!

Reporting on Health in Africa

By Christopher Conte

About the International Center for JournalistsThe International Center for Journalists, a non-profit, professional organization, promotes quality journalism worldwide in the belief that independent, vigorous media are crucial in improving the human condition.

The Knight International Journalism Fellowships program makes tangible that improve the quality and free flow of news in the public interest. Funded by the John S. and James L. Knight Foundation, the year-long fellowships send international media professionals to countries where there are opportunities to promote reliable, insightful journalism that holds officials accountable. To learn

AcknowledgementsThis manual is a publication of the International Center for Journalists in conjunction with the African Health Journalists Association. It was developed as an online course for African journalists and offered on the ICFJ e-learning site, http://icfjanywhere.org

The International Center for Journalists advances quality journalism worldwide. Our hands-on programs combine the best professional practices with new technologies. We believe that responsible journalism empowers citizens and holds governments accountable. For more, visit www.icfj.org.

The Africa Health Journalists Association is an association of health journalism organizations and journalists dedicated to promoting and providing quality media coverage to improve the lives of people across Africa. For more information, visit www.ahja-news.org

International Center for Journalists

Finding Health Stories

Overview General tips for reporting health storiesGood African Health-journalism on the webAdditional ResourcesFurther ReadingDiscussion with Dr. William Mbabazi

Shaping Health Stories

OverviewFinding good health stories- reporting tips by Brenda WilsonResources Glossaries

Health Systems

Overview A framework for story tellingSuggested Reading

Special Topics

Overview Reporting on traditional medicineEthics and health journalismDiscussion with Dr. Anthony ItonResources

Supporting Health Stories

Reporting and Understanding DHS TablesPractical Tips for using numbersDiscussion with Erica NybroResources

About the AuthorChristopher Conte is a writer, media trainer and consultant based in Silver Spring, Maryland (USA). He was a Knight Health Journalism Fellow from 2008 to 2011 in Uganda, where he worked to build a strong network of health journalists throughout the country. That’s why many of the examples cited in this course come from Uganda.

Before he became a fellow, Conte conducted research and wrote reports health, development, social policy and economic issues for organizations such as the World Bank, the International Finance Corp., the Robert Wood

Johnson Foundation, the American Association of Retired Persons (AARP), Congressional Quarterly, and the Journal of Public Health Management and Practice.

From 1979 to 1994, Conte was a reporter, columnist and news editor at The Wall Street Journal. As a reporter, he covered banking, economics, foreign policy and international affairs, health care, the Supreme Court and transportation. As news editor, he planned daily coverage and reviewed stories for the newspaper’s domestic editions, the Wall Street Journal/Europe and the Asian Wall Street Journal. In 1995, Conte joined the staff of Governing magazine as a correspondent covering public health, immigration, education and other policy issues.

He is a graduate of Harvard College.more, visit icfj.org

International Center for Journalists

Special Thanks

Special Thanks to the Following Contributors

Anthony ItonAnthony Iton, M.D., J.D., MPH is Senior Vice President for Healthy Communities at The California Endowment, a nongovernment organization dedicated to increase access to quality health care in the state of California. In 2009, Dr. Iton began to oversee a ten- year effort to advance policies and forge partnerships to build healthy communities and a healthy California.

Dr. Iton has worked on health issues in South Africa for an organization called Medicins Du Monde (Doctors of the World), and done other public health work in Cuba, Brazil, Azerbaijan and low income communities in the US. He served for seven years as Public Health Department Director and Health Officer for Alameda County, a jurisdiction just west of San Francisco. He oversaw a budget of $112 million with a focus on preventing communicable disease outbreaks, reducing the burden of chronic disease and obesity. Dr. Iton’s primary focus includes health of disadvantaged populations and the contributions of race, class, wealth, education, geography, and employment to health status. Dr. Iton received his medical degree at Johns Hopkins Medical School and subsequently trained in internal medicine and preventive medicine at New York Hospital, Yale, and Berkeley and is board certified in both specialties. Dr. Iton also holds a law degree and a Master’s of Public Health from the University of California, Berkeley.

William B. MbabaziWilliam Mbabazi is an international public health physician, currently working as Health/Measles Delegate, International Response and Programs for the American Red Cross. Earlier, he was a maternal and child health advisor with Management Sciences for Health in the Republic of South Sudan, responsible for providing technical support to the South Sudan Ministry of Health in policy, standards and guidelines formulation, strategic and operational planning, monitoring and supervision in addition to design and implementation of catalytic interventions for accelerated maternal and child health in the new republic. Previously, he worked for the World Health Organization (WHO) as an epidemiologist in !

International Center for Journalists

Reporting on Health in Africa

Uganda responsible for integrated disease surveillance and response. Before joining WHO, Dr. Mbabazi worked for the Government of Uganda, first as a medical officer in a regional referral hospital and then as medical officer in charge of Naggalama, a rural Hospital in Central Uganda. In 2001, he worked as a research fellow in the Sydney, Australia Menopause Centre and performance improvement coordinator in a private network of diagnostics and care facilities managed by Mayne Health Australia before returning to Uganda in August 2002. Dr. Mbabazi holds a bachelor’s degree in medicine and surgery (M.B.Ch.B) from Makerere University in Kampala, a master’s degree in public health from the University of New South Wales in Sydney, Australia and a master’s degree in management from McGill University in Montreal, Canada.

Erica NybroErica Nyrob is a Senior Research Associate at MEASURE DHS/Johns Hopkins UniversityCenter for Communication Programs. She has been with MEASURE DHS for eight years, focusing on communications and HIV/AIDS. She holds a Masters of Public Health degree from the University of North Carolina at Chapel Hill with a specialty in International Maternal and Child Health.

Through MEASURE DHS, Nybro has worked in Ghana, the Philippines, Tanzania, and Ethiopia, and has helped develop materials for 20 additional countries. In 1999 Erica lived in Namibia, attending university and doing research on HIV/AIDS. She is a member of the UNAIDS Technical Working Group on HIV Indicators, and the Interagency working group on Youth and HIV.

Declan Okpalaeke Declan Okpalaeke is a Knight International Health Journalism Fellow based in Lagos, Nigeria and president of the African Health Journalists Association, a pan African network established in 2012.

He is a three-time winner of CNN’s African Journalist of the Year Awards for his coverage of health, science, the environment and sports in Nigeria. He also has served as a mentor for the World Federation of Science Journalists, working with reporters in Africa and the Arab world.

A native of Nigeria, Okpalaeke has worked as a top editor at several Nigerian publications, including Tell magazine, Insider Weekly, and News Digest International, a monthly human-

!

!

Special Thanks

interest magazine. He began his reporting career at The Guardian newspaper in Lagos. In 2004, he was named a Nieman Fellow at Harvard University.

Okpalaeke serves as judge at the Nigeria Academy of Science/Pfizer Science Journalism Awards, and for the Red Ribbon Awards for HIV/AIDS reporting. He is a member of the Nigeria Union of Journalists (NUJ), Nigeria Guild of Editors (NGE) and International Reporters and Editors (USA). He holds a bachelor’s degree in microbiology and a master’s degree in mass communication.

International Center for Journalists

We all know that health in Africa (or anywhere else) is a huge topic. We won’t be able to cover everything in this training manual. But we will be able to touch on

many issues, suggest ways you can approach health reporting, and provide resources that can help you in your work.

Each chapter begins with a presentation of key issues, provides practical reporting tips, suggests further reading so you can dig deeper, and features

discussion excerpts from health policy and journalism experts and fellow health journalists.

Introduction

Introduction

1

Reporting on Health in Africa

!Chapter 1: Finding Health Stories

OverviewA health reporter once gave this simple reason for loving his beat: “Everyone has a body.” In short, health journalists convey information that is relevant to every reader, viewer and listener. What beat offers greater opportunity?

The question applies especially to Africa, which is struggling to deal with a wide range of of infectious diseases like tuberculosis and HIV/AIDS; rapidly emerging non-communicable diseases like hypertension and diabetes; a less noticed but widespread incidence of mental disorders like depression; and a host of under-reported (and often under-treated) “neglected” diseases. African health authorities must address these problems with underfunded and often poorly developed health systems that so far have been unable to tame illnesses like malaria and polio that have been eradicated in many other parts of the world.

International Center for Journalists

Finding Health Stories

In this chapter, we ask you to take a broad look at health issues in Africa, consider the situation in your own country, and think about some story ideas.

The Big Picture

In 1978, leaders from around the world defined health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.” They went on to describe health as a “fundamental human right,” and said achieving good health for everybody “requires the action of many other social and economic sectors in addition to the health sector.” (Alma Ata Declaration, 1978: http://www.who.int/publications/almaata_declaration_en.pdf).

This suggests that health journalists should consider focus not only on what doctors, hospitals and ministries of health do, but on a much wider set of institutions and issues. Health issues can be found in almost every sector and institution. Bad roads are a health issue since they are a major cause of automotive injury and death. Inadequate water and sanitation facilities cause widespread diseases like diarrhea. Schools may have as much impact on health as hospitals; some experts believe, for instance, that one of the best health-promoting policies imaginable would be to place nurses in schools. And don’t forget economics: Health problems are both a consequence and cause of poverty and slow economic growth, and while economic development solves some health problems (by making it easier to finance health infrastructure, for instance), it causes others (for instance, by encouraging eating patterns that contribute to modern plagues of obesity, diabetes and hypertension).

The list of health issues that stretch beyond the health sector goes on and on. Public health experts talk about a broad array of factors that influence health (http://www.who.int/hia/evidence/doh/en/). All are fertile ground for health journalists. These “determinants of health” include:

The Environment. Some long-standing threats exist in nature. Mosquitoes carry malaria, for instance. A deficiency of zinc and magnesium is believed to increase the risk of depression. Tsetse flies carry sleeping sickness. Parasitic worms that live in contaminated bodies of water carry schistosomiasis (bilharzia). The man-made environment is at least as much a challenge. Air pollution contributes to asthma and emphysema, for instance. Poor sanitation is a major cause of cholera and diarrhea. Unregulated or poorly regulated mining and manufacturing can contaminate water supplies. The importance of the environment has a health issue is certain to grow in the years ahead as global warming leads to profound changes in human settlement patterns, food supplies and the spread of microbes that carry disease. (http://www.who.int/topics/environmental_health/en/)

2

3

Culture and ethnicity Cultural attitudes can have a significant impact on health, both for good and for ill. A study in Nigeria found that some cultural attitudes promote good health; a belief that women should refrain from sex during lactation promotes child spacing, for instance. But numerous other cultural attitudes are less constructive. A reliance on untrained traditional birth attendants puts women who develop complications during child birth at risk. Female circumcision creates numerous obstetric problems, and helps spread the HIV virus. And traditional ways of building homes leave families vulnerable to malaria-bearing mosquitoes (http://medikkajournal.com/culturalpractices.htm).

Social and Economic Conditions People who are poorest and most disadvantaged are more likely to face illness during their lifetimes and die younger than people who have higher incomes. More broadly, everyone suffers adverse health consequences arising from poverty – both because contagious diseases often break out in poorer communities before spreading to the population at large and because ill-health is a cause of slow economic development. (http://www.healthpovertyaction.org/policy-and-resources/the-cycle-of-poverty-and-poor-health/the-cycle-of-poverty-and-poor-health1/

Education Schooling and health are closely interrelated. Indirectly, education influences health by contributing to economic development, just as efforts to improve health promote better education by reducing absenteeism and drop-out rates. On an individual level, studies have shown that one of the best indicators that children will be healthy is how well educated their mothers are; well-educated mothers more likely to make sure their children are vaccinated, have proper diets and stay in school. While such linkages are well known, good journalists go beyond abstractions to look at the particular factors that influence the complex connections between health and education – as the New York Times did in a story that showed that the absence of adequate latrine facilities is a major contributor to high drop-out rates among girls in some countries (http://www.nytimes.com/2005/12/23/international/africa/23ethiopia.html?pagewanted=all&_r=0

Individual characteristics and behaviors Research shows that some people have a genetic predisposition to diseases like diabetes, hypertension, asthma and arthritis (http://www.who.int/genomics/en/). Behavior, including diet, has at least as important an effect; unsafe driving increases the risk of automobile accidents just as unsafe sex increases the risk of HIV/AIDS. Age is a key risk factor for many diseases; children are more vulnerable to malnutrition and malaria, while older people are more at risk of suicide and developing Parkinson’s disease, dementia and many forms of cancer

Reporting on Health in Africa

International Center for Journalists

Finding Health Stories

General tips for reporting health storiesYour first obligation, of course, is to get the facts right and explain them clearly. Journalists who deal frequently with experts can easily fall into the trap of talking like their sources, using too much jargon and technical language that confuses non-experts. Jargon is a convenient short-cut for people who know their fields well, but journalists must avoid it. You must learn how to explain health issues in everyday language so you can do the same for your audience. Fortunately, there are a number of high-quality web sites that specialize in just that. Among the best is Medline Plus (www.medlineplus.gov), which provides easy-to-use background information on more than 900 health conditions and issues, all written in everyday language and reviewed by panels appointed to ensure scientific accuracy. Medline Plus is produced in the US and funded by the US government – and hence tends to emphasize the health concerns of North Americans. You can fill the gaps by using the World Health Organization web site (www.who.int). WHO, which leads United Nations’ health efforts all around the world, offers a more global perspective.

Describe the magnitude of the problem Health experts usually express this in terms of the number of persons affected per 100; 1,000; 10,000 or 100,000 of the general population. Knowing that a problem affects only, say, one in 10,000 people helps give a news consumer perspective. Magnitude also can be described in terms of the economic cost of the problem to individuals, their families or taxpayers. But because both a simple count of numbers of people affected and an economic analysis are crude, there are other measures, including the “burden of disease” which combines the mortality, morbidity, financial costs and other factors to measure the impact of different diseases. The burden of disease often is expressed in “disability-adjusted life years,” which combines years of life lost due to premature death and years lived with disability. (A list of these and other measures can be found in this article: “Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990—2010: a systematic analysis for the Global Burden of Disease Study 2010,” The Lancet, Volume 380, Issue 9859, Pages 2197-2223, 15 December 2012 (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961689-4/fulltext).

Tell people what they need to know to understand, cope or prevent health problems.

To do this, you must:• Explain how the problem is caused and perpetuated in individuals and at

the population level

• Describe how the condition might be recognized at the household level or among acquaintances.

4

5

Reporting on Health in Africa

• Examine what the public thinks about the problem. Do public officials correctly perceive public attitudes, and are their messages getting through?

• Identify current or available treatments to cure, control or halt the spread of the problem.

• Define what can be done to control or prevent the condition.

Don’t neglect preventive health. Preventing disease even from happening delivers better results at a fraction of the cost of most medical treatments. The World Bank has created a measure allowing for cost-effectiveness comparisons between different health strategies. It turns out that the most effective treatments – the ones that could improve the quality of life for the most people at the lowest cost – are within the budgets of low-income countries (www.dcp2.org). These “best buys” include:

• Routine vaccinations against tuberculosis, diphtheria, whooping cough, tetanus, polio and measles;

• Routine monitoring to prevent or treat pneumonia, diarrhea and malaria;

• Taxing tobacco products to increase costs and reduce consumption;

• Giving pregnant women and children essential nutrients, including Vitamin A, iron and iodine to prevent maternal and infant deaths and complications;

• Enforcing traffic regulations and installing speed bumps at dangerous intersections;

• Teaching mothers and birth attendants to keep newborns warm and clean;

• Promoting use of aspirin and other inexpensive drugs to prevent heart attack and stroke;

• Providing insecticide-treated bed nets, indoor spraying of insecticides and preventive treatment for pregnant women to reduce malaria.

When writing about science, exercise caution.

Specifically:

• Don’t exaggerate the importance of individual studies. There is always a temptation to blow a science story up into more than it really is. In reality,

International Center for Journalists

6

Finding Health Stories

science moves in slow, incremental steps. Most studies, while interesting, are not conclusive. Gary Schwitzer, editor of the online health-journalism review HealthNewsReview.org (www.healthnewsreview.org), says journalists should avoid using certain words that inflate the actual significance of incremental medical news stories or play on the hopes and fears of people who suffer diseases. His banned words include, “cure,” “miracle,” “breakthrough,” “promising,” “dramatic,” “hope,” and “victim.” (http://www.healthnewsreview.org/toolkit/tips-for-understanding-studies/7-words-and-more-you-shouldnt-use-in-medical-news/)

• Distinguish between scientific fact and scientists’ opinions. Scientists are human, and hence may be tempted to exaggerate the meaning of their research either to attract attention to it or keep a funding stream flowing. There is nothing wrong with reporting scientists’ opinions, though, so long as you consult a range of experts and clearly distinguish between fact and opinion.

• Always check to see who paid for a study and who benefits from it. Industries that pay for research almost always get the results they want. The pharmaceutical industry is a good example, but by no means the only one. A study sponsored by an industry with a stake in the results should be taken with a grain of salt.

Use multiple, varied and reliable sources. Among other things, that means you should:

• Verify the qualifications of your sources. What are their academic credentials? Are they affiliated with credible and independent research or health-care institutions? Have they published in peer-reviewed journals? Medline Plus offers some good tips on evaluating the reliability of online health resources. (http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html)

• Seek a diverse set of sources. Don’t rely on experts alone. You also need to consult with policy-makers, “consumers” of health services and bystanders. Important stories can emerge from the contrasts between what the various sources will tell you – if, for instance, experts don’t agree with policy-makers, or if members of the public don’t understand or heed expert recommendations. Also, look for second- and third-level officials, not just bosses. Frequently, the heads of government agencies or organizations are too concerned with their public image or too threatened by shifting political winds to be forthcoming. Also, they often don’t know as much about an issue as the technical professionals just below them because they are responsible for a broader range of matters and, in the case of government, may be appointed for political reasons, not because they know a lot about the subject. Lower-level staff people

7International Center for Journalists

Reporting on Health in Africa

may be better sources, but you may have to guarantee them anonymity in order to get them to talk with you.

• Look out for conflicts of interest. Health is big business. Private companies spend huge amounts of money to influence how governments, front-line health providers and consumers spend their money on health. Investigate and report possible links between sources of information, such as studies and experts, and manufacturers, governments, researchers, universities, drug companies, device manufacturers and nongovernment organizations that may have a vested interest in promoting a certain idea, strategy or therapy. Because conflicts often can be hidden from public view, one of the best ways to avoid being misled is to use multiple sources.

Look critically at public health interventions. Are they working? If not, why aren’t they? What do they cost, and can they be brought to scale? What political forces are aligned behind particular approaches and against others? Are officials creating an environment in which behavior-change communication projects can succeed? If, for instance, they are promoting family planning, are they ensuring that adequate supplies of contraceptives are available?

8

Finding Health Stories

Good African health-journalism on the webOne of the best places to start getting ideas and hone your own skills is to see what your peers are reporting. Below are web sites where you can find some of the best health journalism in Africa.

SciDev.Net (http://www.scidev.net/global/health/). The Science and Development Network is just what its name suggests: an organization devoted to promoting science and development. It’s a rich source of news. Please note the navigation tool on the right side of the page: it enables you to sort SciDev’s many stories by topic, region of the world and country. Also of particular interest to health journalists are a series of practical guides for reporters (http://www.scidev.net/global/content/practical-guides.html).

UN Dispatch (http://www.undispatch.com/7-surprisingly-good-global-health-news-sources-you-might-not-know-about). This site, backed by the United Nations Foundation, provides news and commentary on UN issues, and lists a number of lesser-known but very useful web sites and blogs that provide interesting and different angles on health issue.

IRIN (http://www.irinnews.org/theme/hea/health-nutrition). The Integrated Regional Information Networks often carries useful health stories. IRIN describes itself as an editorially independent, non-profit project of the United Nations Office for the Coordination of Humanitarian Affairs. Funded by contributions from governments and other institutions and based in Nairobi, Kenya, it has regional desks in Johannesburg, Dakar, Dubai and Bangkok and a network of local correspondents.

National Public Radio (http://www.npr.org/sections/global-health). The best radio journalism in the US comes from this organization, which draws support from individuals, governments, foundations and corporations. The site has good health stories, including some audio clips that epitomize high-quality radio reporting.

Health-e News Service (http://www.health-e.org.za/). This non-profit news agency provides public health news to mainstream television, radio stations, newspapers and magazines in South Africa. It uses a very broad definition of health, including in its coverage social and socio-economic issues that affect the physical and mental wellbeing of people.

Additional ResourcesThe Forum for African Investigative Reporters (FAIR) has developed an Investigative Journalism Manual, a step-by-step manual that covers everything from finding stories to gathering information and writing (http://fairreporters.net/ij-manuals/). Particularly relevant to this week’s topic is Chapter 2, “Generating

9International Center for Journalists

Reporting on Health in Africa

Story Ideas” (http://fairreporters.files.wordpress.com/2011/11/chapter_2-story-ideas.pdf).

AllAfrica (http://allafrica.com/health/). All Africa aggregates, produces and distributes more than 2,000 news stories daily from more than 130 African news organizations and its own reporters. It operates in Cape Town, Dakar, Lagos, Monrovia, Nairobi and Washington DC.

The Lancet and Journal of the American Medical Association (www.lancet.com, http://jama.jamanetwork.com/journal.aspx). Peer-reviewed professional journals are the gold standard for information on health. They also can be very technical, and because advances in scientific knowledge usually come at a snail’s pace, finding good stories on them can be a challenge. But since they publish vast amounts of important health-related research, journalists should become accustomed to using them.

Stanford University Libraries (http://www-sul.stanford.edu/depts/ssrg/africa/health.html. This university-based site provides an extensive index of websites with news, information and research related to health in Africa.

World Newspapers (http://www.world-newspapers.com/africa.html). This site has links to news sites in 55 African countries, plus a number of pan-Africans.

Further Reading

Take a look at The World Health Organization’s “The African Regional Health Report: The Health of the People,” (http://whqlibdoc.who.int/afro/2006/9290231033_rev_eng.pdf), a comprehensive report on the health of the 738 million people living in WHO’s Africa region. It’s long but easy to read. Then, check our Discussion with Dr. William Mbabazi, the Health/Measles Delegate for American Red Cross Programs. You can find his biography under “Special Thanks” in the introduction to this manual.

10

Shaping Health Stories

!Chapter 2: Shaping Health Stories Overview

Picking a general topic for a health story is an important step, obviously. But it is just the first step. Once you have a topic, you have to decide on the general approach you will take, the particular angle, the theme and the actual structure of the story. In this chapter, we will talk about these stages in developing a story, provide you some tips on health reporting, and conclude with a pragmatic discussion with one of Africa’s leading health journalists.

Much of the material in this overview is drawn from the work of William Blundell, a former Wall Street Journal reporter who taught many of the Journal’s writers. Blundell compiled his own ideas in “The Art and Craft of Feature Writing,” which can be purchased but, unfortunately, cannot be read, online.

11International Center for Journalists

Reporting on Health in Africa

Approach

After you have settled on a topic, you have to decide on the most appropriate general approach to covering it. This can be a challenge for reporters who cover health, since your specialty is quite broad. Blundell suggests choosing between several different approaches:

• Round-ups collect information on the diverse ways a particular issue arises – the many ways a new trend manifests itself, for instance, or the different ways people respond to it. How well is a new national policy being implemented at the local level? Contact local officials and health experts in different geographic regions. Look for data that shows whether the policy is having a measureable impact. What impact is a certain disease having on society? Contact health providers, employers, school officials. What is the evidence that a behavior-change communication project is working? Contact experts and ordinary people. Round-ups need to be focused. You have to focus on a particular issue that you can manage.

• Profiles explore a given topic or issue in depth. Although the term often is used to describe stories about individuals, Blundell uses it to describe any story that explores one issue, person or event. Because of their singular focus, profiles have to be intrinsically interesting and important.

• Microcosms are like profiles except that they represent case studies designed to shed light on a broader issue. The challenge with microcosms is that they must illustrate the bigger issue or trend you are trying to illuminate. It often is difficult to find a single case study that perfectly embodies your bigger subject. So sometimes it’s best to have several case studies that together tell the whole story.

Stuck? Try a new angle

One of the biggest challenges a journalist faces is to find new ways to tell old stories. How many times can you report that smoking is bad for people’s health? What has NOT already been reported numerous times about malaria or HIV/AIDS?

Perhaps we can all learn a lesson from good photographers: Try a new angle. There are techniques to look for new ways to tell such important stories. In “The Art and Craft of Feature Writing,” William Blundell suggests some techniques:

Extrapolation: Sometimes, an event or issue may seem over-covered, or not big enough or significant enough to justify a big effort. Blundell recommends thinking about it in terms of cause and effect. You can work your way back on the chain of causality and ask what caused the phenomenon you are examining. Or you can try to look ahead and ask what effects the issue may have in the future. Often,

12

Shaping Health Stories

complex phenomena – consider the shortage of trained health personnel, for instance – have numerous effects, each of which could be turned into a story all by itself.

In India not long ago, the Hindustan Times newspaper ran a brief story about an elephant that trampled a child to death. An astute editor wasn’t satisfied with a

straight news story, so she did some research. She soon learned that the incident was not an isolated event, and that conflicts between animals and people are becoming more frequent as humans increasingly encroach on

undeveloped regions. Another editor at the Mumbai Mirror learned about the story and followed up. He found that in another part of the country, attacks on

humans by tigers were on the rise for much the same reason. His inquiry opened another interesting issue to be explored: The problem was mainly affecting poor populations who were settling on public lands because they had been displaced from their native lands. At this point, a single story about one little boy’s tragedy

had grown into a series of stories with health implications affecting the whole nation.

Localization: We all know and use this technique often. You read a global report by, say, an international organization. Your editor is interested, but only if you can find a local angle. So off you go to find the local example that illustrates the global trend. In effect, you are doing a “microcosm” story.

Localization is a useful technique, but only if you dig to find a genuinely local story. Just as people don’t like being stereotypes in tourists’ photographs, they

don’t like being props in reporters’ stories. So while a global report is a good lead that warrants in-depth reporting, strive to learn what’s unique and important

about the individuals you interview. If an NGO helps you find the “real person” who exemplifies a global trend, do your own interview, listen to what your

sources tell you (not just what you or your sponsor want to hear), and then interview some people besides the ones the NGO trots out for you. At a

minimum, your story will be more interesting. Quite possibly, you’ll actually come back with a different – and better—story than your hosts handed to you.

Personalization: In this variant of “localization” or “microcosm,” you tell the story through the eyes of one person.

We’re all familiar with anecdotal lead; starting a story with an anecdote about one person or one event that draws readers in is a tried and true journalism

technique. But it can be overdone, a technique that is easy for the writer but is so common that some readers get tired of it. An alternative approach is to tell the

whole story through the eyes of a single person. You could, for instance, describe a disease by recounting one person’s experience with it. Or you could explain a complex science story – the search for a malaria vaccine, for instance – by telling the story of a scientist who has devoted his life to that single pursuit.

It can make riveting reading, and the essential scientific and technical information can be painlessly weaved into the narrative.

13

Reporting on Health in Africa

In this story, a reporter brought an array of statistics about health to life by describing them through the eyes of one little girl: “Hello, my name is Nimo, and

this is the story of my life” (http://www.nation.co.ke/Features/DN2/Hello+my+name+is+Nimo+and+this+is+the+story+of+my+life+/-/957860/1332020/-/item/

0/-/39a12h/-/index.html)

Projection: Think beyond the moment to what may happen next. While other reporters rehash what’s in a just-released report, for instance, try building your story around what impact it will have, or look back at earlier reports and see if the situation or the proposed solutions have changed. If they haven’t, ask why. When you cover a press conference or briefing, ask yourself why it is happening now or what impact it will have. Often, the real story can be found in the dynamics that led up to the event.

Most African health reporters have written stories about shortages of doctors and nurse. In many countries, it’s a perennial issue. But you can add depth and new dimensions by exploring the impact of the shortage: Stress among overworked

health providers may lead some to emigrate or quit and others to abuse patients; caregivers may make too many mistakes; people may rely more on traditional

medicine; unqualified people may dispense drugs; diseases may spread needlessly; and illnesses that could have been treated easily if caught early may

become serious or even life-threatening.

Changing Perspective: One of the best ways to get a fresh angle on a story is to look for sources who can give you a different viewpoint.

!

International Center for Journalists

14

Shaping Health Stories

When reporting on the brain drain, instead of simply describing the problem, why not talk to the brainy people who have emigrated? (Hint: It’s not always simply a matter of seeking “greener pastures” for themselves, but rather because lack of funding and infrastructure in their own countries prevents them from practicing

their professional skills). In addition to reporting on the symptoms and treatment of a disease, why not produce a story about the effects of the disease on families of the people who are ill? Instead of just doing the standard story on poor health

infrastructure, why not talk to businesses to see how they cope with high absenteeism resulting from frequent illness, or to foreign businesses to see what impact the availability of good health services has on their decision whether to locate or expand in your area? Or instead of waiting for the next outbreak of

cholera, why not spend time in a slum and describe what happens when rains produce more water than drainage systems can remove?

Finding good health stories- reporting tips by Brenda Wilson

Brenda Wilson is a veteran health reporter for National Public Radio. Based in Washington, DC, she has reported on health issues through the US and in many other parts of the world. She also has served as a Knight International Health Journalism fellow based in South Africa.

A story may start with an event, such as a fire, a demonstration, revelations by or about a newsmaker (something he said or did), a car accident, an outbreak of disease, a new and major policy development, an idea. It could be an unusual case, a statistic. Peel the layers back.

An event or release of a report or study is probably the easiest to cover.

Depending on the source of the story, here are some things to think about. If an idea or issue has been brought to your attention by a press release, who is putting it out and why? What do they have to gain by this information being known, the story being told? Who benefits? Who loses?

15International Center for Journalists

Reporting on Health in Africa

What are the facts?

What is/are the source of the facts? Are the people using the facts using someone else’s information? How does their interpretation differ from the primary source? Ask them how they know what they are saying. Can they back it up? Is there a person who doesn’t want to go on record, who can give you a better understanding, and better information?

It’s always a good idea to know the primary source of the information, as well as the people who have studied and analyzed it, and the people reacting to the information.

This may involve research and that may mean talking to many different people within the time it takes to meet your deadline. Unless the person you call is an expert whom you trust to provide information about several facets of the story, be prepared to call several people.

If your news organization has a research center, then use it. If the information comes in a form that is not easy to use, they need to know this. But researchers who work for journalists can often pull a couple of articles that provide an overview and/or background on a subject, as well as quick takes on several perspectives and points of view, identifying likely sources, organizations and or individuals it would be helpful to speak with.

Preparation can take an hour, a day or several days depending on the kind of story you’re doing and the amount of time you have to do it.

The best sources

Here’s a good thing to keep in mind. The person with the answer is not always the top official, but the underling, the person who prepares the position paper who often feels neglected and overlooked. Find them.

If you have a beat, it’s a good idea to develop a relationship with a person whom you trust to understand and explain issues who doesn’t always need to be a part of the story.

In one day, for example, for a story on black lung disease in coal miners in a region where a mine explosion had just occurred, I had to determine which mines were associated with the highest number of deaths, disability claims, and where they were located and who owned them. This information actually existed on an occupational health and safety web site that was managed by one woman, who had been tracking the information for the government for decades. From her I identified several mines and narrowed my focus to clinics that served the workers with a high rate of cases. The owners of the mines turned out to be the same owners of mines in which the explosion had occurred, though they refused to answer questions about any disability claims for black lung. The government

16

Shaping Health Stories

office responsible for surveillance was only answering questions off the record. Initially they didn’t respond at all, until they realized I already knew most of the story and the process by which these claims were reviewed and decided. So they found three experts who were willing to answer my questions – all off the record.

This is not unusual. The more you know, the more cooperation you’re likely to get, and the more people are willing to tell you.

Keep in mind that your responsibility as a journalist is to add to the store of information, not just to repeat a story, but to help people to understand.

You can, of course, do this by making sure that all “sides” are represented, not just “the other side.” It helps to know what consequences are involved, what affect money may have, how far reaching an incident may be, why it happened, as well as the key players, and their role in events.

Challenge conventional assumptions.

But make sure you are sensitive to them and aware of them. Don’t assume you know the truth.

There are lies, denials, things people don’t say, diversion, disinformation and distraction that can steer you away from the story.

Don’t rush through an interview because the official appears rushed, or too important. Make sure the most essential questions are asked first in such cases, but be aware that these techniques are designed to keep you from asking the questions you really want answers to. Be respectful, but don’t rush your questions.

Give the person being interviewed a chance to make their case. They are more likely to answer further questions and you can argue that you want to be sure that you understand what they have told you.

Officials are usually prepared to answer any question you throw at them. That’s their job, either that or to avoid answering questions. They didn’t get where they are, or remain there, by not knowing answers or being able to handle the media. Be prepared for the denial, the obfuscation, and the answer that meanders. Usually, the person will say something like, “Well that’s not really the question.” It’s up to you to remember your question, why you asked it, and to ask it again.I find it is useful to begin with an open ended, but focused question. Don’t forget why you are talking to them, but don’t presume you or anyone else already knows the answer.

Develop a list of key issues and prioritize them in order of their importance, immediacy, likelihood of surfacing as news.

International Center for Journalists

Reporting on Health in Africa

Anticipate. Go Deep. Get Close.

For health reporters, this means having enough information to be able to sell them as news, as stories worthy of air time that will hold the listeners’ attention.Health reporting. It’s a broad subject, with its tentacles in every facet of human lives: social, environmental, political, economic and the personal.It has changed the course of human history, undermined governments and laid waste to economies. Ask India about the cases of bubonic plague in 1994 that slowed travel to the country to a trickle before it was brought under control. Or think of SARS and Canada.

Some of the best reporting on health and medicine treats the subjective like a good “who done it” with a body, a host of characters, and the cause of death or well being, explainable and unexplainable developments, and an endless amount of clues that can be found in statistics and a variety of human stories, profiles and analyses.

And like most good stories, the good ones about health will practically tell themselves if a reporter is furnished with good information, facts, personalities, and conversations.

So whatever you do, don’t lose sight of the mysterious, the dramatic and above all your sense of humanity.

Resources

Tools to develop your reporting skills

The Investigative Journalism Manual published by the Forum for African Investigative Reporters (FAIR) devotes chapters to story planning (http://fairreporters.files.wordpress.com/2011/11/chapter_3-planning.pdf, dealing with sources and spin doctors (http://fairreporters.files.wordpress.com/2011/11/chapter_4-sources.pdf), forensic interviewing (http://fairreporters.files.wordpress.com/2011/11/chapter_5-forensic.pdf), and basic research tools (http://fairreporters.files.wordpress.com/2011/11/chapter_6-research.pdf).

SciDev’s Practical Guides (www.scidev.net/global/content/practical-guides.html). The leading science-oriented journalism web site maintains a special area for journalists to hone their own reporting skills. Read postings on science journalism, data journalism, digital tools, how to report on science topics in local languages that may not have equivalents for scientific terms, how to dig beneath the surface and find the real stories behind press releases and more.

17

18

Shaping Health Stories

HealthNewsReview (www.healthnewsreview.org). This site suggests standards for health reporting – and then applies them to specific stories. See how you would judge a story, and then see how the experts did – and why.

African Health Journalists Association (www.ahja-news.org). A group of health journalists have established this organization to help African journalists help themselves. Please check it out – and consider joining!

Association of Health Care Journalists (www.healthjournalism.org). This organization, much older than the African association, includes in its resources section a variety of tip sheets, health data, reporting guides, blogs and more on a wide range of health-related topics.

Glossaries

The Kaiser Family Foundation’s Global Health Glossary (http://globalhealth.kff.org/Common/Glossary.aspx).

Medline Plus Medical Dictionary (http://www.nlm.nih.gov/medlineplus/mplusdictionary.html); For definitions and background on specific health conditions, see Medline Plus – Topics (http://www.nlm.nih.gov/medlineplus/healthtopics_s.html)

“The A to Z of Kenya’s Health.” A story that gives readers a lot of information about health issues in their country in an engaging way (http://www.nation.co.ke/Features/DN2/The+A+to+Z+of+Kenyas+health/-/957860/1466422/-/t1vd7e/-/index.html).

19

Reporting on Health in Africa

!Chapter Three: Health Systems

OverviewOf all the many determinants of health, some of the most important are the many institutions designed to protect people from disease and ensure good health. In chapter three, we will focus on these institutions and their interactions, collectively called the “health system.”

For health journalists, the health system involves both a particular set of topics and – perhaps more importantly – a way of looking at almost any health topic. We’ll consider each of these matters in turn.

International Center for Journalists

20

Health Systems

Health Systems Topics

Service Delivery. How are the institutions that provide routine and emergency health care organized? As WHO sees it, countries need networks of primary-care providers close to the grassroots, backed up by more specialized institutions to provide advanced care; a comprehensive package of benefits that ensure people’s needs are met; standards to ensure access to high-quality care; and mechanisms to ensure that health providers are accountable and consumers have a voice in their care and in how the system is organized. Some specific issues include:

• Efficiency. Are there bottlenecks in the network of health-care institutions, and if so where do they occur? In 2008, a path-breaking story in Uganda’s Daily Monitor newspaper, part of a five-part series, described a systemic breakdown in the country’s hospital system. The country maintains a network of grass-roots health-care facilities that theoretically provide basic, or primary, care so that a small number of regional referral hospitals can take the more complex cases that require specialized care. But in practice, the local facilities are so poorly equipped and staffed that they cannot handle their caseloads, so many patients to go straight to the regional facilities for routine care. As a result, the regional facilities are overwhelmed. This is a classic example of system failure (Unfortunately, the article is not available online for free, but it is available to subscribers of All Africa.com (http://allafrica.com/stories/200805301111.html).

• Quality. What standards exist to ensure quality of care in various institutions? Are standards enforced, and if not, why not? Journalists periodically report cases of abusive behavior by health personnel. But they need to dig deeper. This is a perfect example of where a shift in perspective can produce insight: In many cases, health workers must deal with overwhelming workloads; stories that focus on health workers’ bad behavior without explaining their great stress are missing an important part of the story.

• Patients’ rights. If people seeking treatment are not satisfied with their care, what recourse do they have? Journalists tend to live in the realm of the anecdote. Often, when we highlight a specific case of abuse, it gets fixed – at least temporarily. But we often neglect to ask the tougher questions: Is there something about the way systems are organized and run that causes abuse, and what can be done to fix it? Those are questions for policy-makers, but you also can offer consumer advice: Tell your audience what they can do if they get poor service. If they lack recourse, that is a very important story too.

International Center for Journalists

Reporting on Health in Africa

Health Workforce. Sub-Saharan Africa has just 1.3 percent of the world’s health workers, but accounts for 25 percent of the global disease burden. Some 57 countries face critical shortages of health-care workers – an estimated shortage of 2.4 million doctors, nurses and midwives. To put it another way, Africa has 2.3 health workers per 1,000 people – about one-tenth the figure in the Americas (http://www.ishib.org/journal/19-1s1/ethn-19-01s1-60.pdf). Journalists must chronicle this crisis, and provide realistic reporting on what is being done to address it. In particular:

• Consequences. What are the consequences of the manpower shortage? Obvious answers include inadequate preventive care; greater reliance on traditional healers; and many cases of disease and death that could have been prevented. But there are less obvious consequences too – absenteeism in workplaces, for instance, and a shortage of rural manpower (because of rampant sickness). Can you think of others?

• Causes. What role do poor compensation and working conditions play in causing shortages of health workers?

• Possible solutions. To what extent could authorities alleviate the problem by training non-professionals to provide some routine health-care services? A number of countries have developed cadres of community health workers and are turning to “task shifting” to enable less-trained health workers to take on some of the work previously reserved for doctors. Since the shortage of professionals is unlikely to be fixed any time soon, this deserves close attention.

Financing. How do governments raise and distribute funds for health, and how do societies protect individuals and families from the potentially-devastating economic effects of serious illness? What safeguards are in place to ensure that health funds are spent efficiently and without corruption? Are they working? Obviously, this topic alone is big enough to keep health journalists occupied full-time. A few key issues include:

• Overall spending. Are countries spending as much as they reasonably can be expected to spend on health? In the famous Abuja Declaration of 2001, African Union countries pledged to devote 15 percent of their annual budgets to health. Many have fallen short of that commitment: (http://www.who.int/healthsystems/publications/abuja_declaration/en/) .

• Sources of funds. How are funds raised to pay for health systems? In part, the question is whether taxes are imposed equitably so everybody pays a fair share to support the system. Equally important is the question of whether the funds are raised from donors or from sources within countries. While donor money is very important, especially in the poorest African countries, critics suggest donors traditionally have concentrated their funding on programs to address specific diseases rather than building the long-term capacity of health systems. They also suggest that

21

Health Systems

when governments rely on donor funding rather than raising funds from their own citizens through taxes, they avoid accountability to their own people.

• Protection from risk. To ensure equal access to basic health services, countries need a strategy for funding basic health care for the poor and for sheltering the poor and the middle-class from the devastating financial effects of serious illness. Generally, countries in Africa accomplish these goals either through state-funded health care systems, social health insurance, community-based health insurance, voluntary health insurance – or, in many cases, a combination of two or more of these strategies. Each approach has its advantages and disadvantages, and journalists need to spell out the options and track how well their countries’ approaches are working.

• Management. Sometimes the way funds are spent can be as important as how much is spent. As government-run health systems have encountered problems, some countries are experimenting with different approaches to providing health care funding – including voucher systems, in which individual consumers can decide how funds are spent for their health services, and franchising arrangements in which public money is funneled to private health-care providers that meet certain standards.

Access to Essential Medicines. Medical products are the second largest component of most health budgets after salaries, and the largest component of private health expenditures in low and middle-income countries. There are numerous issues to cover, ranging from supply, safety and consumer use – and misuse – of pharmaceuticals. Some potential areas of focus include:

• Vaccinations. In some areas, many children don’t get their recommended vaccinations. Journalists can play an important role in explaining the importance of vaccinations and exploring the barriers that keep vaccination rates low.

• Supply. Stories about shortages of certain medicines and devices are common. But the reasons for “stock-outs” often can be obscure or poorly understood. In this chapter’s readings, one reporter analyzed a chronic shortage of contraceptives; she learned that the problem isn’t simply inadequate supply, but rather a complicated lack of feedback between the national supplier of medical supplies, consumers and health-care provider concerning the type of contraceptives women want.

• Misuse of drugs. While journalists routinely hold institutions and professionals to high standards, we also need to report on the failure of consumers to use drugs properly – including self-prescription and failure to follow instructions on how to take medicines. One result is the

22

23International Center for Journalists

Reporting on Health in Africa

emergence of drug-resistant forms of illnesses like malaria and tuberculosis.

Governance. According to WHO, effective governance includes defining and maintaining the strategic direction for health policy; detecting and correcting problems and undesirable trends; articulating the case for health in national development; regulating a wide-range of institutions that comprise the health sector; and establishing transparent and effective accountability mechanisms. Health journalists should focus is on several key issues, including:

• Policy Statements. Reporters should look at the government’s official statements concerning health policies. While often shrouded in jargon and technical language, these represent a country’s roadmap, and often include specific commitments and targets for health. Holding governments accountable for their commitments – including commitments made in international meetings – is a key responsibility for journalists.

• Budgeting. The national budget is the government’s primary tool for putting its health policy into effect. Reporters should ask what their government’s budget shows about its priorities – and whether spending is consistent with government policies and commitments. In addition, they should pay close attention to how budgets are developed: Is the process transparent? Does the government consult broadly with participants in the health sector and the public at large? Does the government run its budget on auto-pilot, generally just adding incrementally to budgets from previous years, or does it take a hard look at programs each year and show a willingness to change directions when experience shows that old strategies aren’t paying off or when circumstances are changing.

• Regulation. WHO argues that effective governance requires that health authorities take responsibility for steering the entire health sector, not just public-sector institutions. Reporters should look closely to see whether the activities of disparate private organizations are included in overall planning and regulated in ways that strengthen the entire system.

• The government workforce. Does government have the skilled civil service manpower needed to direct the health sector? Just as manpower shortages bedevil health-care providers, government also can suffer a brain-drain that clouds its ability to direct the health sector.

• Nongovernment organizations. A great deal of health-care services are provided by NGOs. Health journalists can’t do their jobs correctly unless they scrutinize this large component of the health sector. That includes asking tough questions – about whether their programs are effective and can be brought to scale at affordable cost, for instance, and whether they

Health Systems

are coordinated with other NGOs and the government to avoid duplication and service gaps. This can require diligence since NGOs, like government, often are more eager for favorable publicity than for hard-headed reporting on their activities.

• Donors. As already discussed, donors play a very big role in the health systems of many countries. Journalists should report on donor activities just as they report on government and nongovernment organizations, paying special attention to whether they are enhancing the long-term capacity of the country to manage its own health system.

Health information systems. Some health systems are developing electronic patient records to improve the quality of care. And public health strategies rely heavily on data collected through household surveys, civil registration systems (which keep track of births, deaths and other key social and demographic information), and epidemiological information collected by public health institutions. Besides combing the data for potential stories, journalists should report on whether government is collecting all the information it needs; WHO says reliable information is needed on health financing at the national level to monitor overall health and at the household level to pinpoint where problems occur and to identify barriers to improving health among poor and vulnerable populations.

Thinking Systemically

In recent years, “strengthening health systems” has become an increasing priority for policy-makers. But WHO notes that the job can’t be done simply by tackling each of the building blocks separately, because they all are interdependent. WHO calls for an “integrated” response: (http://www.who.int/healthsystems/strategy/everybodys_business.pdf).

One group of researchers who work with USAID argues the starting point is to distinguish between policies that “support” the health system and those that “strengthen” it: (http://www.who.int/healthsystems/strategy/everybodys_business.pdf). Upgrading facilities, providing supplies like mosquito nets and promoting healthy behavior all support a health system in accomplishing short-term goals, but strengthening the system requires comprehensive changes that improve multiple health services. The researchers suggested four standards for gauging whether a policy, or “intervention,” strengthens a health system:

• Does it have cross-cutting benefits beyond a single disease?

• Does it address policy and organizational constraints or strengthen relationships between building blocks?

24

International Center for Journalists

Reporting on Health in Africa

• Will it produce permanent systemic impact beyond the term of the project?

• Is it tailored to country-specific constraints and opportunities, with clearly defined roles for country institutions?

Of course, journalists can’t take responsibility for strengthening entire health systems. But they can help focus public awareness on system issues. That requires taking a broad view, probing the many factors and institutions that shape our response to health challenges and highlighting the complex connections between them.

This chapter’s reading cites some examples of this kind of broad “systems” thinking.

A Framework for Story Telling Journalists are story-tellers. Besides figuring out what to write and how to get the right information, you also have to put the information you gather together in a coherent and meaningful package. There is no one way to do this, but here’s a simple framework based on an approach developed by William Blundell at the Wall Street Journal (for more, see Blundell’s book, “The Art and Craft of Feature Writing”).

Keep in mind that the process of deciding how to tell your story begins well before you start writing since your ideas about how to tell the story will shape

25

26

Health Systems

what information you seek. A manual produced by the Forum for African Investigative Reporters (FAIR) has a detailed chapter on the planning process: http://fairreporters.files.wordpress.com/2011/11/chapter_3-planning.pdf.)

Every story should have certain key elements. As you start gathering information, check to see if you have material on all of them. The elements include:

• Theme. This is the central, unifying idea. You should be able to state it simply and clearly. Usually, one paragraph should suffice. Your theme may change as you gather information and learn more about your topic, but you should have a tentative theme early in the reporting process, and refine it regularly as you go along since it will guide you in seeking information.

• Focus. What specific event, development, issue, individual or group will be at the center of the story? Will your focus be on a particular case study that illustrates your theme? Or will it be a round-up that shows how your theme plays out in different places and among different people?

• Tension. This is the problem that needs to be solved, the question that needs to be answered, the puzzle that your audience wants to understand. It is what makes people stay with the story to the end.

• Scope. How widespread, intense or varied is the event, development or issue you are describing? Scope can be very broad (that is, it can manifest itself in many places and in any ways) or it can be narrow but intense (in other words, it may not be widespread but it affects some people profoundly). By defining the scope, you help your audience understand where the issue arises and how important it is.

• Reasons. This is the “why” question. Why has the situation you describe arisen? What preceded it in time? Reasons can and often are economic. They often are social – in other words affected by culture, customs, morals, or family or community life. They also can be political – involving laws, regulations or taxes. And they can be psychological, or driven by personalities or beliefs.

• History. Telling your audience what preceded the events you are describing is a key part of giving them the context they need to understand a story. In many cases, history may provide the most important answer to the “why” question.

• Impacts. This refers to the effects the situation you describe has on people. If it’s an event, what was its impact? If it’s a problem, who was hurt? If it is an action by government, business or one social group, who gained and who lost? Impacts can be tangible, but they also can be emotional; when we talk about development, much of the time we are

27International Center for Journalists

Reporting on Health in Africa

discussing people’s livelihood and welfare, but another concern is how we feel about change: Does it make our lives more rewarding and meaningful, or improve the nature of our relationships?

• Countermoves. Almost any action produces a reaction. It’s important for journalists to look for and report on those reactions. What is being done to offset, combat, change or deflect the impacts of the event or situation we are describing? Are people changing their behavior? Is government acting? Keep in mind that often, countermoves produce further countermoves. A government move to address a problem may create new problems or stir a backlash.

• Future. Many people follow the news because they want to know how their lives will be affected. They want to know what is coming next. This can be a hard thing to report since journalists are in the business of finding facts. But after you have gathered enough information to tell a story, you have some ideas about what may be coming next. Will the problem be addressed? And if it isn’t addressed, what might the consequences be? “Reporting” on the future requires great caution, of course. But it is reasonable to make informed comments about what may happen next – how people may respond to a problem, what risks are entailed in certain countermoves, what may happen if current trends continue unabated – because people almost always want to know what might happen next.

Putting it all together

When you put these different elements together, you can present them in whatever order seems appropriate.

If, for instance, you are alerting your audience to a problem they may not know about, it makes sense to start by describing the problem, then its scope and impact (so people understand the importance of the story), hen the causes and countermoves, and you might end with the future.

If, on the other hand, you are focusing on a government strategy to address a long-standing problem, your lead may deal with countermoves, followed by history (what led to the new strategy). Then you might describe scope and impacts to give your audience background. You still might conclude by exploring what may happen in the future.

Maybe instead you are trying to alert your audience to the importance of dealing with an issue. In that case, your emphasis may be on scope and impacts, followed by the other elements.

28

Health Systems

The  most  important  question  is  the  theme.  It  shapes  your  reporting  strategy,  and  your  ultimate  decision  about  how  to  

sequence  your  story  elements.

Suggested Readings

“Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes,” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617455/). WHO’s framework for addressing weaknesses in health systems. WHO describes its six “building blocks” for effective health systems in “Key Components of a well-functioning health system,” (http://www.who.int/healthsystems/EN_HSSkeycomponents.pdf), and provides more details here (http://www.who.int/healthsystems/topics/en/).

“Why differentiating between health system support and health system strengthening is needed” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617455/). This article explains the difference between programs that support targeted health programs and ones that seek to build the overall capacity of health systems.

“Health Financing: A Strategy for the Africa Region,” a paper prepared for by the World Health Organization’s Africa Regional Office. http://www.who.int/health_financing/documents/afrrc56-10-healthfinancingstrategy.pdf

“Health Systems Financing,” WHO 2008. A good summary of the issues (http://www.who.int/healthinfo/statistics/toolkit_hss/EN_PDF_Toolkit_HSS_Financing.pdf)

“Health Financing,” A portal for World Health Organization information on financing (http://www.who.int/topics/health_economics/en/). Good statistics on domestic and international financing can be found in the Global Health Expenditure Database (http://apps.who.int/nha/database/DataExplorerRegime.aspx) and in the Country Profiles (http://apps.who.int/nha/database/StandardReport.aspx?ID=REPORT_COUNTRY_PROFILE).

“Shortage of Healthcare Workers in Developing Countries – Africa.” An analysis of Africa’s health manpower challenges. (http://www.ishib.org/journal/19-1s1/ethn-19-01s1-60.pdf)

“Health System Assessment Country Reports,” USAID. If you want to delve into the many complexities of health systems, take a look at these exhaustive evaluations of health systems in various countries. Scroll down to the bottom of the page to find individual reports on a number of African countries, including South Sudan, Benin, Nigeria, Senegal, Angola, Kenya, Zimbabwe, Lesotho, Tanzania, Uganda, and Mozambique. They are not easy reading, but those who

29International Center for Journalists

Reporting on Health in Africa

plow through them could find many story ideas (http://www.healthsystems2020.org/content/resource/detail/528/)

“Health system strengthening support, Global Alliance for Vaccinations and Immunization (GAVI),” (http://www.gavialliance.org/support/hss/). Established in 1999, GAVI for many years seemed to exemplify the “silo” approach to international health programs, boasting of its “single-minded” focus on the single issue of increasing the rate at which children receive recommended vaccinations against common diseases. But starting in 2006, the international organization made strengthening health systems a priority. In a review of the effort (http://www.gavialliance.org/results/evaluations/hss-review/, the alliance describes the rocky road to achieving that goal, noting among other things that recipient countries themselves generally prefer channeling foreign assistance to “downstream” projects – that is, direct services – rather than to efforts to improve “upstream” institutions.

“Health Systems Strengthening,” Global Fund (http://www.theglobalfund.org/en/about/diseases/hss/).

Here’s how another international aid program describes its efforts to strengthen health systems.

30

Special Topics

!Chapter 4: Special Topics: Mental Health, Traditional Medicine and Community

Overview

In the last chapter, we look at the formal institutions and organizations that affect health. Here, we will look at the important role that social and cultural factors play. We begin with a case study – mental health. We then will look at an issue that perplexes many African journalists – traditional medicine. Then check out our “Discussion with Dr. Anthony Iton” for a lively discussion with a prominent African-American public health expert on the important role of communities in determining health. His bio can be found above, under “Special Thanks”

31International Center for Journalists

Reporting on Health in Africa

Mental Health

In many respects, the state of mental health in Africa is a familiar story. For one thing, mental health disorders are some of the continent’s most neglected diseases: while the World Health Organization estimates that they account for 13 percent of the global burden of disease, governments in sub-Saharan Africa devote only 1 percent of their budgets to them. In part, that reflects preoccupation with four health issues specifically targeted by Millennium Development Goals – namely, child mortality, maternal health, HIV/AIDS and malaria. The US Agency for International Development (USAID) will only support mental health projects that involve one of these priority MDGs. Not surprisingly, then, as many as 90 percent of Africans who suffer severe mental disorders receive no treatment. (http://www.irinnews.org/fr/report/98680/rethinking-mental-health-in-africa)

On top of the considerable human suffering mental disorders cause, their economic toll is staggering. The World Economic Forum, a Geneva-based nonprofit organization, estimates that mental health problems will cost the global economy US$16 trillion in reduced economic output over the next 20 years – one third of the overall losses caused by all non-communicable diseases (http://www.weforum.org/news/non-communicable-diseases-cost-47-trillion-2030-new-study-released-today).

There are many story opportunities in this area, including:

Explainers Mental health is poorly understood. This is especially true in regions like Africa, where the mental health profession is tiny compared to Europe and North America. Among the major mental disorders that cry out for better public understanding are depression, schizophrenia, alcohol-use disorders, dementia, attention deficit hyperactivity disorder (ADHD) and epilepsy (a neurological – nervous system disorder commonly classified together with mental disorders). In addition, mental disorders like depression often strike people who have other health problems like HIV/AIDS or tuberculosis. Lack of information means there is no counterweight to the frequent stigmatization of people with mental disorders, making treatment even more difficult. Medline Plus (www.medlineplus.gov) is a good place to start for the basics.

The mental health system To a significant degree, African governments concentrate their limited mental health funds on large mental hospitals, even though there is considerable evidence that small, community-based programs are more effective. This “silo” approach also tends to focus treatment on the most acute cases, leaving the vast majority of people with mental disorders unable to find treatment. In a series of articles published by PloS Medicine, a group of researchers argue that low- and middle-income countries could go a long way toward improving treatment of mental disorders at reasonable cost by reorganizing current systems for delivering care. They argue that this could be achieved specifically by integrating mental health into the community-based

32

Special Topics

primary-care system instead of relying on large, single-purpose mental hospitals; by training non-professionals to provide many services with guidance of more highly-trained experts; and in at least some cases, by paying more attention to less acute cases rather than focusing solely on the most serious cases. A summary of the PLoS articles can be found here: (http://www.ploscollections.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000160;jsessionid=DD91DDC9AED28267DFA166330B0116F6#pmed.1000160-Patel1%20%3E%3E%20www.ploscoploscollections.org/article/info:doi/10.1371/journal.pmed.1000160;jsessionid=DD91DDC9AED28267DFA166330B0116F6#pmed.1000160-Patel1)Links to individual articles, which provide concise background on the six biggest and most- neglected mental disorders can be found here: (http://www.ploscollections.org/article/browse/issue/info%3Adoi%2F10.1371%2Fissue.pcol.v07.i06).

Legal Issues. Advocates also say that laws and policies governing mental health care need to be updated. The World Health Organization’s Mental Health and Poverty Project advocates legislative changes that would see more patients treated in community-based facilities closer to their homes rather than in large institutions where human rights abuses frequently occur. The project also says legal changes are needed to rebalance the rights of patients and their families. All of these changes would improve treatment outcomes, experts say. (http://www.who.int/mental_health/policy/development/MHPB7.pdf)/.

Social issues. Social factors ranging from family relationships to military conflict are major contributors to mental illness. Psychologists refer to these as “stressors.” In low-income countries, people who must deal with food insecurity, housing problems or financial stress are disproportionately prone to mental disorders (http://www.ncbi.nlm.nih.gov/pubmed/20621748). That doesn’t mean everybody from lower socio-economic groups suffers mental problems, of course. But journalists should explore the connections when they report on mental health. And mental health professionals might make interesting sources for journalists who write on social issues.

Mental health and traditional medicine

Mental health issues often lie at the intersection of western, or “modern,” and traditional medicine. Western medicine focuses on the biological origins of disease, including mental disorders, while traditional medicine takes a more holistic view that encompasses the social and spiritual dimensions of illness as well as its physical causes. There is plenty of support for the traditional perspective. What’s more, the western approach, which in many cases involves the use of drugs to treat mental disorders like depression, is far from infallible: drug-based treatments do not always work and can have adverse side effects. In fact, after becoming increasingly focused on biomedical approaches, the

33International Center for Journalists

Reporting on Health in Africa

pendulum in the West has swung part way back toward recognizing the role of religion in helping people recover from mental problems.

“Today, there is a new rapprochement between religion and biomedical science, with researchers studying how spiritual practices and religious rituals may influence the hormonal system to alter cardiovascular and mental states,” writes Arthur Kleinman, a noted American psychiatrist and anthropologist. “Religious practices have been shown to limit or even reverse these effects. Harnessing the healing benefits of religious practice is now a serious scientific undertaking in medicine.” (What Really Matters: Living a Moral Life Amidst Uncertainty and Danger,” Oxford University Press, 2006, p. 133).

What does this mean for journalists? We will discuss this further in the section on traditional medicine below. But two points seem clear. First, journalists should think about health reporting in broad terms, paying attention to social, cultural and emotional factors as well as biological ones. And second, journalists should not ignore traditional healers. A few ideas about how to cover them can be found below.

Reporting on Traditional Medicine

Traditional medicine poses a dilemma for health journalists. As many as 80 percent of Africans rely on traditional healers rather than medical practitioners trained in modern, western medicine – often because of the lower cost and greater availability of traditional medicines . But journalists often are uncertain how to cover traditional medicine, partly because traditional remedies have been passed on by oral tradition and have not been tested by the methods of modern science.

It would be a mistake, though, to ignore traditional medicine considering the substantial role it plays. By some estimates, Africa has one traditional healer for every 500 people, compared to one western doctor for every 40,000 people.

There are ways that journalists can shed more light on traditional medicine. A few suggestions:

Cover policy and institutional development. Incorporating traditional medicine in African health systems has been a formal goal of governments in the region since at least the Alma Ata Declaration of 1978, and it was reaffirmed by member-states of the World Health Organization’s Africa Region in 2000. As a result, more than half of the countries in WHO’s African Region have developed national policies on traditional medicine; 18 have developed national codes of ethics to ensure the safety, efficacy and quality of traditional medicines; and 21 have developed legal frameworks that provide for accreditation, registration and regulation of traditional health practitioners. Few countries have actually put their policies into effect. What is the state of play on these issues in your country?

34

Special Topics

Engage with traditional healers. Many traditional healers view journalists with suspicion, but reporters who try can build trust, and thus successfully solicit information from healers concerning what they are doing to help bring themselves back into the mainstream of the health-care system; their views of illness and its treatment; and their observations about what concerns ordinary people about their health.

Strive for balance in reporting. How many times do journalism trainers say it’s important to reflect different perspectives in stories? That rule applies to stories involving traditional healers too. Stories about traditional remedies should include the views of professionals trained in western medicine, just as stories based on western medicine should include the views of traditional healers where appropriate. As always, journalists should look for areas where the views of traditional and modern healers coincide.

Beware of grandiose claims. Whether they are covering traditional or western medicine, journalists should refrain from using terms like “cure” or “miracle” that may give rise to false hope. And they should be wary of experts who use such terms too since that could be a warning sign of quackery.

Ethics and health journalism

All journalists have a responsibility to maintain high standards of ethics. This certainly is true of health journalists, whose reporting often directly affects the well-being of people. Some basic principles include:

International Center for Journalists

Reporting on Health in Africa

Accuracy. A journalist’s first responsibility is to provide complete, truthful and well-substantiated information. Many of the basic principles of journalism are designed to ensure that we live up to this standard, including:

• Check the facts.

• Seek out multiple, diverse sources

• Strive for transparency by identifying your sources to the maximum extent possible. When we have to guarantee sources anonymity, we explain to the readers why a source cannot be named. And we never rely on sources to make personal attacks on others.

• Clearly identify and explain matters that are subject to controversy.

• In news stories, avoid injecting your personal opinion explicitly and do not let personal opinion guide reporting strategy or selection of what to report or not to report. Clearly label editorial comments and commentary.

Independence

• Avoid conflicts of interest: Don’t report a story if you are not completely independent of that story. That means you should never accept paid work that would compromise your personal and professional integrity. You also should avoid participating in organizations or accepting paid work that would compromise personal and professional integrity.

• Do not accept gifts or special privileges that would compromise independence or integrity.

• Disclose any and all financial arrangements that might be viewed as affecting independence or integrity.

Professionalism

• Avoid sensationalism. While journalists legitimately can seek to entertain and amuse their audience, it is wrong to offer news simply to titillate the audience, especially when other ethical standards – such as being fair, accurate and complete or respecting personal privacy – are violated.

• Respect the right of every individual to privacy, dignity and confidentiality. It is unethical to discuss individuals’ personal medical conditions or present photographs, videos or recordings of them without their permission.

35

36

Special Topics

• Recognize that health care providers have special relationships with their patients. Journalists do diagnose or treat individuals.

• It is essential to portray the risks and benefits of any behavior, regimen or treatment, not to present only one side.

• It is important to delineate the possible outcomes to different approaches to care, including the repercussions of the absence of care.

Model Ethics Policies

• The Association of Health Care Journalists. This American professional organization has developed a comprehensive set of principles, many of which apply to health journalists in particular: http://healthjournalism.org/secondarypage-details.php?id=56.

• Society of Professional Journalists. An ethics policy developed by one of the leading American professional journalism associations: http://www.spj.org/ethicscode.asp.

• Project for Ethics in Journalism. This nongovernment organization has a somewhat different approach to establishing ethics principles: http://www.journalism.org/resources/principles.

• The Guardian. Here is the ethics code of a leading newspaper in the UK: http://image.guardian.co.uk/sys-files/Guardian/documents/2003/02/20/EditorialCode2.pdf

Resources

Mental Health• Movement for Global Mental Health (http://www.globalmentalhealth.org/),

a coalition that seeks to make mental health a policy priority. For a good backgrounder, see Vikram Patel, “Global Mental Health: From Science to Action,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335087/.

• World Health Organization, Comprehensive Mental health Action Plan (http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R8-en.pdf)

• The Program for Improving Mental Health, a consortium of research institutions in five countries (including Ethiopia, South Africa and Uganda), supported by the UK government’s Department for International Development (http://www.prime.uct.ac.za/). See especially its policy briefs (http://www.prime.uct.ac.za/index.php/research-uptake/

International Center for Journalists

Reporting on Health in Africa

policy-briefs.html), including this one on the connections between mental health and poverty (http://www.who.int/mental_health/policy/development/mhapp/en/).

• Building Back Better: Sustainable Mental Health Care After Emergencies (http://apps.who.int/iris/bitstream/10665/85377/1/9789241564571_eng.pdf)

• African Mental Health Foundation: http://www.africamentalhealthfoundation.org/index.php/en/

• Global Mental Health: a failure of humanity (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961510-5/fulltext)

Traditional Medicine

The World Health Organization web site includes a variety of sources on traditional medicine, including:

• Regional Strategy on Promoting the Role of Traditional Medicine in Health Systems,” (http://www.aho.afro.who.int/en/ahm/issue/18/reports/regional-strategy-promoting-role-traditional-medicine-health-systems)

• “Traditional Medicine,” (http://www.who.int/inf-fs/en/fact134.html). A fact sheet summarizing WHO’s efforts to support traditional medicine.

• “Clinical practices of African traditional medicine,” (http://www.aho.afro.who.int/en/ahm/issue/13/reports/clinical-practices-african-traditional-medicine). A discussion of traditional health practices in Africa.

• “Guidelines for Registration of Traditional Medicines in the African Region,” (http://www.afro.who.int/en/clusters-a-programmes/hss/essential-medicines/highlights/2732-guidelines-for-registration-of-traditional-medicines-in-the-african-region.html.

• “African Traditional Medicine Day 2012,” (http://www.afro.who.int/en/clusters-a-programmes/hss/essential-medicines/highlights/3676-african-traditional-medicine-day-2012.html),

• “Regulation of Traditional Medicine in the WHO African Region,” (http://ahm.afro.who.int/issue13/HTML/article3.html),

• “Institutionalization of African traditional medicine in health care systems in Africa,” (http://www.ncbi.nlm.nih.gov/pubmed/17298111). A summary of the global effort to make traditional medicine a part of African health-care systems.

37

38

Special Topics

• “Press Coverage of Traditional Medical Practice in Nigeria,” (http://www.krepublishers.com/02-Journals/JC/JC-03-0-000-12-Web/JC-03-2-000-12-Abst-PDF/JC-03-2-075-12-047-Batta-H-E/JC-03-2-075-12-047-Batta-H-E-Tt.pdf). An analysis of media coverage of traditional medicine in Nigeria.

• Takudzwa Shumba, “Bridging the Gap: Traditional Medicine Use in Sub-Saharan Africa ,” AfricaNow (http://www.yale.edu/afrikanow/1.1/article1.1.4.htm). A reader-friendly discussion of the role of traditional medicine in Africa.

•

39

Reporting on Health in Africa

!Chapter Five: Using Data to Support Health Stories

Good journalists are in the field because they hope to prompt action, to make a difference, to bring new issues to light. In 2014, most audiences are skeptical of claims that cannot be supported by data. Where do you find good data, and how do you use it wisely so that it supports your story? That is our topic for this chapter. Read on, and be sure to check out the discussion with DHS expert Erica Nybro.

Why Use Data in Stories?

Data help journalists demonstrate the significance of their stories and put them in context. Without data, our stories could be seen as mere anecdotes – isolated

International Center for Journalists

40

Using Data to Support Health Stories

events that, while perhaps interesting, may have little relevance to our readers. But with data, we show how many people are affected, who they are, and what they believe. And the data enable us to reach conclusions based on hard, factual evidence.

Data also help us understand stories in important ways:

• They show trends. By describing whether conditions are getting better or worse, they help us evaluate current efforts to address them and decide what more needs to be done.

• They help us explain issues. By showing what underlying demographic, economic or social factors are associated with the problems we describe, they give important clues about why conditions are the way they are and what needs to be changed to improve them.

• They enable us to compare ourselves to others. By contrasting conditions in our countries or localities to conditions in other places, data show how well we are doing, and point to jurisdictions we might want to emulate as we tackle our own problems.

The Journalist’s Job

Experts have long used data to shape public policy and decision making. But journalists have a key role to play in making data available and useful to everyday people. Specifically, journalists:

• Identify data that are relevant to their audiences.

• Use data in storytelling so that everyday people can participate in public debate and influence policy makers.

• Explain data clearly so that people understand changes in populations and economic, social and health conditions that affect them.

• Help people understand data by showing that they describe real people.

Case Study: Demographic and Health Surveys

Some of the best data sources for health and population issues are Demographic and Health Surveys (DHS). What makes DHS data reliable?

• The DHS surveys are part of a respected and long-standing international data collection program. They have no national agenda; they are not influenced by elections, money, or popular opinion. When looking at a data source you should always ask yourself, who is providing the data? Who funded the survey? What is their agenda?

International Center for Journalists

Reporting on Health in Africa

• The samples for DHS surveys are very large and nationally representative; that is, data are collected from thousands of women and men, in every region, from urban and rural areas, from educated and uneducated people, from rich and poor. Other surveys often ask questions of women at a health care center, or men at a bar. These groups may not represent the whole country. Always ask, who was included in this survey?

• DHS surveys are consistent across time and across countries. The DHS has used standard questionnaires and methods since 1984 in more than 90 countries. You can be comfortable comparing the fertility rate in Zimbabwe to the fertility rate in Senegal. With other data sources, read carefully to make sure you are comparing appropriately.

• DHS survey information is transparent. DHS survey results are available for free on the DHS website (www.DHSprogram.com) and the STATcompiler (www.statcompiler.com). Survey instruments, such as questionnaires, are also available. It should not be difficult to ask questions about a survey, find out the full set of results, or how it was implemented.

So you have a good data source. But the DHS final report is hundreds of pages long and has very complex tables! How do I find a good story in here? First, read the Key Findings or other shorter summaries of the findings. This will give you a good idea what the major findings are. Then browse the table of contents in the final report to see the breadth of topics covered. Once you find an area of interest, dig in. Select a couple of indicators or tables, and consider the following questions:

• What are the major trends? The fact that 75% of children are vaccinated may not, in itself, be a story. But if the vaccination rate has increased from 50% in 2008 to 75% in 2013, that is a sign of major progress. Sometimes even a lack of change is a story: if 75% of children were vaccinated in 2008, and the same percentage are vaccinated today, then what happened with the big vaccination campaign that was launched in 2009?

• Look at patterns across groups. Nationally, 75% of children are vaccinated. But your table tells you that only 40% of children in the poorest households are vaccinated. That is a story about inequality and access to health care. Or perhaps very few children in a distant region are vaccinated. Calling attention to this group could prompt programs to focus their attention in that region, rather than in the well-served capital.

• Compare yourself to others. Everyone likes to know how they stack up to their neighbors. Use DHS data (via STATcompiler) to compare your country’s vaccination rate to other neighboring countries. You may be

41

42

Using Data to Support Health Stories

able build some pride in your national health system, or you may spur legislators to focus more attention on a health issue on which your country is lagging behind its peers.

• Is there something surprising or unexpected? In the early 2000s, a review of DHS data disproved a common myth: HIV infection was most common among wealthy women and men. Previously it had been assumed that poorer populations were more at risk of contracting HIV. This discovery changed HIV programs and policies worldwide, as well as popular understanding of risk. This is a headline!

• Can these data contextualize my story? Even if your story is not about the data point, data can help justify to the reader the importance of the story. Consider the headline “Local woman has 14th child”. In some settings, this would not be newsworthy. But some background data will help you determine whether or not this is interesting. If most women in the region have an average of 3 children, a woman with 14 births is exceptional. Share this with your reader.

Here are some examples of ways DHS data can be used to enrich stories. The left column below lists several different story topics. The right column shows data from Demographic and Health Surveys that could be used to put the story in context.

International Center for Journalists

Reporting on Health in Africa

Reading and Understanding DHS Tables Below are examples of data pulled from Demographic and Health Surveys, along with an explanation of how to read and use the information.

If you have a good internet connection, you can also follow this activity on YouTube (https://www.youtube.com/watch?v=FxFEcv-1iJI&list=PLxS9TwgmtLVWf1vcbL32X7IHDihaxDX6k&index=5).

A second video on interpreting tables is also available here (https://www.youtube.com/watch?v=m7kDLqldblE&list=PLxS9TwgmtLVWf1vcbL32X7IHDihaxDX6k).

Data-­‐based  Stories

• Identifying  data  which  is  relevant  to  the  story      • Using  data  in  storytelling  to  influence  decision/policy  making

• Explaining  data  clearly  to  show  practical  changes  in  population  and  health  situations        

• Reporting  data  with  the  aim  of  helping  the  audience  understand  behind  the  numbers  are  real  people  

Stories   DHS  data  tells  us:Aberash Hailay’s case  ignites  campaign  to  stop  violence  against  women  in  Ethiopia.  

Men’s  and  women’s  attitude  about  wife  beating

Ethiopia  set  to  achieve  Universal  Primary  Education  by  2015.  

Trends  in  School  Attendance  for  boys  and  girls    

Ministry  of  Health  announces  delivery  care  in  hospitals  is  to  be  free  of  charge.  

Percent  of  women  who  deliver  their  babies  in  hospitals

UNICEF  launch  nation’s  first  HIV/AIDS  forum  for  the  youth.  

Percent  of  people  who  know  how  to  prevent  HIV,  and  where  people  learn  about  HIV

Ministry  of  Health  is  scaling-­‐up  access  to  long-­‐term  family  planning  methods  in  rural  Ethiopia.    

Percent  of  women  using  modern  family  planning  methods

Men  are  leaving  their  country  to  find  work  in  South  Africa.  

Percent  of  woman-­‐headed  households,  women  who  work  for  cash  earnings  

43

44

Using Data to Support Health Stories

Practical Tips for Using Numbers in Reporting

Use numbers when numbers are the story (when a new survey or piece of research is released, for instance. A new HIV prevalence rate; a reduction in infant mortality; changes in school attendance rates all are big stories.

Use numbers to put a story in context. If there is a compelling human story, include some population-based data to show why this is important. For example, if a local woman dies in childbirth, find out how many women deliver in health facilities, what the maternal mortality ratio is in your country, and whether health care facilities are sufficiently staffed.

Look for ways to display numbers visually. Create a graphic of health indicators comparing your country with neighboring countries. Show how health has improved over recent years, or use a map to show regions with disease outbreaks.

Always check your data. Make sure you have read and interpreted it correctly. Ask someone else to confirm that the data are correct. Confirm that data in a graphic are correct and have not been mislabeled by a graphic designer. Also, don’t exaggerate your numbers. If one-third of children are malnourished, your headline should not read “Most children malnourished”. It might make a more dramatic headline, but your credibility will be questioned. And if you are doing your own math to “crunch numbers” make sure that someone checks your work.

Limit how many numbers you use. There are no absolute rules, but use as few numbers as necessary to make your point. For instance, “The ministry’s budget grew 48 percent in 2011, from Ksh9.56 billion to14.1 billion,” could be simplified to: “The ministry’s budget rose by nearly half this year, to Ksh14 billion.”

Simplify by Rounding. Scientists and bankers may need exact numbers, but everyday readers or viewers do not. If your country’s population is projected to grow 62.5 percent, say 63 percent or, better yet, more than 60 percent. It’s just an estimate.

Simplify numbers by putting them into words. If traffic accidents increased 105 percent, you can say they “doubled, or if 35 percent of people driving red cars are under age 20, say “more than one-third” or “one in three.”

Don’t expect numbers to speak for themselves. Explain them and use different language so that your audience has a second chance to understand. For example, don’t just say “7% of adults in Uganda are HIV-positive,” but instead add: “This means that about 1 in 14 Ugandans are infected with HIV.”

Or if writing to a Ugandan audience, you should not just say that “About 33 million people worldwide are infected with HIV.” Note that the figure is the size of

International Center for Journalists

Reporting on Health in Africa

the Ugandan population. Other comparisons that may work include: Enough people to fill a football stadium, the population of a local city or region, or comparisons with other diseases (for example: “More children will die this year from diarrheal disease than from HIV, cancer, accidents, and malaria combined.”)

45

46

Using Data to Support Health Stories

Resources

The Journalists’ Guide to the Demographic and Health Survey (http://www.measuredhs.com/pubs/pdf/DM24/DM24.pdf).

Demographic and Health Survey – Final Report (http://www.measuredhs.com/What-We-Do/Survey-Search.cfm). This is where you can find the latest DHS data on your country.

DHS learning course (www.globalhealthlearning.org/course/demographic-and-health-surveys-data-use).

The Data Journalism Handbook: http://datajournalismhandbook.org/1.0/en/index.html. An excellent guide, rich with examples and case studies, of what data journalism is – and what it is not.

Integrating Data Journalism into Newsrooms: http://www.icfj.org/resources/integrating-data-journalism-newsroomsWorld Health Organization Data and Statistics (http://www.who.int/research/en/). World Bank health statistics portal (http://data.worldbank.org/topic/health).

47International Center for Journalists

Reporting on Health in Africa

Conclusion

Thank you for reading this introduction to health reporting in Africa, put together by the International Center for Journalists in cooperation with the African Health

Journalists Association.We have touched on several areas of interest for journalists who plan to write

about health issues. This includes: finding solid topics for your stories; techniques for reporting these stories effectively; investigating health systems

within your country; dealing with special topics like mental health and traditional medicine; and using data to support and enhance your health story. We hope

that these basic lessons will be helpful as you begin to develop your own stories.We encourage you to reach out to other health reporters in your area—there are

a number of journalism associations across Africa that support health and science writers as they research their stories and expand their skills, as well as

the African Health Journalists Association (AHJA). You can find more information about AHJA and more localized associations at www.ahja-news.org.

2000 M Street NW, Suite 250Washington, DC 20036USAwww.icfj.org