Report and recommendations

THE ASIAN REGIONAL WORKSHOP ON EFFECTIVE COMMUNICATION FOR NUTRITION IN PRIMARY HEALTH CARE

Education and information for behaviour change are being increasingly recognized as key interventions in the improvement of health and nutrition. However, functional illiteracy, the lack of infrastructure, and expensive technology often mean that efforts in health and nutrition communication at the community level are minimal, difficult, and disappointing.

Many Asian countries have adopted primary health care (PHC) as the fundamental philosophy in their health-care systems, making effective communication crucial. It was for the purpose of evaluating, expediting, and expanding the progress made by various countries that the Asian Regional Workshop on Effective Communications for Nutrition in Primary Health Care was held from 3 to 7 October 1983.

The five-day workshop featured eight papers on various aspects of communication, ranging from a broader view of planning to more specific details regarding media production, methodology, and application. Three case studies from Thailand, Indonesia, and the Philippines gave insights into ongoing projects in nutrition communications. Six country reports and three individual reports described the efforts of various countries and institutions in Asia that are working with communications for nutrition education.

Special interest groups discussed planning, development evaluation, and growth charts. Pertinent points were raised in regard to each activity, providing a chance for the exchange of ideas between resource persons and participants.

The small group discussions covered the following four topics:

1. Integration of communication in PHC.
2. Human resources and training needs recommendations.
3. Information network needs and recommendations.
4. Research needs and recommendations.

Problems, constraints, and possible or potential solutions were discussed, and the recommendations for each of these topics were as follows:

Integration of Communications in PHC

1. Increase communication among policy-makers/planners concerned with PHC in the various agencies and ministries.
2. Define common goals for all agencies and revise them until acceptable to all.
3. Establish monitoring and feedback loops between village workers and all levels in agencies and ministries (including reinforcement of "good work").
4. Provide easier channels for communities to request resources and assistance.
5. Use existing community leadership and information networks, with different change agents for different goals.
6. (a) Involve communications experts in early stages of planning and development; (b) provide training programme in communication techniques for all involved in PHC.

Human Resources and Training Needs

1. Recognize the enormous number requiring training in PHC in Asia:

• 300-400 million parents;
• 30-40 million village workers; and
• 20-30 million subdistrict- to provincial-level workers.

2. Train, using strategies to maximize cost-benefit: (a) standardize using same basic training package from top to bottom; (b) "piggy back" content on other successful training programmes (e.g. nutrition may be piggy-backed on family planning); (c) use participative, job/task-oriented training methods - train for behaviour change; and (d) evaluate and monitor the training process (pre- and post-test the training materials).
3. Develop trainers and supervisors of training before starting to train the change agents and caretakers (effective and efficient training requires significant level of skill).
4. Tap other sector resources: (a) advertising agencies, consultants, etc.; (b) other government agencies - family planning, community development, agriculture.
5. A second workshop should be planned with geographic- and problem-specific focus.

Nutrition Information Network Needs

1. Establish a national-policy-level committee to co-ordinate nutrition information activities (include non-governmental agencies).
2. Activate this national committee by: (a) appointing national head of nutrition as member secretary; (b) using mass media to publicize needs; and (c) providing research findings to committees to convey nature and urgency of problems.
3. Establish monitoring and feedback loops between the community and policy level.
4. Set up intra- and inter-country clearing-houses to make nutrition messages consistent.
5. Set up Asian facility for inter-country exchange of information concerning communication projects for nutrition in PHC - perhaps a newsletter sponsored by an international agency like UNICEF.

Research Needs

1. Explore models for scaling up pilot projects.
2. Analyse appropriate task-load for village volunteer workers.
3. Study "positive deviants" with regard to: difference from "average"; - what maintains their behaviour.
4. Research which format/medium is most effective for which type of objective.
5. Evaluate methods of systematic monitoring for decision-making and planning and provision of timely feedback to village workers.
6. Investigate use of growth charts vis-á-vis: (a) mother's understanding of use and purpose; (b) impact on mother's knowledge of normal growth; (c) impact on child's nutritional status; and (d) effect of mother's ownership of chart on child's nutritional status.