“Communication has been a consistent current running through many major health developments of recent years. And yet, despite the demonstrated promise of communication as a tool for improving public health, not enough has been done to date to capitalise upon its potential, particularly in the poorest parts of the world.”
This policy briefing by BBC Media Action makes the case for why donors, practitioners, and developing country governments need to pay more attention to the role of communication in tackling global health. It does this by examining the current situation of health communication practice, highlighting that although health communication has had significant impact on global health, not enough is being done. It looks at why the practice of health communication is not living up to its potential and offers recommendation for the way forward.
The briefing is divided into 5 sections. Part 1 shows how communication successes and failures have been part of the trajectory of major public health developments over the last 30 years and have influenced health outcomes around the world. In particular it provides three case studies that show how health communication has had an impact on the course of Ebola in West Africa, and polio and HIV globally. As stated in the brief, “[W]hether by influencing individual behaviour, galvanising community action, shaping social expectations or informing the way in which health services are provided, communication has been at the heart of public health. It has the potential both to mitigate health crises and to exacerbate them.”
Part 2 explores the extent to which social and behaviour change communication (SBCC) has been adopted as a priority in public health policy and programming, and how it is reflected in a range of important public health policy statements such as the Strategic Framework for Malaria Communication at the National Level, 2012–2017 developed by the Roll Back Malaria Partnership, and the Global Polio Eradication Initiative’s Polio Eradication and Endgame Strategic Plan 2013–2018. Despite these commitments on paper, the briefing makes that point that, in practice, commitment to effective communication at a scale sufficient to accelerate improvements in health remains elusive. Health communication still remains poorly funded, under-utilised, and badly planned, and simply bolted on to programmes as an afterthought.
Even when communication interventions are prioritised in public health, these often fail to reflect best practice and therefore limit impact. Part 3 of this brief looks at whether lessons learned about what elements make health communication successful are being consistently applied in practice. In particular, it assesses whether current programming reflects the following key lessons learned around successful practice: (i) employing sound behavioural analysis to underpin communication interventions; (ii) moving beyond “messaging” to embrace the importance of dialogue and more nuanced approaches to social and behaviour change; (iii) emphasising local ownership and leadership of communication interventions; (iv) integrating communication more firmly with broader programmes to improve health; (v) employing socio-ecological models to understand and address the determinants of health. It concludes that too often these key ingredients are missing, and that “[O]verall, it would seem that both greater and more strategic allocation of resources and closer attention to lessons learned will be critical if health communication is to achieve its full potential for public health.
Part 4 of the briefing examines the reasons for the ongoing under-prioritisation of health communication and identifies promising attempts to bring it more firmly into the heart of public health practice. It identifies four inter-related factors that help to explain why health communication is still not being prioritised: (i) the dominance of science in public health in a context where social and behavioural sciences are important; (ii) the complex nature of “messy human change” in an era of quick wins; (iii) debates around “what counts” as evidence; and (iv) the failure of SBCC to coalesce as a field and build an effective brand. It concludes that while progress is being made in each of these areas, challenges remain.
Part 5 suggests ways in which those working to accelerate progress towards better public health can maximise the potential of evidence-based health communication. It offers a set of recommendations for policy-makers, donors and health communication practitioners. These are discussed in more detail in the briefing but, in short, cover the following areas:
- Health policies, programming and funding: Health policy-makers and donors alike should systematically consider the importance of communication in the health programmes they plan and fund.
- Applying lessons learned: Policy-makers, donors and health communication practitioners should be rigorous in applying lessons learned from past health communication to their programmes. Donors should ensure that their staff are familiar with the health communication evidence base and lessons learned from past programmes, so that they are equipped to plan and evaluate proposals for new communication interventions effectively.
- Building the evidence: Ongoing investment is required to bring together public health and health communication experts to agree appropriate evidence standards for health communication. For example, the brief suggests increased donor support for research efforts to fill evidence gaps, and for health communication practitioners to be more insistent on the need for funding to enable stronger evaluations, and open to holding their work to higher standards of scrutiny, including external review.
- Strengthening the field: Current efforts to build the health communication field and encourage strategic coalescence and mutual learning should be accelerated. Sector-wide meetings are essential, as are platforms for encouraging greater interaction between practitioners, with emphasis placed on peer learning and more rigorous peer review of programmes and research.
- Capacity strengthening: A further important step in building the health communication field will be giving greater prominence to health communication capacity strengthening – particularly in government health agencies and civil society organisations.
BBC Media Action website on November 3 2016.