Transforming approaches to public health challenges in Africa, the project Mainstreaming Behavioural Insights into Public Health in the African Region has marked a milestone in integrating behavioural sciences into health systems. Spearheaded by the WHO Behavioural Insights (BI) Unit at headquarters, alongside the Health Promotion and Social Determinants of Health Unit at the WHO Regional Office for Africa and several country offices, this initiative has empowered four pilot countries – Burkina Faso, Namibia, Tanzania and Zambia – to adopt innovative strategies that bridge the gap between human behaviours and health outcomes.
The adoption of behavioural insights into public health is key to understanding the factors that influence human decision-making and behaviours. These insights can, in turn, inform the design of targeted interventions, policies and strategies to overcome barriers to healthy behaviours.
Project overview
Funded by the Rockefeller Foundation, the project ran from January 2023 to December 2024. It aimed to integrate behavioural science into health and enhance collaboration between the public health and academic institutions for the adoption behavioural evidence-informed policies and practices.
Elena Altieri, Unit Head of the Behavioural Insights Unit at WHO HQ, highlighted the necessity of the project, noting:
"Over the past decade, we've seen a growing interest in integrating behavioural sciences into public health among governments and institutions. However, the COVID-19 pandemic highlighted significant practical and technical challenges in adopting these approaches. We face limitations in capacity, funding and time, and there's also a lack of confidence among policymakers about the impact, sustainability and replicability of behavioural interventions. This project was designed to tackle these issues by offering robust, evidence-based strategies to practitioners to test and develop people-centred policies and interventions."
Key achievements
- Academic integration: Universities in Burkina Faso, Namibia and Zambia launched behavioural science for public health courses as part of health promotion courses, with Namibia initiating a postgraduate diploma. The University of Pretoria integrated behavioural science capacity building and evidence-generation into its terms of reference as a WHO Collaborating Centre.
- Institutional capacity building: Ministries of health in all participating countries received support to pilot test behavioural approaches and considerations into selected initiatives, strategies and work plans.
- Health information systems innovation: Zambia's Ministry of Health piloted behavioural insights and data collection within its routine antenatal care data collection system.
The project achieved mainstreaming outcomes called for in the Behavioural sciences for better health resolution adopted by WHA76 in May 2023. Documented outcomes include strengthened cross-country networks, established behavioural insights pathways in academic institutions and health systems, and creation of new behavioural insights-based initiatives in the region.
Positive spillover effects
Doris Kirigia, Team Lead for Health Promotion and Social Determinants of Health Unit at the WHO Regional Office for Africa, reflected on the project:
"The connections we've created between universities, ministries of health, WHO country offices, the Regional Office for Africa, and headquarters are already bearing fruit and will be highly beneficial moving forward. There's growing interest in behavioural science in the region, and as an organization, we'll focus on supporting other countries in establishing behavioural insights functions, providing technical support to initiate projects, and leveraging our pool of experts and trainers at the country level to sustain capacity-building efforts."
The project integrated behavioural insights into strategic plans, guidance, and new initiatives, including the Strengthening community protection and resilience: regional strategy for community engagement, 2023–2030 . Several countries are using behavioural evidence to inform their risk communication and community engagement strategies in response to outbreaks. Countries like Mauritius have incorporated behavioural interventions into health promotion activities to reduce noncommunicable disease risk factors. Burkina Faso, Tanzania and Zambia use behavioural insights to promote people-centred sexual and reproductive health. New research projects include promoting healthy eating in Zambian schools, understanding the use of harmful skin lightening product in Gabon, and increasing uptake in parenting programmes in Tanzania.
Reflections: strategies for success and pitfalls to avoid
The project highlighted strategies for success and pitfalls to avoid when integrating behavioural sciences perspectives into public health.
- foster active collaboration between universities and ministries through the delivery of joint projects and training programmes to help discover synergies and facilitate the exchange of ideas;
- encourage cross-country collaboration to support knowledge exchange and document lessons learned;
- prioritize capacity building through diverse training approaches such as national and sub-national face to face trainings and online courses, to help mainstream behavioural sciences within universities and ministries of health;
- showcase examples of practical applications of behavioural insights, including success stories, real-world case studies and pilot projects to demonstrate the potential benefits of the approach and to enhance visibility and credibility of behavioural insights champions; and
- avoid overly ambitious timelines or overly complex pilots as rushing the process may compromise quality and lead to stakeholder disengagement and resistance.
WHO calls on countries to deepen their understanding of integrating behavioural science into public health strategies. By replicating successful approaches and sharing experiences, we can leverage behavioural insights for better public health outcomes.
