Health communication, HIV/AIDS, social mobilisation, learning evaluation, capacity building

Maria Zuniga introduced a debate on communication challenges faced by people involved in local, regional and international advocacy. She stressed how international advocates and grassroots communities must work together if real improvement in people's health is to be achieved.

Maria is Coordinator of the Information Centre and Advisory Services in Health (CISAS) based in Nicaragua, and she is the Global Coordinator of the International People’s Health Council (IPHC). Maria described her initial work in Central America beginning in 1968 as a community based health worker in Nicaragua working with the Mesquite Indians.

Maria also worked on a primary health care programme in Guatemala that was one of the models used by the World Health Organization in developing its strategy of Health for All, based on integrated and comprehensive approaches that considered the social and economic determinants of health as well as the biomedical factors. She gave an example of a number of organisations that were training community health workers throughout the country at that time, but rarely communicated with each other. She visited many of them and encouraged them to share experiences and work together.

A similar situation existed in other countries of Central America. In 1978 she helped set up a regional committee of community health workers that is still going strong today. A key focus for the regional committee has been to take up advocacy work around health.

Maria said community health workers naturally get involved in strategies looking at the wider determinants of health because of their close involvement with the communities in which they work. People in the communities are often more literate about the impact of social and economic policies on their lives than some of the people working in health-related NGOs. People in communities have their health impacted by so many different variables that it is unrealistic for national policy units to work in isolation to try to influence health.

This analysis around the politics of health also led to the creation of an international network in 1991 – the International People’s Health Council (IPHC). Maria said that one of IPHC’s objectives was to ensure that people’s voices are heard internationally. IPHC’s strength comes from having people who work both at the grassroots level and the international level.

Macro-economic policy affects both rich and poor countries and has an impact at many different levels. As a result, said Maria, we can be advocates at several levels. It is important that international advocates do not isolate themselves from the reality on the ground. Grassroots communities have to be heard.

She concluded by pointing out that many civil society organisations have tried to work with policy issues. People in communities have their health impacted by so many different variables that it is unrealistic for national policy units to work in isolation to try to influence health. There needs to be a way to get policy makers to work together and see that they cannot impact on health on their own.

Issues raised during the discussion included the need to look at diversity within communities and the possible conflicts of interest that could arise. Maria mentioned the example of not paying enough attention to young people, for example in Nicaragua, she said, 67 percent of the under 25 did not have a voice. Learning from each other was recognised as a fundamental communication challenge. The issue of how to get people from different sectors to communicate with each other needs to be explored.

Communication work around HIV and AIDS is helping to move the debate beyond the health sector and is beginning to help stimulate new networks and advocacy. A question was raised as to whether it was possible to identify in advance who to involve in a network. Should they organically grow, or can they be planned. There was a sense that when networks were relevant to people’s needs and let people on the ground express their views they tended to work more effectively. But, said Maria, although networks have to live and breath, they also have to die when they have served their purpose. Organising around a common purpose is one of the keys to a healthy network.

Exchange agreed to prepare and circulate an information dossier that signposts to organisations involved in advocacy and networking around health and health communication.

There was general appreciation for the good, lively presentation that reflected personal experience. However, there was dismay that there was not enough time for discussion and that the discussion tried to cover too many areas. Some people felt that the larger group discussion this time was good; others would have preferred small group discussions with focused questions.

A recommendation for providing some reference materials on networks working in health communication for advocacy was suggested, and will be followed up by Exchange.

Linking local, regional and international action: health communication challenges