Systems-Level SBC: Behavioral Levers Across Health, Finance & Workforce

What if the biggest reason outcomes-based financing doesn't deliver outcomes has nothing to do with funding levels, architecture, or reporting, but everything to do with what people actually do? What if the 15% of health budgets that go unspent each year isn't a budgeting failure at all, but a behavioral one? What if catalytic grants stall not because governments lack capacity, but because incentives, trust, and norms don't align with how decisions really get made? This 10-minute story flips the script on a core assumption driving global financing reform: that outcomes can be purchased. In reality, systems only mobilize when people mobilize. And resilience is built through behavior, not budgets. This is exactly where SBC practitioners come in. As financing shifts from aid to investment, from activity to accountability, and from parallel systems to country ownership, our field has a powerful and largely untapped role. SBC brings the science of human behavior, communication, identity, and social norms that can make financing mechanisms work as intended. We can help governments, funders, and implementers design reforms around the behaviors that will make or break success. Using examples from JSI's behavioral design work, I will show how identifying the system behaviors that truly drive outcomes can sharpen strategies and expose what financing reforms must unlock to succeed. If the development sector wants to realize new financing models that actually deliver outcomes, we need to start designing for the behaviors that make resilient systems possible.

Social and Behavior Change (SBC) is often framed and resourced around public health outcomes. This talk flips that script by presenting a practical SBC approach as applied in the Community Service as a Pathway to Work (CSPW) project that uses structured community service, participatory reflection, and youth leadership to shift mindsets, social norms, and perceived agency to support young people intentionally moving toward dignified work. Traditionally, community service has been viewed as voluntary civic engagement, but CSPW transforms it into a platform for self-expression, leadership, and mindset change. CSPW combines repeated hands-on tasks, short-term responsibilities with visible social value, peer-led reflection sessions, and simple work-oriented exercises. Together these activities target the core drivers of intention and behavior identified by the Theory of Planned Behavior: attitudes (valuing work and effort), subjective norms (community and peer expectations about youth work), and perceived behavioral control (concrete skills and a sense of "I can do this"). Rooted in local narratives and lived realities, the project creates spaces that elevate and celebrate young people's capabilities and contributions in addressing local challenges faced by communities. Anecdotal evidence from monitoring data indicate gains in work-readiness, stronger career intentions, and easier transitions to employment or entrepreneurship. The talk is an urgent call to the donor community, SBC practitioners, and youth programmers to reimagine SBC as a cross-sectoral, culturally rooted tool for youth development.

Vaccine hesitancy, or delaying or refusing recommended vaccines, significantly contributes to gaps in global childhood vaccine coverage. Pediatric providers are trusted sources who can positively influence vaccine uptake, yet many report lacking confidence in communicating about immunizations effectively with families. To address this gap, the American Academy of Pediatrics partnered with the Albanian Pediatric Society, Japan Pediatric Society, and Philippine Pediatric Society to co-create tailored, simulation-based communication curricula for pediatric vaccinators. Unlike traditional trainings that focus primarily on vaccine information, these curricula emphasize building confidence, relational engagement, and practical communication skills. The curricula incorporate evidence-based strategies, including presumptive communication and motivational interviewing techniques, and employ pre-recorded video simulations facilitated in small groups by local experts. Participants practice responding to realistic vaccine hesitancy scenarios and engage in debriefing and discussion to reinforce learning. Close collaboration with national pediatric societies ensured the trainings were contextually relevant, culturally appropriate, and aligned with local health systems. Over 330 vaccinators in Albania, Japan, and the Philippines have participated to date. Participants reported greater confidence, more positive interactions with families, and improved ability to navigate difficult conversations. This model demonstrates that communication skill-building, supported by local professional leadership, is essential to improving immunization delivery. It offers a roadmap for other countries to strengthen vaccine uptake, enhance patient experiences, and integrate context-driven, practice-based communication training into routine care.