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

Assessment

AnalysisAction

Rights Advocacy

Information System

Social Mobilization

Education

Training

Service Delivery

COMMUNICATION

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:

0.0

20.0

40.0

60.0

80.0

%

2000 2005

Children exclusively breastfed

<2 months

2-3 months

4-5 months

Source: DHS

What was done?SINCE WHEN?

WHAT?

2001 Annual breastfeeding event – now one month each year

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

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 in-school 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) Timing Births(2) Safe Motherhood (3) Child Development and Early Learning,(4) Breastfeeding,(5) Nutrition and Growth,(6) Immunization, (7) Diarrhoea, (8) Coughs, Colds and More Serious Illnesses(9) Hygiene, (10) Malaria, HIV/AIDS, (11) Child Protection, (12) Injury Prevention(13) 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.