Institutionalising Social and Behaviour Change Systems for Universal Health Coverage in Fragile and Humanitarian Settings: Evidence from the South Sudan Social and Behaviour Change Strategic Framework (2026–2030)
Abstract:
Social and Behaviour Change (SBC) is increasingly recognised as an important health systems function for strengthening Primary Health Care (PHC), health security, community resilience, and progress toward Universal Health Coverage (UHC), particularly in fragile and humanitarian settings. However, SBC implementation in many settings remains fragmented across disease-specific programmes, limiting coordination, institutional learning, sustainability, and national ownership. This study examines the South Sudan Social and Behaviour Change Strategic Framework (2026–2030) as a national health systems reform for institutionalising SBC. This study used a qualitative Health Policy and Systems Research approach, drawing on a documentary review and thematic analysis of national policies, strategic frameworks, programme documents, stakeholder consultation reports, international guidance, and peer-reviewed literature. The analysis identified governance and leadership; behavioural and social insights; community engagement and service experience; strategic communication and digital innovation; monitoring, evaluation, and adaptive learning; and sustainable financing and multisectoral coordination as interrelated institutional functions. Building on these findings, the study proposes the Integrated Social and Behaviour Change Systems Institutionalisation Framework (ISBCS-IF), illustrating how institutionalised SBC can strengthen health system performance, service utilisation, community trust, emergency preparedness, and progress toward UHC. South Sudan’s experience provides an adaptable systems model for governments and development partners seeking to institutionalise SBC within routine health systems in fragile and resource-constrained settings.References:
[1].
World Health Organization, United Nations
Children's Fund. Declaration of Astana. Global Conference on Primary Health
Care. Geneva: WHO; 2018.
[2].
United Nations. Transforming our world: the
2030 Agenda for Sustainable Development. New York: United Nations; 2015.
[3].
World Health Organization, United Nations
Children's Fund. Operational framework for primary health care: transforming
vision into action. Geneva: WHO; 2020.
[4].
World Health Organization. World health
statistics 2024. Geneva: WHO; 2024.
[5].
United Nations. Sustainable development goals
report 2024. New York: United Nations; 2024.
[6].
World Health Organization. Everybody's
business: strengthening health systems to improve health outcomes: WHO's
framework for action. Geneva: WHO; 2007.
[7].
World Health Organization. Behavioural and
social sciences for better health: WHO technical guidance. Geneva: WHO; 2023.
[8].
World Health Organization. Monitoring the
building blocks of health systems: a handbook of indicators and their
measurement strategies. Geneva: WHO; 2010.
[9].
World Health Organization, United Nations
Children's Fund. Primary health care measurement framework and indicators.
Geneva: WHO; 2022.
[10]. United Nations Children's Fund. Social and Behaviour Change Strategy
2022–2030. New York: UNICEF; 2022.
[11]. World Health Organization. Behavioural insights for better health.
Geneva: WHO; 2022.
[12]. United States Agency for International Development. Social and behavior
change evidence review. Washington (DC): USAID; 2022.
[13]. Michie S, van Stralen MM, West R. The Behaviour Change Wheel: a new
method for characterising and designing behaviour change interventions.
Implement Sci. 2011;6:42.
[14]. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to
designing interventions. London: Silverback Publishing; 2014.
[15]. Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.
[16]. Bronfenbrenner U. The ecology of human development. Cambridge (MA):
Harvard University Press; 1979.
[17]. World Health Organization. WHO guideline on health policy and system
support to optimize community health worker programmes. Geneva: WHO; 2018.
[18]. World Health Organization. Risk communication and community engagement
(RCCE) readiness and response to health emergencies. Geneva: WHO; 2021.
[19]. Africa Centres for Disease Control and Prevention. Risk Communication
and Community Engagement Framework for Public Health Emergencies. Addis Ababa:
Africa CDC; 2022.
[20]. Perry HB, Zulliger R, Rogers MM. Community health workers in low-,
middle-, and high-income countries. Annu Rev Public Health. 2014;35:399–421.
[21]. Kok MC, Dieleman M, Taegtmeyer M, et al. Which intervention design factors influence performance of community
health workers? Health Policy Plan. 2015;30(9):1207–1227.
[22]. Scott K, Beckham SW, Gross M, et al. What do we know about
community-based health worker programmes? BMJ Glob Health. 2018;3:e000768.
[23]. World Health Organization. Communicating risk in public health
emergencies. Geneva: WHO; 2018.
[24]. Gavi, the Vaccine Alliance. Demand Generation and Social and Behaviour
Change for Immunisation. Geneva: Gavi; 2023.
[25]. United Nations Children’s Fund. The State of the World’s Children 2023:
For Every Child, Vaccination. New York: UNICEF; 2023.
[26]. United Nations Children’s Fund. Programme Guidance for Social and
Behaviour Change in Humanitarian Action. New York: UNICEF; 2023.
[27]. Ministry of Health, Republic of South Sudan. National Health Policy
2016–2026. Juba: Ministry of Health; 2016.
[28]. Ministry of Health, Republic of South Sudan. Health Sector Strategic
Plan II 2023–2027. Juba: Ministry of Health; 2023.
[29]. Ministry of Health, Republic of South Sudan. Revised Community Health
Strategy: Boma Health Initiative 2024–2028. Juba: Ministry of Health; 2024.
[30]. United Nations Office for the Coordination of Humanitarian Affairs.
South Sudan Humanitarian Needs and Response Plan 2025. New York: United
Nations; 2025.
[31]. World Bank. South Sudan Economic Monitor: Building Resilience in Fragile
Settings. Washington (DC): World Bank; 2024.
[32]. Ministry of Health, Republic of South Sudan. National Health Promotion
Strategy. Juba: Ministry of Health; 2022.
[33]. Ministry of Health, Republic of South Sudan. National Risk Communication
and Community Engagement Strategy. Juba: Ministry of Health; 2023.
[34]. Ministry of Health, Republic of South Sudan. Community-Based Networks
Integration Strategy under the Revised Boma Health Initiative 2024–2028. Juba:
Ministry of Health; 2025.
[35]. Ministry of Health, Republic of South Sudan. South Sudan Social and
Behaviour Change Strategic Framework 2026–2030. Juba: Ministry of Health; 2026.
[36]. Ministry of Health, Republic of South Sudan, United Nations Children's
Fund. South Sudan Social and Behaviour Change Operational Framework 2026–2030.
Juba: Ministry of Health and UNICEF; 2026.
[37]. World Health Organization. Global strategy on people-centred and
integrated health services. Geneva: WHO; 2016.
[38]. Sheikh K, Gilson L, Agyepong IA, et al. Building the field of Health
Policy and Systems Research. Health Res Policy Syst. 2011;9:19.
[39]. Gilson L. Health Policy and Systems Research: A Methodology Reader. Geneva: WHO; 2012.
