Information, Education and Communication

Introduction

"This paper was commissioned by the Department of Reproductive Health and Research at the World Health Organization to examine lessons learned from more than two decades of experience in applying information, education and communication (IEC) interventions in support of public health. It represents an attempt to gather and synthesize experience in IEC for public health, and to succinctly analyse and share these experiences so that IEC can be effectively integrated into, and support, improved reproductive health programmes and service delivery. This effort is intended to serve as an orientation, or a 'tour d'horizon', to future IEC work as educators, practioners, policy-makers and communication specialists in all aspects of public health strive to build upon past experience in enabling people to effect more healthful behaviours.

The document is primarily intended for individuals working in public health generally, and in reproductive health specifically, who are conversant with - but not expert in - the principles and practices in IEC. It is a retrospective rather than a prospective work. The paper is qualitative in nature and attempts to articulate lessons learned throughout the years. It is not the purpose of this document to critique the projects from which it has drawn lessons or to report evaluation findings, although wherever available, documented evidence of effectiveness has been included (in many cases, impact is anecdotal). For a more refined view of projects cited, readers may find it necessary to consult original sources as listed in Appendix 3: Information sources. Further, it is not possible in a document such as this to offer definitive IEC choices, best practices, or recipes for programming in individual situations. Each strategy must be designed and implemented based upon its own IEC objectives, the intended audience, cultural, social and political characteristics, and any facilitators or barriers that may exist in a given situation.

In order to undertake this work, a literature search was conducted. In-depth individual interviews as well as "round table discussions" were held with key informants (i.e., designers, implementers, evaluators and managers of IEC projects in health). It was also considered very important to garner the opinions and experience of people working directly in the field. To that end, a questionnaire was sent to numerous field contacts by WHO as well as by other agencies or organizations interviewed.

This document outlines a set of "lessons learned". These lessons reflect a retrospective view of what we know now about planning, implementing, monitoring and evaluating IEC interventions. They focus on generic practical steps and on what has "worked". This section is followed by a presentation of special considerations which must be taken into account when applying IEC to reproductive health initiatives.

At the onset, it is necessary to state several caveats with regard to the contents of this document. First, this paper brings together the results of an in-depth search for the most recent and the most relevant material and opinions. It is not, however, exhaustive. Constraints in time and other resources, and the extraordinary amount of information related to this task make it impossible to claim absolute coverage of all pertinent issues.

Similarly, this is not necessarily a consensus document. A wide range of views and experiences exist with regard to IEC work. While this paper attempts to capture the main nuances of professional discourse in an even and fair way, it cannot claim to be all-inclusive. In the end, parameters for discussion had to be established and within those parameters, as rich and full a picture as is possible has been laid out within the limitations of time and space. Thus, for example, projects "showcased" as models have been chosen for their innovation, their illustrative nature, their longevity, and so forth; no judgement is implied. Lessons learned are included because of their generic or thematic nature; it is not possible completely to dissect every project or every component of the methodology in order to extract lessons.

Further, this paper assumes a basic knowledge of the form and function of IEC interventions and of the disciplines which inform its practice. It is simply not possible to discuss all of the relevant theories and schools of though which have contributed to the ever-evolving discipline of health promotion and communication.

It should also be underscored that attempts to apply the experience and lessons of vertical public health programmes using IEC to integrated reproductive health can be extremely challenging. Reproductive health is composed of many complex behaviours. The ways in which these behaviours interface in terms of individual actions, which can be largely influenced by culture and values, and in terms of IEC objectives, strategies and messages, must be carefully considered. At every step of the continuum (i.e., planning, implementation monitoring and evaluation), there are numerous variables and issues to be considered.

The majority of this paper relies heavily on, and in some instances draws directly from, the work of others. All people, materials and organizations consulted are listed either in the Acknowledgements or in Appendix 3; Information sources. There is no intent to claim as original or proprietary the contribution of others, which may have been paraphrased or repeated from documents in the public domain.

Finally, this document is intended as a catalyst for further discussion and exploration. It is important to realize that it is necessarily limited in scope and that it intentionally raises more questions than answers. It is believed that looking back is helpful insofar as it enables one to look ahead, and that in the dynamic world of public health and IEC, change is inevitable."