEF
and beyond, and specificallywhat it can and can't do for
communities who are facing theworld's most complex challenges.
(01:22):
In this episode,we'll be talking about
system strengthening.
You may have heard thisterm tossed around in past
episodes, but now we're doinga deep dive into what it
means and what it has to dowith improving outcomes and
responding to challenges thatmay arise in the future, such
as climate catastrophe, diseaseoutbreaks, political turmoil,
(01:42):
economic challenges, and more.
Let's go to Vincent Petit,who has spent the last 12
years working in social andbehaviour change at UNICEF,
starting back when it wasstill known as Communications
for Development, or C4D, andhas overseen and played a
big role in the shift to SBC.
We're going to startoff with the basics.
(02:03):
What do we mean when wesay system strengthening?
What are these systems?
Vincent Petit (02:08):
So when you look at the system, it has
a few pillars, traditionallylike policy, governance,
planning, financing, andthen more public-facing ones
like the workforce or thecommodities or the services.
So typically, if you areable to send your daughter to
school, it's because there'sa system behind it, right?
(02:29):
There are trained teachers.
You have approved curricula, youhave a national administrative
and, uh, supervisory backbone,you have funding allocations,
buildings, and so on.
Similarly, if you live ina rural area in Congo or in
Bangladesh or Canada or Romaniaor wherever, and if you can get
a tetanus or diphtheria shot,it's because there are vaccine
(02:53):
manufacturers, there are boatsand planes and warehouses and
a cold chain system and somepeople overseeing dispatch
and you have health centersand fridges and doctors,
nurses and records and so on.
These are systems bydefinition, sectoral ones.
Yes, they are upstream, but theygo from upstream to downstream.
(03:15):
And at the end of the day,they define the conditions
in which we behave inquite an extensive way.
What people call systemstrengthening is basically
building the capacity of thesedifferent pillars so that these
systems can perform better.
And performing better in thatsense means developing better
(03:37):
policies, delivering serviceswith a higher rate of uptake,
delivering commodities and goodsthat are more adapted to the
needs of the people and so on.
So I guess at a basiclevel, that's what I think
system strengthening is.
Qali Id (03:50):
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 playa crucial role in the system
they support, but why does thisall matter when we talk about
social and behaviour change?
Vincent Petit (04:10):
The reason SBC is critical is because these
systems interact with peopledirectly at the downstream
level, even if they areconceived at the upstream level.
They exist to serve people.
One could say thatthey're only as good as
their ability to do that.
They depend on people's use, onpeople's satisfaction, or even
people compliance sometimes.
(04:31):
I mean, all of thatis SBC business.
So that's why SBC as afunction is critical to
strengthen public systems.
Qali Id (04:37):
We've talked a lot in the series about how SBC
focuses on people understandingtheir context, culture,
history, and working withthem and letting them lead.
So for any system designedto serve people to not
involve these principlesseems quite wrong.
Is there a barrierto bringing SBC into
strengthening our systems?
Vincent Petit (04:58):
It's kind of the technocratic worldview
of many decision makers.
The idea that expertsknow better, right?
Experts design in theircorner, in their offices, and
they roll out to the masses.
And I've worked with a lotof doctors and technical
professionals in ministriesof health, for example, and
those who truly believe thatcommunities have valuable
(05:20):
contributions to offer inimproving the way the health
system operates are very few.
But the people we're tryingto serve, they have an
expertise, which is theexpertise of their daily lives
of their daily realities.
And this is kindof irreplaceable.
And the further you are fromthem, the harder it is to, you
(05:40):
know, think on their behalf.
It's the decision makersability to recognise that
they don't necessarily knowbetter, regardless of their,
you know, privileged educationor their graduate degrees.
It's a tricky thing to navigate.
I think we need to socializeexamples of success and
convince these decision makersthat there is something in
it for them, you know, ifthey change the way they work
(06:02):
traditionally, which is noteasy because it can feel like
a hassle to work with people.
You know, it takes longer.
It requires considering otheroptions and different views.
But at the end of the day, itshould affect the results and
make them look good, right?
Qali Id (06:20):
Well, I'm not sure.
You tell me.
Is there an example thatcomes to mind when you
think about successfullystrengthening systems with SBC?
Vincent Petit (06:30):
Recently, I was discussing with the, our team
in the Latin America office,and they were explaining how in
Bolivia, our SBC colleagues andthe national partners had kind
of developed their own take onHCD on human-centred design,
which is traditionally rootedin Northern perspective, right
(06:50):
in Western perspective, butthey adapted the methodology
with indigenous populationto incorporate elements that
were central to the Quechuaand Guarani communities and
cultures they were working with.
And they made a larger space forconsidering their cosmovision
in relation to the task athand, which was to improve
(07:11):
immunisation service delivery.
So, you know, they were managedto stick to the principle of
collaborating with the peopleto design a service better.
And yet make it relevant to thepeople they were working with.
So I don't thinkcontext is an issue.
At the end of the day, I thinkadapting our interventions
to a local context is easy.
It's not a problem.
(07:31):
But again, it's the wholeculture of experts versus
beneficiaries that is themain barrier in my opinion.
Qali Id (07:38):
So what is at risk here?
Beyond creating systems thatare not conceived with the ideas
and values of real people andcommunities, which is already
major when you think aboutthe big systems you mentioned,
like education and vaccination.
If these systems don'taccount for us, what
do you see happening?
Vincent Petit (07:56):
Systems are a key determinant in social trust.
I think trust iseverything in what we do.
It's kind of the conditionfor any collective action.
To do something together, peopleneed to trust each other, right?
We had that intuitiveunderstanding for a long time,
but now there is pretty harddata to show how dramatic
the influence of trust is oneverything we do in cooperation
(08:20):
and humanitarian action.
There's a study that waspublished in the Lancet
during the COVID pandemicin 2022, where they analysed
the contextual factorsof transmission in almost
180 countries, I believe.
And they looked at one or twoyears of data from all over
the world and their conclusionwas that the countries that
(08:42):
curbed the pandemic the bestweren't really those with
the strongest health systems.
They were those with thehigher level of trust.
None of the, what we call,"health security capacity
indices", which is like measuresof how strong the health system
is and how prepared it is - noneof these were meaningfully
associated with infection rates.
(09:03):
It's the measure of trust in thegovernment, so vertical trust,
but also trust interpersonally,so horizontal trust, and both
of these had very statisticallysignificant association with the
spread of the virus and with theuptake of the vaccine as well.
So less trust, moredeath in a nutshell.
And I was shocked when I sawthis study because it was
(09:28):
the first time I was seeinga quantitative confirmation
of something that I hadbelieved for a long time.
And I think this shedsa quite a different
light on the importanceof system strengthening
for crisis preparedness.
And you'll hear a lotof my colleagues talking
about that, and rightly so.
But what they mean by thatis usually stockpiling
(09:49):
masks and stockpilingvaccines and aquatabs
and so on and Plumpy'nut.
We never talk aboutstockpiling trust.
And at the end of theday, it's social cohesion
that we're talking about.
And that is important toadapt to the crisis to come.
Qali Id (10:04):
That COVID example is really striking, and you
mentioned having this inklingabout trust even before
this research confirmed it.
I'm curious to hear where elseyou've seen this in your work.
Vincent Petit (10:16):
I'm gonna try and give you a concrete
example, which is one Iexplained in an article in
a magazine that we are aboutto release fairly soon.
I was in Basra, inIraq, last year in the
southeastern part of Iraq.
Basra used to be an areacalled the Venice of the
(10:37):
East because of its canals.
And nowadays it's an areathat's already devastated
by the climate crisis.
It's one of these placeswhere we're not talking
about future impacts.
We're talking about alreadynavigating through a daily
reality that temperaturesare through the roof.
Water scarcity is tremendous.
(11:00):
You can literally seepastoralist communities
being displaced from themarshlands on a real time
basis because of that.
It is a very shockingcontext for climate.
And so I was there workingwith the UNICEF colleagues
from the field officeon water conservation.
One of their programmeswas to organize meetings in
(11:25):
local communities and localneighborhoods of the cities.
They had very skilledlocal facilitators that,
honestly, I have a lot ofrespect for these people.
They were doing an amazingjob and they were asking the
participants, you know, whatcan you do at your level to
help conserve water giventhe dire situation that
we're in, and given that theprospect is not so great.
And people immediatelyresponded that they wouldn't do
(11:48):
anything until the governmentwould do its share, which
was basically fixing pipesand 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 itthat you can do at your level
(12:12):
to conserve water and contributeto reducing the problem?
The response was the same.
The response was nothing becausethe government is not playing
ball, so we're not doing it.
And it was just a clear exampleof people who had enough.
I think the socialcontract was broken.
Basra is also an area whereoil production is enormous.
(12:36):
We're talking millionsof barrels a day.
I assume people understandwhat that means financially.
So not seeing a local governmenttaking care of basic services.
Yeah, trust was broken.
That's why you need abasic level of trust,
mutual understanding andcollaboration to be able to
(12:57):
face the crises, includingclimate, that are to come.
Qali Id (13:02):
So if I'm following correctly, that social
contract starts withmaking sure our systems are
designed for the people,with the people, and remain
accountable to the people.
Try saying thatthree times fast.
That is what builds trustbetween people and institutions.
So where do we begin using SBCto strengthen these systems?
Vincent Petit (13:23):
The first objective, I guess, is to
define our ability to go throughdifficult times and to maintain
the level of social cohesionthat will help us work hand
in hand and make it throughthe crises that are coming.
And unfortunately, thereare a lot of them coming up.
So all of the system pillarsthat are, you know, policy,
(13:45):
governance, workforce,and services, and so on,
they can all be reshapedto be more people centred.
We have built a lot ofcommunity feedback and social
accountability mechanismsto improve the governance.
We are pushing for HCD,Human-centred Design, to
help craft better servicesand overall user-focused
(14:07):
products development.
Recently, my team was involvedin redesigning wash dignity
kits, like these kits thatwe give in humanitarian
situations to help familiesmaintain good hygiene so that
they better match their needs.
So that's what people-centredsystems look like.
The trick, I guess, is toconstitute system strengthening,
(14:30):
these tactics or theseprogrammatic approaches should
not be run as projects, butreally institutionalised
in the day to day.
So if you do an HCD workshop, itcan support what you're doing.
It could be a good thing,but an HCD workshop is not a
default way of working, right?
(14:51):
It needs to be broughtinto the core processes
of the institution.
Similarly, if you do a civilsociety consultation, it's a
good thing, but it's not enough.
Participation must becomethe new normal if you
want the system to operatein a different way.
If we increase this partnershipbetween the right holders
(15:12):
and the duty bearers, if wemanage to bring together the
communities we're supposedto serve with those who have
the power, the decision andthe financial power to change
something, we're going toincrease the perception of
inclusiveness, of equity,of active partnership.
And at the end of theday, we're going to
(15:32):
improve the relationshipwith the population.
This is key toincrease the trust.
So what is getting in theway of institutionalizing
SBC to strengthen systems?
I know you mentionedthis culture of
experts knowing better.
But is that all?
I think it is prettytricky to get support
(15:53):
for system strengtheningbecause it is long term.
Trust is easily broken,but it takes time to
earn and to earn back.
That doesn't make people-centredsystem strengthening very
bankable from that perspective.
If we are to sell the immediateresults for uptake of vaccines
(16:14):
or number of girls registeredin schools, that could
increase because we work moreclosely with communities.
I guess that that's a way ofdoing it, but the long term
perspective is difficultto fund because everything
that takes time doesn'tmatch the pace of political
agendas, it doesn't match thepace of development funding
(16:34):
and are very programmaticcycles in our organizations.
You know, everythingis so short term.
So every time you talk aboutmulti-year processes and the
perspective of having resultsthat are not immediate,
uh, not even guaranteedat times, it's extremely
difficult to get funding.
But once we integrate thesepeople-centred approaches
(16:55):
into systems, then ithappens on a routine basis.
You don't necessarilyneed to fund it anymore.
And it also serves theemergency response.
So balancing is difficult,mostly because we're
lacking resources.
And when we're lackingresources, we're focusing
on responding and not onpreventing and not on preparing.
Similarly with the expert-basedculture that I mentioned
(17:17):
before, we live in a worlddominated by a supply culture.
I think supply versus demandis, it's something very
widespread in UNICEF andtypically my SBC colleagues
are asked to build demand.
That's the standard ask thatwe receive from anyone who is
willing to collaborate with us.
Supply versus demand is avalid economic principle
(17:39):
when it comes to markets,but it's a pretty bad
framework for public sectors.
And I actually think it goesagainst system thinking.
The immunisation example isonce again the most striking one
because during the pandemic whenwe had issues with COVID vaccine
uptake, what was in everymouth was vaccine hesitancy.
Colleagues were asking usto build demand and to fight
(18:01):
this vaccine hesitancy.
But in reality, what makes themajority of reasons for not
being vaccinated, wherever westudy, is supply side barriers.
It's like the health centerbeing too far, opening
hours being inappropriate,profile of the health workers
being inappropriate, costof going there and getting
the vaccine being too high.
(18:23):
And yet we are asked to createdemand when demand is first
and foremost, created withinsupply when you design this
supply, and it's that sameculture that underpins and
generates the idea that SBCis about communication, right?
It's about selling somethingto people after the fact,
rather than working with them.
Qali Id (18:43):
I'm sure there'll be people listening to this who
still won't be sold on whythere needs to be investment
in SBC for our systems, for allof the reasons you described.
What would you tell them?
Vincent Petit (18:55):
A colleague of mine, Karen, has this restaurant
analogy, which is if customersdon't go in a restaurant, you
don't blame the customers.
You try and think aboutwhat's wrong with the
restaurant itself.
And so, you know, SBC couldbring supply and demand together
in a real systems approachand recreate the link between
(19:15):
Public services, policies andthe people they're trying to
serve when we build consultationprocesses, when we build
platforms to engage with localleaders, with religious leaders,
when we build partnerships withwomen-based organizations for
the purpose of development work.
All of these assets can beeasily repurposed when the
(19:37):
crisis hit, and they are.
We've done that, uh, includingwith social listening
mechanisms in the past.
And we've seen thatwith some long-existing,
people-centred, systemicapproaches I mentioned earlier.
You know, micro planning hasbeen a long proven effective
strategy where in healthdistricts, you have staff who
(19:59):
rally a few local influencers,community members, village
chiefs, and they work togetherto map out where people are and
what has changed since the lastimmunisation campaign and where
our service is not availableor where are the people that,
you know, didn't get coveredlast time and they try and
(20:20):
reconcile admin data withthe, the experience of these
communities and of these people.
It's a very lowtech intervention.
It's been all around theworld for a very long time.
Um, classic example is withpastoralist communities.
This helps tailor the deliveryof vaccines to their movements.
We have seen vaccine deliverypoints being built around water
(20:43):
holes and things like that.
Once you have a propermicro planning in place, if
there is a crisis, you canimmediately leverage that to
respond to the crisis, right?
So again, here, I thinkthe long term needs and
the short term needs align.
If we manage to sell some shortterm goals, and we try and
achieve these short term goalsthe right way, then this right
(21:06):
way of working is going to beextremely useful when we respond
to emergencies in the future.
Qali Id (21:11):
What would you like to see at UNICEF?
Vincent Petit (21:14):
I think I'd like to see UNICEF make
the people-centred way ofworking its default way of
working across all systemstrengthening efforts, I
would say, instead of having aprojectized or issue specific
way of dealing with a problem.
I wish we as organizations andthe governments we work with
(21:37):
could invest in creating thefoundation for preventing these
issues in the first place.
Qali Id (21:46):
That's our show.
Thank you so much toVincent Petit for joining
us and sharing his wisdomon system strengthening.
You can read more aboutstockpiling trust in
UNICEF's upcoming magazine.
I've gotten a sneak previewof it and it is such a
colorful compendium ofsocial and behaviour change
at UNICEF and beyond.
Whether you're a seasoned pro ornew to these approaches, there's
(22:07):
something in it for everyone.
As always, those details willbe in the show notes along with
other research and resourcesmentioned in the episode.
If you're craving more on systemstrengthening, you can check
out UNICEF's tool on systemstrengthening in their online
programme guidance, which hastons of other quick guides
to SBC tools and approaches.
(22:28):
Stay tuned for moreepisodes this Fall.
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