Executive summary
Behaviour change communication (BCC), often referred to as social and behaviour change communication (SBCC), is one of the most misunderstood tools in development practice, more often than not because its potential is often overestimated as a stand alone intervention. In Pakistan, it is routinely expected to deliver results that belong to service delivery, governance reform, or economic policy – and then blamed when those outcomes fail to materialise. The evidence from Pakistan and global research is more precise: well-designed communication can shift knowledge, norms, and intentions; it can increase uptake of services when those services are reliable; and it can protect gains by sustaining habits over time. But communication cannot substitute for availability of products and services, cannot out-message deep trust deficits, and cannot overcome structural constraints like poverty, insecurity, or weak state capacity on its own. This article offers a practical framework for setting realistic expectations, designing campaigns that respect local context and power dynamics, and measuring what matters – behaviour and outcomes, not vanity metrics.
1. Why BCC in Pakistan needs a reality check
Pakistan has no shortage of “campaigns.” Public service messages run on television, radio, and increasingly through social platforms and messaging apps. Donors and government departments commission creative work, influencer activations, and community mobilisation. Yet the public often experiences these efforts as noise – or worse, as propaganda – because they are frequently deployed without the enabling conditions that make behaviour change possible. Changing sentiments on its own is a fool’s errand when conditions remain the same. When the clinic has no stock, the school is unsafe, the electricity is unreliable, or the cost of living is rising faster than incomes, a message alone can feel tone-deaf. In that context, good communication is not about being louder; it is about being more honest, more specific, and more connected to practical pathways people can act on.
2. What BCC actually is (and what it is not)
BCC is the disciplined use of communication to change a specific behaviour in a specific audience under real-world constraints. It is not branding. It is not public relations. It is not “awareness” as an end in itself. The best BCC begins with a behavioural diagnosis: What is the exact action we want people to take? What prevents it – cost, convenience, fear, norms, misinformation, or low trust? What makes it easier – social approval, reminders, incentives, or better access? Only then does creative work matter.
3. What the evidence says BCC can do
Across many settings, mass media and multi-channel campaigns can produce measurable behaviour change – often small to moderate effects at the individual level, but meaningful at population scale when reach and frequency are high. But reach and frequency of messages is not just a function of talent in crafting the message, it is often one of budgets – campaigns get sanctioned without the budgets to reach critical mass leading to failure.
A major review of mass media health campaigns found positive changes across behaviours such as tobacco use, road safety, cancer screening, and child survival, especially when campaigns are well executed and sustained. In practice, this means three things: (1) frequency matters; (2) credible messengers matter; and (3) messages work best when they reduce friction – by pointing to a clear, doable action.
The strongest results emerge when communication is paired with an enabling environment: products, services, or policies that make the desired behaviour easier. In other words, communication often moves demand; systems must be ready to meet it. A systematic review for the Community Guide has shown that mass media campaigns combined with health-related product distribution can increase product use, illustrating how supply-side supports can amplify communication.
4. Pakistan lessons: where campaigns worked—and why
4.1 Handwashing: behaviour change is possible when you remove barriers
One of the clearest Pakistan examples comes from Karachi, where a cluster-randomised handwashing intervention combined promotion with soap provision. A follow-up evaluation found sustained improvements in handwashing indicators years after the intervention. The lesson is not that soap alone is magic or that messages alone are magic. The lesson is that when you design for the real constraint – availability and habit formation -you can sustain behaviour beyond the campaign window. In Pakistan’s WASH programming, this is the template: make the behaviour easy, normal, and locally rewarded.
4.2 Polio: communication cannot replace trust and safety
Polio illustrates both the importance and the limits of BCC. Pakistan’s eradication effort has faced barriers that are not primarily informational: insecurity, politicised narratives, community fatigue, and the viral spread of misinformation on social media and WhatsApp. A systematic review of Pakistan’s polio programme identifies multiple barriers and facilitators, including refusals and operational challenges. Research on polio misinformation shows how false rumours can rapidly shift attitudes and disrupt uptake. Communication can help – through trusted local influencers, religious engagement, and rapid response – but it cannot on its own fix the underlying trust deficit or the risk environment faced by frontline workers.
4.3 Lady Health Workers: interpersonal communication works when the system supports it
Pakistan’s Lady Health Worker (LHW) programme is a reminder that behaviour change is often interpersonal before it is mass mediated. LHWs are expected to counsel families on maternal and child health, nutrition, and preventive behaviours. Evaluations have highlighted how programme performance varies by context and depends on supervision, training quality, and system reliability. Studies of LHW training and curricula also identify gaps that matter for effective community engagement. In practice, when workers are poorly supported, the communication element collapses into box-ticking. When they are supported, their legitimacy and proximity to households can outperform any poster.
5. What BCC cannot do—and why campaigns often disappoint
A critical perspective begins with boundaries. Communication cannot: (a) substitute for broken service delivery; (b) overcome structural poverty on its own; (c) resolve political conflicts or legitimacy crises; or (d) outpace the economics of daily life. This is not cynicism; it is a design constraint. If a desired behaviour increases a household’s costs (time, money, risk, or social conflict), the message must either reduce those costs or offer a credible benefit. In high-inflation, high-anxiety contexts, people are not “resistant to change” so much as they are protecting limited resources.
In Pakistan, campaign failure is often caused by a mismatch between message ambition and delivery reality: telling parents to vaccinate when clinics are inconsistent; telling girls to stay in school without transport and safety; telling households to wash hands without water and soap; telling citizens to trust information sources when the information ecosystem is polarised. BCC is not powerless, but it is not sovereign either.
6. A practical framework for designing BCC that works in Pakistan
Over two decades, the consistent pattern is this: campaigns succeed when they are specific, locally credible, paired with a pathway, and measured honestly. The following principles are a practical checklist.
- Start with a behavioural diagnosis, not a slogan: define the one behaviour that matters and the real barrier. Imagining a creative before finding a solution is inviting failure.
- Segment the audience: the same message cannot move a sceptic, a supporter, and an undecided household equally. There are demographics and then there is psychographics.
- Use trusted messengers: community health workers, local teachers, religious leaders, and peer networks often outperform “celebrity authority.” Closer to the home, closer to the heart.
- Make the action doable: small steps, clear instructions, and friction reduction beat grand appeals.
- Pair communication with service readiness: ensure supply, staff, timing, and quality can absorb the demand you create.
- Design for norms, not just information: show the behaviour as normal, socially approved, and locally meaningful.
- Invest in frequency and continuity: short bursts fade; habit change requires repetition and reinforcement.
- Build a misinformation plan: pre-bunk predictable rumours, monitor signals, and respond fast with credible sources.
- Measure outcomes, not impressions: track behaviour, service uptake, and sustained change; treat vanity metrics as secondary.
- Protect dignity and safety: avoid coercive fear; use consent, privacy safeguards, and conflict sensitivity – especially in displacement contexts.
7. Measuring impact: the difference between proof and performance
Pakistan’s development sector often confuses delivery with effectiveness. Counting posters, trainings, impressions, and “reach” may prove that activities happened, but not that behaviour changed. Practical measurement starts with three tiers: (1) exposure and comprehension (did people see and understand?); (2) intermediate drivers (did beliefs, norms, confidence, or perceived cost change?); and (3) behaviour and outcomes (did uptake rise and stay up?). Where feasible, use quasi-experimental designs or routine administrative data to detect change. Where resources are limited, use rapid cycles: test, learn, adapt.
8. Where Pakistan should be more ambitious, and where it should be more humble
Pakistan can be more ambitious about professionalising BCC as a discipline: investing in behavioural research, improving government and implementing-partner capacity, creating stronger content governance and disclosure norms, and building modern listening systems for rumours and public sentiment. It should also be more humble about what communication can achieve when the underlying political economy is misaligned. The most credible campaigns in hard times are those that acknowledge constraints and still offer a practical step: where to go, what to do, what it costs, and what happens next.
Conclusion: communication is the last mile, not the whole road
The central lesson from Pakistan and global evidence is that BCC is a force multiplier, not a substitute. It works best when paired with services that function and when messages respect how people actually live. It can shift norms and sustain habits, but it cannot deliver vaccines, water, jobs, or justice. If Pakistan’s donors and institutions treat communication as a technical discipline that is rooted in behavioural diagnosis, local credibility, and honest measurement then campaigns can do more than produce visibility. They can produce change.
9. Five myths that keep BCC weak in Pakistan
Myth 1: “Awareness equals change.” In most campaigns, awareness rises quickly and behaviour does not. People may already know what is “right” and still face costs, constraints, or social penalties.
Myth 2: “One big film will do it.” Creative is important, but repetition and reinforcement drive habits. A single burst can create attention, but sustained change usually requires a sequence: launch, cues and reminders, peer reinforcement, and service-linked prompts.
Myth 3: “The public is irrational.” Many “resistant” behaviours are rational responses to risk, scarcity, and mistrust. If vaccination rumours spread, it often reflects a deeper credibility gap, not a lack of intelligence. Good BCC treats people as problem-solvers and respects their lived reality. That being said – irrationality does exist in large groups that can even vote against their interests. Here sometimes it is the secret sauce of identifying emotions and values that need to be triggered into attention for messages certain audiences don’t want to hear.
Myth 4: “Digital fixes everything.” Social media enables targeting and rapid testing, but it also accelerates misinformation. Digital must be paired with trusted local channels and real-world verification points.
Myth 5: “Communication can compensate for weak institutions.” When governance and delivery are inconsistent, communication can at best protect partial gains; it cannot carry the whole burden. The strategic goal should be alignment: messages that point to services that work, and services that fulfil the promise of the message.
10. What Every Donor and Project Implementation Agency Should Emphasize
If Pakistan wants better returns from BCC investments, three shifts matter. First, make behavioural evidence a procurement requirement: every campaign should start with a short diagnostic and end with a measurable behavioural outcome. Second, fund the unglamorous middle: local listening systems, community-level reinforcement, and frontline worker support – because this is where trust is built. Third, link communication to economic and service pathways: show people where to go, what to do, and what changes when they do it. In an era of economic stress, the most credible campaigns are those that acknowledge constraints and still provide a practical step. That is how communication moves from “messaging” to public value.
About the Author
Fasi Zaka is a Strategic communications and behaviour change leader with 25+ years’ experience delivering donor-funded programmes in complex, low-trust environments, including post-conflict contexts. He has advised government and development partners including UNDP, the EU and FCDO across governance, public finance, social protection, education and reform communications. Alongside his development work, he has built a strong media profile as a TV host and op-ed columnist, bringing a public-facing lens to policy and social change.
References (selected)
- Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. The Lancet. 2010. https://pubmed.ncbi.nlm.nih.gov/20933263/
- Bowen A, et al. Sustained improvements in handwashing indicators more than 5 years after a cluster-randomised trial in Karachi, Pakistan. Tropical Medicine & International Health. 2013. https://pmc.ncbi.nlm.nih.gov/articles/PMC4626884/
- Ataullahjan A, et al. Eradicating polio in Pakistan: a systematic review of the barriers and facilitators associated with the delivery of polio eradication activities. Expert Review of Vaccines. 2021. https://www.tandfonline.com/doi/full/10.1080/14760584.2021.1915139
- Ittefaq M, et al. Polio vaccine misinformation on social media: challenges and for Pakistan. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8475597/
- UNICEF Pakistan. Performance Evaluation Report: Lady Health Workers Programme in Pakistan. 2019. https://www.unicef.org/pakistan/media/3096/file/Performance%20Evaluation%20Report%20-%20Lady%20Health%20Workers%20Programme%20in%20Pakistan.pdf
- Sohail S, et al. Perceptions of Lady Health Workers and their trainers about curriculum gaps for effective community-based interventions in Pakistan. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8377911/
- WaterAid Pakistan. National behaviour change campaign on WASH. https://www.wateraid.org/pk/national-behaviour-change-campaign-on-wash
