A Behavioural Playbook for Public Health Responses: Learning from the MENA Experience, Preparing for the Future

"With unprecedented levels of funding for SBC, the COVID-19 pandemic enabled expansive implementation and rapid accumulation of experience, which has since been the subject of a great deal of reflection and evaluation."

This playbook focuses on social and behaviour change (SBC) solutions to public health crises, drawing upon promising SBC initiatives that were deployed during the COVID-19 pandemic within the Middle East and North Africa (MENA) region. Initiated by the United Nations Children's Fund (UNICEF)'s Regional Office for Middle East and North Africa with support from The Behavioural Insights Team (BIT), UNICEF country offices, and a range of experts, the playbook is designed to be a resource for practitioners within UNICEF and beyond. It distills lessons learned from the MENA region to shape more effective strategies for future responses to epidemics, pandemics, and other types of health crises. 

As explained in the playbook, "One of the unique features of the MENA region is the co-existence of low-, middle- and high-income countries, as well as fragile and conflict-affected states and sub-regions. While much of the experience and response to COVID-19 was common across the region, some distinctions were evident across these categories of countries, such as varying trust in government institutions, ability to swiftly mobilise resources and reach communities."

The playbook is structured along four general phases of response to a public health crisis:
 

1. Emergence of the Virus - This phase involves an immediate response to contain infections and provide immediate guidance and reassurance to the public.
2. Continuous Adaptation - This phase involves the continuous adaptation of response measures to control infections and address prolonged impacts of disruption.
3. Vaccine Rollout - This phase involves the distribution and roll out of vaccines, as they became available in different countries at different times.
4. Recovery and Integration - This phase is characterised by a slowdown of infections, with increasing focus on integrating the response into routine health services.

Within each phase, the playbook seeks to learn from the past by revisiting the progression of the COVID-19 pandemic within the region, highlighting common response measures as well as differing timeframes across countries. It then explores the relevant pain points emerging from MENA, with an emphasis on the distinct behavioural challenges faced by individuals, communities, and systems at each phase of the pandemic. Finally, each chapter explores behavioural solutions to the different pain points, supported by case studies (see list below) in order to offer guidance for the future. 

Two cross-cutting themes are also addressed that span across the response phases:
 

• Social and Behavioural Data - Pain points here include the availability of and access to timely and accurate information to better understand public attitudes, beliefs, or perceptions and to develop effective interventions. Solutions highlighted include mechanisms or systems set up to better understand pain points for specific populations or communities, such as social listening and surveys.
• Economic and Social Support - Pain points here include factors impacting broader wellbeing, such as poverty and unemployment, inequality, gender, education, stability, and security. Solutions include interventions or programmes that provide social and economic assistance - for example, unemployment benefits, mental health services, and digital learning programmes.

The playbook includes 12 UNICEF case studies from across MENA that highlight the solutions outlined in each chapter. These case studies are drawn from the COVID-19 pandemic response or routine immunisation efforts and provide more detailed context, implementation details, and impact of selected SBC solutions. They are:
 

• Qatar: Health guidelines in migrant languages
• Libya: Trusted public health messengers
• Lebanon: Behaviourally-informed pamphlets
• Yemen: Faith-based engagement
• Syria: Demand generation for teachers and healthcare workers
• Yemen: Comprehensive vaccine uptake strategy
• Iraq: COVID-19 integration and bundling with routine immunisation
• Jordan: Phone survey for missed appointments
• Sudan: Social listening for gender equity
• Oman: Campaign for positive parenting