Rafael Obregon

Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries

The combined weight of the eight articles in this journal tell us that as a field we have certainly passed a tipping point on continuing to question the importance of social and behavior change to achieve public health outcomes. The Evidence supporting some behavioral change interventions presented here in fact compares favorably to evidence in clinical research fields of biomedical interventions. Important gaps such as those around gender and discrimination still need to be filled and areas such as longer term sustainability of change need to be further explored. Yet today we can move forward with confidence to apply the available evidence to achieve the important population level behavioral shifts necessary to end preventable child deaths. It is key to ensure that the evidence of what works is integrated into national and subnational public health programs and used to tighten and focus interventions and practices for population level behavior change around the world. Along the way global and regional advocacy to make sure that social and behavior change interventions are based on evidence and supported with adequate human and financial resources to achieve the greatest impact will remain a critical component of global and national efforts. As several authors have put it rather than being a question of whether social and behavior change interventions can drive improvements in health outcomes the key is to ensure that these interventions consistently measure up to the rigor quality and investments needed to facilitate the desired change. This is the challenge for multiple stakeholders involved in global regional and country level efforts to ending preventable deaths and ensuring that all children survive thrive and develop to realize their full potential. (Excerpt)

Vaccine Special Issue on Vaccine Hesitancy.

tancy; and For most readers of “Vaccine,” it is a truism that vaccines epresent one of the safest and most effective tools available in lobal efforts to control and prevent infectious diseases. Yet, parnts searching the Internet about whether or not it is safe to get hemselves or their children vaccinated will find this consensus ecast as a controversy, or even a conspiracy. Many of the top nternet search results question or dispute the scientific consenus about the safety and effectiveness of some or all vaccines n a number of grounds, from secular to religious to politicalhilosophical. The gap between expert consensus and the thinking mong many publics around the world is not limited to the Internet. he proliferation of conflicting information and the ease with which isinformation can amplify — via old and new media channels — rovide a confusing context for parents seeking additional guidance rom health workers, religious leaders, family members, or other rusted sources, many of whom may themselves be misinformed bout the risks and benefits of vaccines. In this context, perhaps it is ot surprising that some caregivers have become “hesitant” about ecisions to vaccinate. Drawing on examples from around the world, in richer and oorer countries alike, the papers in this Special Issue demonstrate hat there is no single form that vaccine hesitancy takes, and that he reasons behind decisions to delay or refuse vaccination are ighly variable and context specific. Skepticism and rejection of accines among a portion of the public is as old as vaccine technolgy itself. But there are reasons to believe that new dynamics in the arly 21st century have made the question of how to address vacine hesitancy more acute, including the accelerated introduction f additional vaccines into routine programs, high-profile global nitiatives to bring the benefits of immunization to the one-in-five hildren in developing countries who currently do not receive those enefits, and tectonic shifts in the production and consumption of nformation associated with the emergence and global penetration f social media. These dynamics set the backdrop for the request by he Strategic Advisory Group of Experts (SAGE) on Immunization o establish a working group on vaccine hesitancy. As vaccine hesiancy trends persist and associated risks have arguably increased in ecent years, this supplement represents a timely contribution to he state of knowledge regarding “vaccine hesitancy” halfway into he Decade of Vaccines (2011–2020). The introductory article in this Special Issue summarizes the hisory and rationale for SAGE’s initial request to establish a Working roup on Vaccine Hesitancy in March 2012. It notes that reports bout declining public trust and acceptance of vaccines and/or

The Handbook of Development Communication and Social Change: Wilkins/The Handbook of Development Communication and Social Change

The M.A. degree offered through the Communication & Development Studies program focuses on using communication to promote social change. Emerging Issues in Communicating Development and Social Change. Karin Gwinn The Handbook of Development Communication and Social Change. is a Professor of Communication Arts & Sciences and Human Development & Family Communication and intimacy for older adults, and the Routledge Handbook of class in popular media, and resistance and movements for social change.

Social mobilization and community engagement central to the Ebola response in West Africa: lessons for future public health emergencies.

Key lessons for the crucial components of social mobilization and community engagement in this context: Invest in trusted local community members to facilitate community entrance and engagement. Use key communication networks and channels with wide reach and relevance to the community, such as radio in low-resource settings or faith-based organizations. Invest in strategic partnerships to tap relevant capacities and resources. Support a network of communication professionals who can deploy rapidly for lengthy periods. Balance centralized mechanisms to promote consistency and quality with decentralized programming for flexibility and adaptation to local needs. Evolve communication approaches and messaging over time with the changing outbreak patterns, e.g., from halting disease transmission to integration and support of survivors. Establish clear communication indicators and analyze and share data in real time. Key lessons for the crucial components of social mobilization and community engagement in this context: Invest in trusted local community members to facilitate community entrance and engagement. Use key communication networks and channels with wide reach and relevance to the community, such as radio in low-resource settings or faith-based organizations. Invest in strategic partnerships to tap relevant capacities and resources. Support a network of communication professionals who can deploy rapidly for lengthy periods. Balance centralized mechanisms to promote consistency and quality with decentralized programming for flexibility and adaptation to local needs. Evolve communication approaches and messaging over time with the changing outbreak patterns, e.g., from halting disease transmission to integration and support of survivors. Establish clear communication indicators and analyze and share data in real time. ABSTRACT Following the World Health Organization (WHO) declaration of a Public Health Emergency of International Concern regarding the Ebola outbreak in West Africa in July 2014, UNICEF was asked to co-lead, in coordination with WHO and the ministries of health of affected countries, the communication and social mobilization component—which UNICEF refers to as communication for development (C4D)—of the Ebola response. For the first time in an emergency setting, C4D was formally incorporated into each countrys national response, alongside more typical components such as supplies and logistics, surveillance, and clinical care. This article describes the lessons learned about social mobilization and community engagement in the emergency response to the Ebola outbreak, with a particular focus on UNICEFs C4D work in Guinea, Liberia, and Sierra Leone. The lessons emerged through an assessment conducted by UNICEF using 4 methods: a literature review of key documents, meeting reports, and other articles; structured discussions conducted in June 2015 and October 2015 with UNICEF and civil society experts; an electronic survey, launched in October and November 2015, with staff from government, the UN, or any partner organization who worked on Ebola (N = 53); and key informant interviews (N = 5). After triangulating the findings from all data sources, we distilled lessons under 7 major domains: (1) strategy and decentralization: develop a comprehensive C4D strategy with communities at the center and decentralized programming to facilitate flexibility and adaptation to the local context; (2) coordination: establish C4D leadership with the necessary authority to coordinate between partners and enforce use of standard operating procedures as a central coordination and quality assurance tool; (3) entering and engaging communities: invest in key communication channels (such as radio) and trusted local community members; (4) messaging: adapt messages and strategies continually as patterns of the epidemic change over time; (5) partnerships: invest in strategic partnerships with community, religious leaders, journalists, radio stations, and partner organizations; (6) capacity building: support a network of local and international professionals with capacity for C4D who can be deployed rapidly; (7) data and performance monitoring: establish clear C4D process and impact indicators and strive for real-time data analysis and rapid feedback to communities and authorities to inform decision making. Ultimately, communication, community engagement, and social mobilization need to be formally placed within the global humanitarian response architecture with proper funding to effectively support future public health emergencies, which are as much a social as a health phenomenon.

Community Engagement in Liberia: Routine Immunization Post-Ebola

A national integrated polio, measles, and deworming campaign was implemented across Liberia May 8–14, 2015. The community engagement and social mobilization component of the campaign was based on structures that had been invested in during the Ebola response. This article provides an overview of the community engagement and social mobilization activities that were conducted and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunization in the post-Ebola context. Focus group discussions and interviews were conducted across four counties in Liberia (Montserrado, Nimba, Bong, and Margibi). Thematic analysis identified the barriers preventing and drivers leading to the utilization of routine immunization. Community members also made recommendations and forwarded community-based solutions to encourage engagement with future health interventions, including uptake in vaccination campaigns. These should be incorporated in the development and implementation of future interventions and programs.

Opportunities and challenges for health communication in health disparities settings

What are some of the recent milestones and challenges in global health equity? Rafael: As part of its emphasis on equity, UNICEF has been working with regional and country offices to increase focus on the most marginalized and disadvantaged populations, and to ensure that those who are typically left out of the reach of social services or programmatic interventions are brought into the picture, and benefit from them. For instance, the global initiative A Promise Renewed, which focuses on accelerating the achievement of the Millennium Development Goals (MDG), has mobilized stakeholders towards efforts in this direction, and a number of countries have made additional progress towards achieving the MDG, particularly goal four (reduce child mortality) and five (improve maternal health). Polio eradication efforts, especially the recent success in India, are an example of how the international development community has made significant progress in improving the lives of children by bringing in the equity focus. However, we continue to face challenges surrounding most of the basic indicators that reflect the well-being of children in many parts of the world. Along with other vulnerable populations, children placed within some of the various dimensions of poverty and discrimination are more likely to be affected by disease or by various disparities and conditions. The challenge, then, is to ensure that our programs reach out to these children, and those that belong to marginalized groups. Benjamin: Some of the places where we are really struggling to realize equity are where people are affected by insecurity and violence, and where we are trying to get basic access to the population. This is the case in the Central African Republic, federally administered tribal areas of Pakistan, some parts of Afghanistan, Syria, and northern Nigeria—some of the areas where the last reservoirs of circulating wild poliovirus are. How have communication strategies helped achieve these successes, or how can they be used to address these challenges in health disparities settings? Can you provide some specific examples? Rafael: Communication, specifically Communication for Development (C4D), is a key component in UNICEF’s work across the whole development spectrum from the introduction of new vaccines, to polio eradication efforts, maternal and newborn health, child health and well-being, basic hygiene, and prevention of mother to child transmission of HIV. It provides UNICEF the opportunity to advocate with different stakeholders and partners, mobilize communities, and implement strategies that address social and behavioral determinants, and promote healthy practices and behaviors. Benjamin: As an example of innovative programming, we have been using mobile theaters in Mozambique to communicate with communities about the importance of immunization, and also to listen to the communities and record their voices. Through an iterative process of listening and communicating, we have refined the delivery of immunization services in Zambezia, a region of Mozambique with high population density and very low access to communication channels, including radio. We have packaged the immunization services with other essential health services that the communities are asking for, such as water, sanitation, nutrition, and antibiotics. Rafael: Another interesting development has taken place in Niger, West Africa, where we have been working over the last six years to implement an essential family practices package. This is a community-based, action research approach, involving several components—community meetings, household visits, community radios, advocacy with religious leaders—and focuses on the promotion of eight life-saving practices, including having children sleep under insecticide-treated mosquito nets, hand washing, and exclusive breast feeding. Through a systematic approach, we ensure that families begin