Strategic Communication for Health in a New Age

To respond effectively to the growing epidemics of AIDS and TB around the world, a strategy for communicating messages that influence change of individual behavior, community attitudes and socio-political dynamics is absolutely critical.

In order to make communication effective, there is a need to fully and rigorously understand the audiences, including contextual factors (political, cultural, economic, gender etc.) that determine the health choices people make.

The underlying factor is that communication does not occur within a vacuum, and thus it is essential to be aware of elements that may deter effective communication in the design, distribution and measurement of AIDS or TB messages.

Communication that saves people’s lives, improves health and enhances well being is about ideas, creativity, research, knowledge and money. Given the fact that resources are finite, strategic communication needs to consciously build upon existent social capital to ensure sustainability of processes.

Strategic communication can help to shape context and build relationships that enhance the achievement of objectives to respond effectively to AIDS and TB.

To be effective, strategic communicators must understand attitudes and cultures, respect the importance of ideas, adopt advanced information technologies, and employ sophisticated communication skills and strategies. To be persuasive, they must be credible.

More importantly, strategic communication for better health appreciates what works scientifically combined with flexibility to adapt it to specific cultural contexts.

As already stated, it should go beyond simply addressing individual behaviour to structural and institutional realities that are largely responsible for driving diseases and epidemics. In many ways, public policies tend to be responsible for social and health inequalities and cannot be ignored in the communication process.

Therefore, an effective communication strategy puts people and structural realities at its heart in the design, development, implementation and evaluation of messages.

In essence, strategic communication for better health needs to be informed by a process that identifies behaviours and attitudes, identifies policy priorities, and embarks on a process to influence a broad section of society through appropriate themes and messages.

In that respect, communication is not an end goal, but rather a means to influence dialogue and engagement through relevant mediums.

Barnlund Communication Model

Labouring over which medium to choose when targeting a specific audience is a critical component in the communication for health process. In many ways, the medium defines the message in as much as does the target audience. A chosen medium has its limitations, and key messages and themes have to be aligned to the limitations of the medium to ensure effective message delivery. Obviously, the research-based needs of a target audience determine what delivery mechanisms to utilize.

It is important to know at the outset what goal seeks to be achieved with the particular choice of a medium so that the measurements of success or failure are specified.

Events, activities, messages, and materials must be designed with your objectives, audiences, partnerships and resources clearly in place. Building a communication strategy is about directing and focusing evidence-based messages and themes according to clearly defined pathways to achieve intended objectives.

The process of strategically positioning communication needs to ensure the participation of intended beneficiaries in the designing of messages, no matter what the level of focus.

Strategic communications shifts away from communicating to, and instead focuses on communicating with target groups in order to establish solutions., with emphasis being on how to build a relationship that allows for communication to take place so that appropriate action is taken. In that sense it is a significant shift from the magic bullet theory of communication which treats audiences as inactive recipients of messages.

Fact-based communication research is necessary for demonstrating and validating the need for resources required to increase the impact of communication. It is also essential that message platform for key initiatives are identified through the research process.

According to Wikipedia, “strategic communication provides a conceptual umbrella that enables organizations to integrate their disparate messaging efforts”. In other words, it enables organizations to “create and distribute communications that, while different in style and purpose, have an inner coherence”.

New media offers a significant opportunity to unify organizational health communications in order to achieve that inner coherence which is often times based on the vision, mission, goals and values of the organization.

New media offer an opportunity to encourage conversation and promote collaboration in creating appropriate messages. It is essential to integrate social media into the communication infrastructure and tap into its potential to create dialogue and reach a wide audience. New media make it easier and faster to communicate and collaborate, and essential element to public health communications.

The ability of new information tools to alter the way we communicate needs to be tapped into but as with any component of the health communication process the focus must be on people and not just the technology.

Overall, a strategic communication process needs to be planned, directed, coordinated, funded, measured and conducted in ways that promote the wellbeing of individual in a manner that aligns with organizational values and goals.

Is Cutting the Male Penis An AIDS Miracle?

 “If you’re a man, get cut today”

Male circumcision (the cutting of the foreskin from the male penis) is increasingly gaining currency among medical researchers as an alternative method to reduce HIV-infection.

But will this solution really work? 

Researchers say that if all men in sub-Saharan Africa — the worst HIV/AIDS affected region in the world — were circumcised over the next decade, roughly two million new infections and 300 000 deaths could be averted. 

An additional 3.7 million new HIV infections and 2.7 million deaths could be avoided in 20 years.

Put simply, while the benefit of male circumcision to an individual man is immediate, a large scale impact of the intervention will be realized in two decades. 

AIDS risk lowered by 60% 

In fact, evidence from observational studies in sub-Saharan Africa has shown that circumcised men have a lower risk of acquiring HIV infection than uncircumcised men. A study in South Africa showed that male circumcision might reduce by about 60 percent the risk of men contracting HIV through sexual intercourse with women. 

The study focused on 3000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Of these, half were randomly selected for circumcision while the other half remained uncircumcised and served as a control group. 

For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study. 

The argument is that the inner surface of the penile foreskin contains Langerhans cells, which have HIV receptors, and is also vulnerable to disruptions during intercourse. Second, an intact foreskin exposes a man to a greater risk of ulcerative sexually transmitted infections, which in themselves are a risk factor for HIV acquisition.

Furthermore, the virus’ chances of survival might be higher in a warm, wet environment like the one under the foreskin. 

How will it affect society? 

The evidence that circumcision may protect against HIV infection is now considered strong enough that further trials evaluating the efficacy of circumcision as part of an HIV prevention program have been advocated.

This could herald a new era in HIV-prevention methods. But the question remains: what are the societal implications of such a solution? 

Male circumcision has been practiced extensively in some sub-Saharan communities in rites of passage ceremonies from boyhood to manhood. The gruesome circumstances under which such practices occur may be exacerbated in the light of this new evidence. Other communities have not practiced it at all. 

However, qualitative studies in the Botswana, Haiti, Tanzania, Zambia, and Zimbabwe revealed positive attitudes toward male circumcision in populations that do not traditionally practice it.

From 45 to 85 percent of uncircumcised men in surveys expressed interest in the procedure if it is safe and affordable. In spite of the interest in male circumcision, it is not a magic bullet in the fight against HIV-infection. To be effective, circumcision has to be promoted alongside condom use and faithfulness, long-established approaches in the fight against HIV. 

Education and money will be essential 

Some men may be tempted to engage in unprotected sex because they perceive they are protected by male circumcision. And some women may get a false sense of security when having sex with a circumcised man. 

In itself, male circumcision provides little or no protection against urethral STDs such as gonorrhea and chlamydia and certainly cannot prevent unwanted pregnancies. This issue will need to be strongly emphasized in social campaigns. 

To be successful, male circumcision will have to be complemented by a massive investment into education and counseling programs. There will be need for widespread and culturally sensitive dissemination of information that outlines the benefits and potential complications of male circumcision. 

Another danger is that male circumcision can be risky or fatal if conducted by untrained personnel. There’s no doubt that with increased knowledge of male circumcision as a barrier against HIV, many men will try to perform it on their own.

There will be obviously costs involved in getting circumcised which some people will try to circumvent. Circumcising large numbers of adult men will be a major undertaking. If circumcision is not performed correctly it will increase the risk of infection.

A major surgical system infrastructure needs to be developed. Who will fund this and how long will it take? Also, most health facilities in sub-Saharan Africa are in a shambles and ill-equipped to perform widespread male circumcision.

In addition, there’s also lack of social acceptability of circumcision in many of the sub-Saharan communities that have not traditionally practiced it. Besides the safety and acceptability issues, perhaps the greatest drawback is the financial means required to undertake circumcision whole scale.

Male circumcision will come with high costs through social mobilization efforts and upgrading of medical facilities. The more the men get circumcised, the more the success — and that’s tough ground. 

Imagine the social marketing message: If you’re a man, get cut today.

15% Now Campaign Targets Africa Health Budgets

Imagine four African countries without any living soul – Botswana, Namibia, Lesotho and Swaziland – all because of deaths to preventable, treatable and manageable diseases.

Across Africa, public health systems are in a ramshackle state, as a result, over 8 million African lives are being lost annually to diseases, because people have little or no access to public health services.

“That figure of 8 million people dying annually is easily the combined populations of Botswana, Namibia, Lesotho and Swaziland dying in one year. At this rate, many countries will run out of burial space. Consequently Africa’s fastest growing industry is the coffins and burial business. In 20 years the number of lives lost could be equivalent to the population of Nigeria – at 130 million – Africa’s most populous country,” said Rotimi Sankore, coordinator of the Africa Public Health Rights Alliance which is promoting the 15% Now! campaign to push African governments to adopt appropriate health policies.

“Investment in health is key to resolving this situation”

Maternal and child mortality, HIV/AIDS, malaria and tuberculosis are the main diseases affecting the populations yet governments are doing little to reverse the ide of deaths.

“It is clear that the vast majority of African governments have under-invested in health systems and there has been no long-term planning and understanding of health needs of citizens by government,” said Sankore

Heads of State African Union (AU) meeting in Abuja, Nigeria in 2001 agreed to commit at least 15 per cent of national budgets to health. But, six years later, only two out of fifty three AU member countries (Botswana and Seychelles) have clearly met that pledge.

“To say it is tragic that in 2007 only two out of fifty three AU member countries have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy,” said Sankore.

Since the pledge was signed in 2001, Africa has lost a staggering 40 million lives due to a failure by African governments to develop, implement and fund comprehensive public health policies.

Worryingly, many of the governments are relying mainly on external efforts and donor funding to resolve their numerous public health problems.

“The leadership of most of the governments have not had to depend on the health systems of their countries for treatment and are therefore not committed to resolving the problem,” said Sankore.

According to the 15% Now Campaign, African governments must urgently implement their 2001 Abuja Declaration pledge to dedicate 15% or more of annual budgets to health care within three years. Commensurate to this must be a commitment to dedicate a significant chunk of the money to resolving the brain drain of health care workers, and addressing key concerns such as reproductive health, child mortality, HIV and TB.

“If you look at countries where health systems can meet the needs of citizens, anything from 15 to 30 percent of budgets have been spent on public health. In Africa, the lion’s share of budgets goes to military and defense spending,” said Sankore.

“The consequence is that once a higher percentage of citizens need health services, it becomes impossible for grants to deliver services.”

Currently, the doctor per patient ratio in Africa is appalling.

For example, the Democratic Republic of Congo (DRC) with a population of 57 million, roughly equivalent to the populations of UK, France and Italy has only 5,827 doctors compared to the France’s 203,000, Italy’s 241,000 and the UK’s 160,000.

Cuba with a population of about 11 million has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi’s 266, Zambia’s 1,264 and Zimbabwe’s 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as developed countries while the average life expectancy for African countries compared to it here is 37 to 40 years.

“To come anywhere near meeting the WHO recommended health worker to patient ratio or meeting the health based millennium development goals (MDG), these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years,” states the 15% Now! petition. “This is Africa’s priority.”

The 15% Now! campaign urges African governments to make the adoption of comprehensive health strategies a top priority, including the involvement of health care workers and civil society in setting measurable targets of progress.

Some people argue that funding the health sector is not the solution, but if all the people are dead, what will the other sectors be for, said Sankore.

The loss of health care workers to developed nations is also a major factor contributing to the poor state of health care system in Africa. Some developed countries maintain domestic public health policies that promote the recruitment of health care workers from Africa.

Improving health care systems in Africa will require developed nations to abandon such practices. Because developed countries have benefited from poaching African health care workers, they have a moral responsibility to promote the training of healthcare workers to improve Africa’s health care workforce.

However, ordinary citizens in Africa are not informed enough to lobby their governments to adopt proper public health policies.

“The citizens are not adequately informed and it’s the job of organized civil society to inform and mobilize ordinary people to campaign for their right to health and life,” said Sankore.

Given the critical importance of good health to national development, an obvious question is why African governments pay little attention to the matter.

“There’s phenomena that health is a private matter, but the truth is every single citizen’s health issue when brought together presents a collective challenge. We may die individually of TB or HIV, but collectively our deaths impact society as a whole,” Sankore commented.

“Ordinary citizens in Africa have two choices – either they campaign for governments to accord their right to health, or they will die.”

But the fact is that if African governments do not meet their obligations, they will soon find themselves presiding over countries without people, added Sankore.

Implementing the agenda of the 15 percent Now! campaign, coupled with international donor support and policy change, offers the best chance for African governments to address the health needs of ordinary citizens.

“Doing nothing is not an option because if the situation persists, some countries in Africa will cease to function,” said Sankore.