As social and behavior change practitioners, we’re in the business of helping people make healthier choices. We study the determinants of health, we craft messaging and we design interventions meant to nudge, inform or inspire. But lately, I’ve found myself wrestling with a persistent and uncomfortable question: Is this enough?
There are days, especially when working in complex environments like Ethiopia, where the challenges faced by communities feel insurmountable. It can feel superficial to ask someone to focus on a single health behavior when they are already navigating deep economic pressure, systemic obstacles and cultural expectations. I’ve found myself wondering: At what point does behavior change become inseparable from the systems that shape people’s lives?
A few weeks ago, a moment in Southern Ethiopia crystallized this for me. I was facilitating a leadership and SBC training for health system actors from different zonal and district administrations. I’d been struggling with the gap between the language we often use – scale, impact, transformation – and the reality people were living every day.
During a reflection session, one of the participants looked up and said, “The training came at a time that I had almost given up, but having these discussions openly gave me the energy boost to continue doing what I do.”
His words stopped me. I’d assumed I was the one carrying the weight of the system. Instead, I realized everyone in that room was carrying it. We weren’t looking for easy answers. We were looking for enough hope to keep going.
That changed the way I thought about my role. Maybe my job isn’t to fix the entire system. Maybe it’s to create the conditions for small wins that help people keep showing up.
Over the years, whether I’ve worked in maternal health, malaria, nutrition, youth empowerment or leadership development, I have come to a singular, humbling realization: we organize development around sectors, but people organize their lives around, well, life.
A pregnant woman isn’t thinking about maternal nutrition as one piece of her day. She is thinking about feeding her family, getting to work, caring for her children, finding transportation and making ends meet. Health is woven into all of it.
Yet our programs often ask people to separate those realities into categories that make sense to us, not necessarily to them.
As I look ahead, I don’t pretend this is easy. Systems don’t change overnight.
But I keep coming back to that room in Southern Ethiopia.
The participant who thought he was alone was not alone.
Neither was I.
Maybe our job isn’t to fix the entire system by ourselves. Maybe it’s to better understand the realities people are already navigating and design with those realities in mind.
That’s a much smaller ambition. But after that conversation in Southern Ethiopia, I’m beginning to think it may also be the more important one.
Biruk Melaku Ayalew is CCP’s director of design and implementation in Ethiopia.
