Annual Ministerial Review (AMR) for Asia and the
Pacific
Beijing 29-30 April 2009.
____________________________
UNICEF’s practices and new initiatives related
to health literacy:
By
Dr. Festo Kavishe,
Deputy Regional Director,
UNICEF East Asia and Pacific Regional
office, Bangkok, Thailand.
UNICEF and “Health Literacy” (1)
• Though not a catchy phrase in UNICEF jargon, UNICEF
has always promoted the principles of “health literacy” as
key strategies to achieve child survival and development.
• Health literacy is critical to the achievement of the health
related MDGs with equity, addressing the changing
epidemiology of maternal and neonatal health and
confronting new emerging threats (like avian and swine
influenza).
• With partners, UNICEF continues to work towards the
achievement of health literacy in the child and health
related MDGs focusing on MDGs 4, 5, the components
of MDGs 1 (nutrition, child poverty), 6 (HIV/AIDS,
Malaria) and 7 (sanitation and hygiene) with MDGs 2
(Education) and 3 (on gender) as cross-cutting.
UNICEF and “Health Literacy” (2)
• With partners, UNICEF supports the development
of capacity and a conducive environment that
enhances health literacy. This includes:
– Basic Education: at least primary education is essential
at individual level to gain health knowledge, develop
the right attitude, behaviour and practice for a good
health outcome;
– Functional and well resourced health systems that
provide effective services including health promotion
and responsive health information systems;
– Good policies that ensure equitable and gender
sensitive health delivery based on evidence and with
conducive legal frameworks.
UNICEF and “Health Literacy” (3)
• Taking the definition of health literacy as the
"ability to gain access to, understand and use
health information for promoting and
maintaining health”, UNICEF uses three main
evidence informed strategies to promote
health literacy:
– Communication for Development (C4D);
– The empowering triple A process cycle of
assessment, analysis and action and;
– Rights-Based Advocacy and social mobilization;
The Triple A Process for community
empowerment & health literacy
COMMUNICATION
Information System
Social Mobilization
Assessment
Rights Advocacy
Education
Training
Service Delivery
Action
Analysis
Some “Literal” health moments that
have greatly impacted child survival:
• Promotion and use of Oral Rehydration
Therapy (ORT) for treatment of diarrhea;
• Promotion and adoption of “hand-washing
with soap” and its impact on reducing the
major three killers of children “diarrhea,
pneumonia and acute respiratory
infections”
• Promotion and large scale adoption of
immunization with high levels of coverage
Beyond individual Health literacy
• Health literacy goes beyond the individual and
incorporates the “knowledge, attitude, behavior and
practice (KABP)” of communities, policy makers and
institutions beyond health.
• It is critical to have enough experts and health workers
who not only form the basis for an “evidence-based”
approach to health, but also are able to address
challenges that go beyond “individual health literacy”.
• Individuals and Communities require high levels of
health literacy for large scale impact of health
interventions;
• Health Policy Makers require high levels of health
literacy to be able to develop evidence-based health
policies that can be translated into practice, monitored
and evaluated.
Example of UNICEF
success in impacting
on child health
through increased
health literacy:
_______________
Breastfeeding:
communication for
behavioural
change in
Cambodia
Exclusive breastfeeding in Cambodia:
C hild r en exclusively b r east f ed
80.0
60.0
<2 m onths
% 40.0
2-3 m onths
20.0
4-5 m onths
0.0
2000
Source: DHS
2005
What was done?
SINCE
WHEN?
2001
WHAT?
2004
Baby-friendly community initiative – now covers
over 2,500 villages in 12 provinces
2004
Broadcast of TV & radio spots focusing on early
initiation and exclusivity
2005
Sub-decree banning promotion of formula for
children under 2 years
Annual breastfeeding event – now one month
each year
What led to success?
• Government priority and strong
support from development partners in
health sector SWAp
• Combination of communication
channels – media, health workers and
village facilitators
• Progressive geographic and
programmatic extension
• Sustained implementation
What did UNICEF do?
• Led conceptually and technically
within a partnership framework, but
most of all got political support
• Provided resources with a focus on
particular behavioural objective
• Tracked results and disseminated
lessons learned
Why the success?
• Consensus among partners that improving
exclusive breastfeeding was critical for
young child survival;
• Political commitment: sub-decree issued on
sale and promotion of breast-milk substitutes
• Resources were availed (financial, human
and organizational)
• Strong partnerships at all levels
• Focused and consistent message through
multiple media and at all levels (individual,
community, and policy makers)
HIV Awareness & Knowledge
In Cambodia
• UNICEF-supported awareness programme among factory workers
contributed to increased comprehensive knowledge of HIV. Twice
as many workers - 59% - are aware of how HIV spreads compared
to 32% in factories without an HIV-awareness programme (Data
from survey conducted in November 2008)
• UNICEF-supported HIV and AIDS information hotline, Inthanou,
received 39,000 calls from both males and females from January to
October 2008, mainly from 15-24 year olds, leading to an increased
awareness and knowledge about HIV among callers. Launched in
2000, the hotline has received over 400,000 calls, averaging over
250 a day in the past few years.
HIV Awareness & Knowledge
• In Indonesia, UNICEF-supported awareness and education efforts
aimed at influencing knowledge, attitudes, and risk behaviour in
selected segments of the population, including young people inschool in Jakarta and Surabaya, demonstrated that nearly all of
those surveyed have heard of HIV/AIDS and more than 60% know
how HIV is transmitted and how to prevent from getting infected
(based on the 2008 Behavioural Surveillance Survey)
• In China, UNICEF facilitated projects using peer-education to reach
out-of-school youth resulted in improved comprehensive knowledge
of HIV transmission and prevention. The projects also led to changes
in behaviour and practice, with 52% of participants in the pilot areas
reporting condom use during most recent sexual activity as apposed
to 24% at baseline
UNICEF’s New Initiatives on health literacy: Individual
and community level
Facts For Life
• 15 million copies disseminated in 215 languages
world-wide by 2002;
• New edition planned for completion by end of
2009
• Brings together the most authoritative information
about practical, effective and low-cost ways of
protecting children’s lives and health, targeting
parents, caregivers, young people, health
workers, teachers, etc. Anyone who reads it
benefits!
• Uses a life-cycle approach to continuum of care
Possible Content of Facts for Life 2009
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Timing Births
Safe Motherhood
Child Development and Early Learning,
Breastfeeding,
Nutrition and Growth,
Immunization,
Diarrhoea,
Coughs, Colds and More Serious Illnesses
Hygiene,
Malaria, HIV/AIDS,
Child Protection,
Injury Prevention
Disasters and Emergencies
UNICEF’s New Initiatives on health
literacy: Policy level
• UNICEF’s outcome of the Asia Pacific
Representatives Meeting (APRM) emphasizing
need for strategic shifts in achieving MDGs with
equity;
• Developing Investment Cases for Health in Asia
Pacific: with Ministries of Health and other
partners, supporting development of country
specific strategic analyses (CSSA) to provide
evidence-base for greater investments in health
through “Marginal Budgeting for Bottlenecks
(MBB)” Analysis.
Two requests to partners
• Adopt and disseminate health literacy
messages from the soon to come Facts for
Life to complement current efforts;
and
• Facilitate the country specific strategic
health investment analyses (Investment
Cases) to increase policy health literacy
for the achievement of the MDGs.