Behavioral Communication Strategies for Global Epidemics (BCSGE)

This model for disease outbreak, public health education, and humanitarian response provides professionals with an opportunity to develop competencies, including systems thinking, behaviour change, and human-centred design and equips them with tools to develop more novel approaches to SBCC.

The course was launched in response to the Ebola virus disease outbreak in 2014, and, since its launch, has been offered in New York, United States, or US (2015 and 2016), Ghana (2017), Nepal (2018), and Beirut, Lebanon (2019). Each iteration of the course brings new groups of participants together to tackle new challenges. The course engages participants through a curriculum with online and live (in-person) sessions. Systems thinking, mixing of professionals and students, "avatars" or role-playing, and real-life, context-specific challenges make up the core components of the course. Specifically:

• The first phase of the course occurs online. It covers topics such as systems thinking, epidemiology, risk perception, community and culture, theories of behaviour change, disaster preparedness, and communication approaches. During this time, participants are asked to complete assignments such as building systems maps, creating and analysing epi curves, and assessing the availability, affordability, approachability, appropriateness, and acceptability of an intervention.
• During the live portion of the course, professional staff and students are placed on teams to develop strategies to address public health challenges. These interdisciplinary teams allow for each strategy to be addressed from multiple perspectives and respond to the systems-level problems that lead to the spread of disease, such as violence, political turmoil, or lack of basic infrastructure. Once assigned to teams, every member of the team is assigned a role (epidemiologist, anthropologist, environmental scientist, data specialist, external communications specialist, SBCC specialist, etc.) that diverges from his or her area of expertise. Participants are encouraged to address their challenge through this lens to provide them with new ways of thinking about these complex problems. Specifically, each team is tasked with drawing systems maps to demonstrate the complexity of their issue and to allow them to prioritise areas for intervention and plan for possible unintended consequences. During each day of the course, participants have the opportunity to interact with lecturers and guest speakers.
• Each year, instructors design an outbreak simulation in which students are challenged to brief key players in the government, the World Health Organization (WHO), and the media on their response. During the 2019 iteration of the course, participants traveled to informal settlements in the Baalbek governorate in Lebanon to assess the living situation of refugees from Syria and to listen to their stories. On returning to the course site, instructors notified participants of the simulation: a suspected case of cholera in the informal settlements they had just visited. Participants then had 3 hours to devise a comprehensive and cohesive briefing on cholera. Exercises such as these are meant to challenge participants on how they think about emergency response and the necessity for collaboration between sectors and a systems-level approach.
• By the culmination of the course each year, staff, alongside students, develop tangible and implementable strategies to bring back to UNICEF country and regional offices. In 2019, the field challenges included chikungunya in Sudan, monkeypox in Nigeria, Ebola in the Democratic Republic of Congo, and destroyed health systems in Iraq, Syria, and Yemen. Teams were required to demonstrate the value of their proposal, how it met the need of the local community, and how it would change behaviour.

To date, 35 strategies for 23 countries have been created. These strategies are designed to be of little cost to UNICEF country offices while tackling the systems-level barriers to behaviour change that can make programme implementation so challenging. Some of these strategies implemented at the country office level have included a polio eradication programme, a cholera outbreak response strategy, and a field epidemiology training programme. Staff also said they adapted the strategies they designed during the course to other situations and employed systems thinking during critical moments such as disease outbreaks and natural disasters. One respondent reported that during a pertussis outbreak, they used systems thinking to bring together various experts to perform roles from clinical care to risk communication. Another participant noted they adapted systems thinking to design programmes to end child marriage in their country.

Health, Emergencies

As of April 2020, staff from UNICEF country offices from over 50 countries had attended the BCSGE course. In a programme evaluation of the course, it was reported that participants gained competencies in professional development such as negotiation, multitasking, and communication in addition to technical skills such as systems thinking, bottleneck analysis, and epidemiology. These findings indicate the course's capability to ready participants to work in real-life settings where collaboration with stakeholders is often the key to successful programme implementation.

The strategies implemented in country offices have also demonstrated impact, addressing challenges at the community and policy levels. A colleague from Yemen described how skills in building community ownership developed throughout the course assisted in the office's detection and prevention of a cholera outbreak. At the policy level, another colleague discussed how the same strategy designed to address cholera outbreaks in Yemen was adapted into UNICEF Liberia's country office emergency preparedness platform and the country's national emergency contingency plan.