Broad Challenges in Health Communication

This 14-page presentation-style document for the Joint United Nations Programme on HIV/AIDS (UNAIDS) Meeting on Communication for Social Change highlights the broad challenges facing communication for development in the field of health communication. It is an analysis of the current trends in the field and some specific international communication campaigns, as well as the author's historical perspective.


By opening his presentation with logos from multiple communication campaigns, the author looks at the current competitive health context in an effort to show the challenge of establishing an international profile and establishing programme communication as a sector distinct from advocacy, profile raising, and fundraising. He uses the distinct areas of tuberculosis (TB) and polio communication to illustrate some lessons learned.


The presentation focuses first on tuberculosis campaigning, highlighting the Stop TB Partnership. James Deane reviews the adoption of "advocacy, communication, and social mobilisation (ACSM)" as a strategy and lists the challenges addressed by the Stop TB strategy, including TB detection and treatment adherence, stigma reduction, patient empowerment, and building political support. Results include a Patients' Charter [PDF], a community care initiative, and increased funding as a result of technical support for Global Fund proposals. The strengths of the Stop TB communication approach are listed as: significant ownership and inclusion of stakeholders, including patients; long-term and coherent roots in the Stop TB strategy; integration of different approaches; a context of strong leadership; and a "living" and resonant communication document. Its weaknesses include: a weak link to HIV and other working groups; limited respect from activists and limited implementation planning; concerns from national TB managers on infrastructure assumptions (in particular, overestimating the strength of national health systems); heavy dependence on volunteers; fragmented, under-resourced technical assistance; and weak advocacy.


The presentation discusses links to communication for social change (CFSC). Because the Stop TB strategy emphasises increased case detection, behavioural change is central to successful treatment. Stigma and discrimination as a barrier to reporting must be overcome. As stated here, community and patient empowerment (the Patients Charter being a key response) are at the root of successful programmes, e.g., Mexico, Bolivia, and Bangladesh. Challenges include the increase of stigma surrounding multidrug resistant forms (MDR/XDR) of TB and increasingly transitory populations as a barrier to building patient empowerment (i.e. cured TB patients may move on, rather than work within a TB movement, as some HIV patients do). However, the author notes a building activism linked to the HIV patient movement.


The document details a new focus on social determinants, among which are: a 1% decline in TB yearly (with or without Stop TB resources); countries showing a link between decline of TB and improved economic and social factors rather than TB treatment; evidence showing a decline in some countries with weak TB programmes and an increase in some with strong TB programmes; and evidence of omission in the Global Stop TB plan, including the role of pollutants, smoking, and nutrition, as well as missing strategies for prevention.


The presentation shifts its analysis to the case of polio communication. It recognises the effectiveness of the traditional communication/social mobilisation approaches in reducing polio to a small number of cases in very limited regions. The problematic aspects of these polio endemic locations are cited in the document as rumours, boycotts, and politicisation of polio immunisation efforts, as well as low prioritisation of compliance where communities believe they have greater problems than polio.


The document highlights the polio communications technical advisory group (TAG) recommendations, including the need for "a community based communication strategy that involves community leaders, mobilisers, [and] partnerships with state and private media, and strengthened links with local NGOs [non-governmental organisations] to promote ownership."

The document continues with challenges and trends for communication for development in the health sector:

• Some common challenges facing all health sectors are listed as:
  
  
  
  • lack of clear and long-term communication strategies within agencies and programmes;
  • poorly understood communication programme function (particularly when communication for development is grouped with external relations);
  • fragmented technical support;
  • competitive funding that discourages collaborative efforts among agencies;
  • the medical model being reasserted over social and political drivers; and
  • fragmentation of sectors resulting in confused and incoherent messaging to the populous and journalists.

  
  
  

• HIV specificities and the long wave:
  
  The document looks at HIV/AIDS communication and finds that longevity is being taken into account because no cure or vaccine is available. This has sparked, as stated here, a social movement focused on identity assertion, leading to the question of whether empowerment on a health issue requires identity formation. The document acknowledges the success of the HIV agenda as an engine for political mobilisation for health, including related challenges like TB.
  
  
  
  
  
• Some personal, historical perspectives:
  
  This section reflects the author's perspectives, noting historical circumstances, particularly in HIV/AIDS communication campaigning. First, the author observes that social and political drivers have been understood since as early as 1986. Communication has had measurable and predictable prevention impacts, allowing for long-term programme planning. However, pressure for verifiable short-term results has resulted in a deviation from the route of investment in "a serious, long term, coherent strategy designed to prevent the spread of HIV/AIDS ... [and in] systematically built communication capacity and expertise on the ground." He states that "communication appears to be discredited and poorly understood...[by] activists and [the] mainstream medical community and within major funding bodies...; debates within communication [are] stifled as [the] whole sector [is] diminished, leading to lack of opportunities for systematic learning...; [but that the] Commission on Social Determinants of Health [is] an important opportunity for the sector."
  
  
• A few broader linked trends in development:
  
  The author reiterates the problem of "conflation of definitions and roles of communication" resulting from the placement of communication for development in external relations; the undermining of strategic coherence of communication programmes with "mainstreaming" of programme communication; and the historical shifts in the health, particularly HIV/AIDS, sector from media and communication to governance and government accountability.
  
  
  
• Commission on the Social Determinants of Health:
  
  As stated here, CFSC is now focused on empowerment through social and political contexts, amplifying voices of those most affected and enabling them to participate in health and development agenda shaping, focusing on agency of those affected, and on internally driven change shaped by empowered communication environments.