Opportunities and Challenges for Health Communication in Health Disparities Settings

"How can we build health communication and other capacity in disadvantaged settings?"

This is one of the questions asked in this interview of Rafael Obregon, PhD and Benjamin Hickler, PhD, both involved with communication for development (C4D) at the United Nations Children's Fund (UNICEF), whose strategic plan for 2014-2017 emphasises equity. The interview focuses on how communication strategies have helped achieve successes in global health equity - as well as how C4D can be drawn upon as an approach to address challenges in this arena. Some of the key points from the interview include:

• The interviewees are first asked to describe some of the recent milestones and challenges in global health equity. Obregon points to the global initiative A Promise Renewed, which focuses on accelerating the achievement of the Millennium Development Goals (MDGs) - particularly goals four (reduce child mortality) and five (improve maternal health). He also references polio eradication efforts, especially the recent success in India, as an example of how "the international development community has made significant progress in improving the lives of children by bringing in the equity focus." Both Obregon and Hickler discuss challenges, however, such as reaching children who belong to marginalised groups and/or who are affected by insecurity and violence (e.g., in some of the areas where the last reservoirs of circulating wild poliovirus are: Central African Republic, federally administered tribal areas of Pakistan, some parts of Afghanistan, Syria, and northern Nigeria).
• Obregon explains that C4D is a key component of UNICEF's work - and both he and Hickler provide examples to illustrate how these strategies have worked to support health equity. For instance, Hickler describes a UNICEF project that is using mobile theaters in Mozambique to communicate with communities about the importance of immunisation, and also to listen to the communities (i.e. about their need for other essential health services, such as water, sanitation, nutrition, and sanitation) and to record their voices. Obregon discusses a UNICEF initiative in Niger, West Africa, where the development and implementation of an essential family practices package has involved a community-based, action research approach, involving community meetings, household visits, community radios, advocacy with religious leaders. It focuses on the promotion of 8 life-saving practices, including having children sleep under insecticide-treated mosquito nets, handwashing, and exclusive breastfeeding. "Recent surveys have shown significant improvements in maternal and child health in intervention zones, and it is expected that by 2015 the program will reach over 350,000 households."
• Some of the lessons that both interviewees discuss include: (i) the need to strengthen the capacity of governmental and non-governmental partners in the effective use of communication strategies - Obregon says: "We use a two-tier approach: a more formal effort to strengthen local capacities by strengthening systems and organizations...; and engaging and empowering local communities to address health disparities and inequities"; and (ii) the importance of a dialogue-based approach so as to use the communities' priorities and needs to inform programming and advocacy, and to give our governmental counterparts the tools to deliver to communities the services they are asking for. Obregon provides the example of U-Report, one of the communication components of an initiative developed in UNICEF's Uganda country office. This SMS (text message)-based platform allows community members to provide feedback and information in real time in an effort to influence how providers, governments, and agencies make decisions on improving various aspects related to the well-being of families, communities, and children.

(Obregon and Hickley were interviewed by Radhika Ramesh, MA, Editorial Assistant, Journal of Communication in Healthcare: Strategies, Media, and Engagement in Global Health)