The health system we don't budget for — and what the current Bundibugyo outbreak just proved
When an outbreak hits, health systems quickly discover that medicine, surveillance, and infrastructure are only part of the response. Whether people seek care, trust health services, report symptoms, follow guidance, or avoid treatment can determine whether an outbreak is contained or accelerates.
The current Bundibugyo outbreak has made that visible again.
During the response, evidence about trust, care-seeking, and people’s experiences of health services is being treated as outbreak intelligence, informing operational decisions around community surveillance and treatment cascades. But it took an international public health emergency to unlock the attention and resources needed to use that capability at scale.
When the emergency ends, much of that investment risks disappearing with it.
That points to a larger structural problem. Social and behaviour change (SBC) is essential to health outcomes, yet the capabilities behind it are often scattered across health promotion, community engagement, behavioural science, and service delivery rather than financed as a sustained health-system function. Governments can therefore struggle to define what the function actually comprises, calculate what it costs, measure its contribution, or finance it consistently.
Important pieces of the architecture are now emerging. UNICEF has developed guidance and supported national partners across regions. Africa CDC and partners including JSI are working with governments to define, cost, and track SBC as a health-system function. WHO has developed an institutional framework and indicators for mainstreaming behavioural sciences.
The question is how to get from frameworks to budgets.
What would it take for governments to cost this capability, build it into public financing processes, and sustain it between emergencies? How should domestic and international financing work together without recreating the fragmented, project-based approaches the sector is trying to move beyond? And how do we make the economic case for investing before the next crisis rather than paying considerably more once it arrives?
With pandemic prevention, preparedness, and response high on the UNGA agenda, this is a timely opportunity to make the case that preparedness is not only about what health systems have. It is also about whether they understand how people behave, why they make the choices they do, and how that evidence informs action.
What to expect
A lively working conversation bringing together public health institutions, government representatives, behavioural science expertise, and funders to tackle the practical financing question behind SBC institutionalization.
Rather than stopping at the case for investment, participants will examine what governments and their partners actually need: a clearer definition of the function, credible costing, meaningful indicators, links between spending and outcomes, and financing models that can survive beyond individual projects and emergencies.
The session will work toward a short set of practical asks for governments, funders, and multilateral institutions that participants can carry into wider pandemic preparedness and health financing conversations during UNGA.
Who this is for
This session is for government and Ministry of Finance representatives, global health funders, public health leaders, behavioural science and SBC practitioners, multilaterals, researchers, and others working on pandemic preparedness, health-system strengthening, and sustainable health financing.
What you will get out of it
A clearer case for treating social and behaviour change as a core health-system function
Lessons from the current Bundibugyo response about the cost of waiting for a crisis to invest
A practical look at what it takes to define, cost, measure, and finance SBC
Shared language for making the case to governments, funders, and multilateral institutions
A short set of asks participants can carry into wider UNGA discussions on pandemic preparedness and financing
Hosted by
Africa CDC
UNICEF
WHO Behavioural Sciences TAG
JSI