Communication for improved health services.

Health education and communication efforts are critical elements in improving individual acceptance of vaccines and of community participation in immunization programs. In particular, communication efforts are needed to involve informal groups and community leaders in promoting preventive health measures. Oral rehydration therapy has a demonstrated efficacy in correcting dehydration and is felt to be an important household intervention to prevent dehydration, malnutrition, and death. Recognition of the usefulness of this simple and inexpensive technology has led to its incorporation into national health programs in most developing countries of the world. Yet, despite this recognized importance for the last decade, ORT was estimated by the World Health Organization to be appropriately used for only 4% of diarrheal episodes in children of developing countries in 1983. It is obvious, from evaluations of some ORT programs, that information on proper treatment of diarrhea is not being conveyed adequately to the public. The communication of the ORT message to the public and to health workers at all levels is of increasing importance. Some health programs can be cited for their successful use of communication techniques to achieve greater use of ORT. The Oral Therapy Extension Program of the Bangladesh Rural Advancement Committee was initiated 5 years ago. This program is built around oral rehydration workers who receive training in a 5-day course, 3 days in class and 2 in the field, and further training in teaching methods and communication skills to enable them to effectively deliver their ORT messages. Mass communication also has been used successfully in ORT programs. The Honduras Mass Media and Health Practices Project used a combination of radio, printed material, and interpersonal communication through health workers to popularize the use of a new ORS product. These interventions illustrate several important steps in communication of health messages: analysis of the local vocabulary and beliefs to enable optimal message design and implementation; pretesting as many messages, materials, and methods as possible; focusing on carefully selected sets of objectives and behaviors; and monitoring and improving the campaign while it is in progress.