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HIV and AIDS communication
Social mobilisation
Learning evaluation
integrated communication
Capacity development
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Full report: Exchange lunchtime discussion 24
January 2002
AfriAfya is a consortium of 8 major organisations involved
in an 18-month exploratory project to develop an effective information
system. There is a ‘hub’ and seven field centres run by the
partner organisations. Through strengthened infrastructure - a computer,
printer and WorldSpace receiver in each centre - information goes out
to local change agents, but also a two-way flow of information is ensured
with questions and feedback coming to the centres. HIV and AIDS is being used
as a ‘pathfinder topic’ to develop and assess the information
flow.
Introduction
Christopher Wood and Caroline Nyamai from AfriAfya (Africa
Health) briefly described AfriAfya and raised questions that they were
facing in their work. Participants also received background materials
and a short case study based on activities in a rural government dispensary
in Kwale district, Kenya.
Information ‘beyond the computer’, that is of
relevance and use to local communities is of primary interest for AfriAfya.
Caroline explained that the need for more information was identified through
the direct experience of the field staff of the partner organisations,
and from a baseline study, which included focus groups. Two key concerns
are:
- how to establish a Knowledge Management system and to
collect, process and repackage the information people really want to
know about; and
- how to measure whether you have successfully established
a communication system that was two-way and effective
Group discussions
Participants looked at three main questions:
- how to establish a knowledge management system
- how to ensure two-way communication
- how to provide the support to make new information communication
technologies (ICTs) work.
The discussion drew on lessons from the case study and from
people’s own experience, with a focus on practical solutions.
Key points
Who is communicating with who?
When talking about the delivery of health information it is important
to clarify the end-user - is the system providing information primarily
to lay community members or healthcare workers? Some participants suggested
that the provision of up-to-date medical information to primary health
care workers was a good focus for the project and made best use of the
available technology.
Others stressed the need for a more horizontal communication
system (two-way and beyond) that builds on what is already in place and
does not focus narrowly on health information. It is still important to
clarify who is involved in the communication. Even in the field of health
information, ‘vertical’ components of communication such as
delivery of information, might be useful problem-solving peer-to-peer
networks for (1) healthcare workers, teachers, and others; and (2) horizontal
communication between ‘advisers’ and others in partner agencies
and beyond.
Beyond a medical focus
A related discussion noted the importance of looking beyond
health workers and health infrastructure to the wider resources and communication
networks at community level. There may be important existing information
systems in agriculture, or local individuals who are key and respected
repositories of knowledge. Caroline noted that of the variety of partners,
those in agricultural organisations actually drew representatives more
directly from the local community. Other key points include:
- it is inappropriate to only focus on medical infrastructure
when determinants of health and local information systems were in practice
much broader.
- problems and questions raised by the local community
are also likely to include not only ‘medical’ problems,
but also social issues such as marital relations, which are often culturally
influenced.
- many of the issues and problems raised by community members,
because of their local socio-cultural determinants, might not be easily
dealt with by reference to existing static Internet resources.
- however, the hub might be used to provide support for
field-centre healthcare workers through links with designated advisers
in partner agencies in Kenya and elsewhere.
Adapting information
- Repackaging and adapting information to provide focused
and practical information is key – although some people had misgivings
about the ‘filtering’ of information.
- Locally appropriate materials could be prepared for field
centres in response to the more frequent issues, whether socio-cultural,
psychosocial, or medical.
- Medical questions (e.g. questions of diagnosis and management)
raised by community members and healthcare workers might ‘feed
out’ into the international health information community, triggering
international efforts to address common primary care problems in low-resource
settings in a way analogous to the approach of the evidence-based publication,
Clinical Evidence.
Building on what is already there
- building on existing local communication systems and
methods is important, so it is vital to get a clear picture of what
these were.
- vulnerable groups are often not ‘represented’
in formal community structures, again emphasising the need to get an
accurate picture of community channels of communication.
- in a related way, how AfriAfya might fit into, contribute
to, and draw from other health communication initiatives in Kenya was
discussed. Exchange is specifically planning to map this ‘bigger
picture’ in Kenya over the coming months.
Facilitating change
- training and capacity development are vital for making
sure people had the capacity to use the information that was available.
- the key role of getting people to openly discuss issues
together is highlighted in accounts of video projects such as ‘Ace
communication’ and multi-media approaches such as Soul City.
- using multiple communication methods and combining approaches
is another important strategy illustrated in these projects.
Indicators of progress should be developed for AfriAfya
as soon as possible. The fundamental question of how much difference health
information would make, and whether ICTs are the most appropriate approach
could then be more effectively tracked. Given the short lifespan of the
project, it was suggested that a realistic measure of success would be
in showing an increase in the level of community-based dialogue. The inclusiveness
of any communication system would also give a measure of how effective
it was in promoting horizontal communication.
Evaluation of the Discussion
Most participants enjoyed the practical focus afforded by
a concrete case study. Many appreciated the provision of background materials
in advance, though some didn’t get chance to look at them (and one
person wanted more). The diversity of backgrounds of participants was
also valued. A number of people commented on the lack of clarity or focus
of the questions being discussed, and that the discussions strayed off
the point. At the same time people enjoyed the open and wide-ranging nature
of the group discussions and felt that this breadth made the debate more
rich and interesting.
Issues people said they would like to explore in future
discussions include:
- qualitative and quantitative approaches to evaluation
for evidence of impact
- comparing communication theories
- HIV and AIDS communication
- sector-wide approaches and communication planning
- issues people offered to lead sessions on included:
- specific behaviour change ‘tools’
- branded product marketing as a vehicle for communicating
generic health messages
- young men and HIV communication
More on integrated communication
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