Healthlink Worldwide

Key lessons in health communication

The following key lessons in health communication have emerged from practical work by development workers working in many different environments and at different levels.

1. Learning-evaluation is the most useful
Evaluation works best when the emphasis is on learning for the future. This is most likely to be the case when the process is initiated, designed and owned by those directly involved in project work and those the work is supposed to be helping. Recent work with participatory monitoring and evaluation (PM&E) approaches highlights the benefits of getting input from all the stakeholders involved in a project (IDS 1998).

But too often evaluation is externally dictated and experienced as a punitive management tool (Delgadillo and Borja 1999). De-linking the processes of learning from funding and project cycles may also be important, since there is evidence that this makes for the most productive evaluation (Carden 2000: 188). Learning and reflection must not only be about making projects more efficient, but must also consider critically the political and policy context in which projects operate. Otherwise there is a danger that PM&E approaches will merely co-opt people and become a 'new tyranny' (Cooke and Kothari 2001).

2. The process is as important as the results
The 'right' procedure of evaluation is no substitute for good ongoing communication and relationships of trust built up over time (Vincent 2001). Making time for ongoing reflection on activities is vital. This is increasingly recognised by donors even if it hasn't filtered through to practice yet. (For more on this, see the IDS efela report at www.ids.ac.uk/efela/). There is a good deal of mystique around monitoring and evaluation. But the real aim is quite straightforward: it is to generalise and formalise the good practice in documentation, consultation and responsiveness that people develop when they are working well.

The case of 'Radios Mineras', the Bolivian miners' popular radio programming in the 1970s, reinforces this point: effective monitoring and evaluation mechanisms grew directly out of the desire to consult and adequately express the priorities of the mining communities the radio programmes served (Dagron 2001). Conversely, adopting what seem to be the right procedures is often not enough on its own. Despite massive investment of time, resources and training in participatory evaluation, the work of CARE International in Zambia in the early 1990s found that local communities still did not feel a sense of ownership of the process, which meant less local involvement.

3. Start from where people are on the ground
With health or disability communication for development, it is important to work with the practices of communication that people are already using. This is particularly important in the light of the introduction of new information and communication technologies (ICTs) in a range of developing country settings (FAO 1998).

4. Social context is vital to health and communication
Focusing on individual behaviour change is rarely sufficient. In development circles, the awareness of the impact of poverty and wider determinants of health appear to be evidence of a growing appreciation of context in general terms. More specifically, the UNAIDS new communication framework for HIV/AIDS (Airhihenbuwa et al 2000), with its recognition of five levels of context - government policy, socio-economic status, gender relations, culture and spirituality - is an example of a recent attempt to take context seriously.

5. A little 'capacity-building' goes a long way
Capacity-building, that is helping people to develop the skills and confidence to determine their own agenda and priorities, is perhaps the most useful (only?) way of looking at 'development' (www.capacity.org). 'Development' energy is then spent on enabling people with all their rich and particular life experience, to determine the ways of improving their health and be the agents of their own change (Grey-Felder 1999 communication for social change). This avoids repeating the mistakes of trying to impose a model based on a very specific 'Western' history and experience onto everyone else.

6. Long-term timescales work best
Increasingly the short-term project and funding cycle are being shown to be inadequate (Carden 2000: 175). Patience and long term commitment are needed to build trust, an informed and inclusive social environment, and effective and sustainable health systems.

7. Don't re-invent the wheel
There are frequent examples of good practice, lessons to be learned and people engaged in similar work already out there. If you have health and disability communication lessons you want to share, get in touch with Shampa Nath, Head of Knowledge Sharing, Healthlink Worldwide: e-mail: nath.s@healthlink.org.uk

 

References
Carden, F (2000)
'Giving evaluation away: challenges in a learning-based approach to institutional assessment'
In Marisol Estrella (ed) Learning from Change: issues and experiences in participatory monitoring and evaluation, London: Intermediate Technology Publications

Cokke, B and Kothari (2001)
Participation: the new tyranny?
London: Zed Books

Delgadillo, K and Borja, R (1999)
Learning lessons from Telecentres in Latin America and the Carribean www.idrc.ca/telecentre/evaluation/nn/16_Lea.html

Dargon (2001)
Making waves

Estrella, M (ed) (2000)
Learning from Change: issues and experiences in participatory monitoring and evaluation
London: Intermediate Technology Publications

FAO (1998)
www.fao.org/waicent/faoinfo/sustdev/CDdirect/CDre0025.htm

Gray-Felder, D and Deane, J (1999)
Communication for Social Change
New York: Rockefeller Foundation

Institute of Development Studies (IDS) (1998)
'Participatory Monitoring and Evaluation: Learning from Change'
Policy Briefing, 12 November 1998
http://server.ntd.co.uk/ids/bookshop/details.asp?id=466

Richardson, D and Paisley, L (1998)
The first mile of connectivity
Rome, FAO.

Vincent R (2001)
Beyond circles in square boxes: Lessons learned from health communication impact evaluations
www.healthcomms.org/pdf/iispaper.pdf

Ward, P
'Getting the right end of the stick: participatory monitoring and evaluation in an organisational context' In Marisol Estrella (ed) Learning from Change: issues and experiences in participatory monitoring and evaluation
London, Intermediate Technology Publications

Webb, D and Elliot, L (2000)
Learning to live : monitoring and evaluating HIV/AIDS programmes for young people
London, SCF