When it comes to health campaigns, there are many barriers. Let me give you an example from the real world with a focus on Tuberculosis (TB). TB is one of the great causes of morbidity and mortality in the world today, with the World Health Organization estimating that one third of the world’s population is infected with the TB bacteria.

A day in the life of a man getting tested for TB

One evening, a man working for a farmer in a community is visited by a community health worker in a door-to-door campaign aimed at preventing the spread of TB.

The aim is to raise awareness, and encourage individuals to be tested and treated for TB. The skin test is free and provided by a health clinic in a rural agricultural region.

This well-intentioned health worker who lives in the community is invited into the home of this man, and has an opportunity to educate him and his family on Tuberculosis. The health worker concludes the presentation by encouraging the family to be tested for TB at the free clinic in town. The man, not wanting to put his family at risk, and having been compelled by the presentation of this neighbor, plans to visit the clinic the following week.

On Monday, following a 14 hour day at work, he takes the bus from the farm where he works into town to attend the free clinic. He arrives shortly after 7pm and is dismayed to find a large sign indicating the clinic is closed and hours of operation are 8am to 5pm. After some negotiation with his boss the following morning he plans to visit the clinic first thing the following morning and then head back to work after the testing is complete.

The next morning he takes the bus directly into town and arrives at 8am at the opening of clinic, after 20 minutes navigating the building to find the TB testing area he is only met with more bad news- the free testing takes place from 11am-1pm only.

Having lost a morning’s worth of work he stays until 11am is tenth in line and finally at 12:00noon he is next in line, finally he is called forward and the 5 minute test is completed. He is then told to get the results he will need to come back in two days time between the hours of 11am and 1pm. He heads back to work in time to work the final two hours in the field and then journeys on home.

Use your imagination to hypothesize how this story continues.

Victims of false advertising

It is not until we venture into a ‘Day in the Life Of’ or DILO (a term shared with me by Dr. Everold Hosein) that we truly understand the barriers both individual and systemic that plague even the most well-intentioned campaigns to promote health and other social programs.

Now, the clinic did have some important aspects to their campaign that were culturally sensitive and responsive to the needs of the particular community:

• they utilized key opinion leaders from the neighborhood to implement the door-to-door campaign and
• they eliminated the financial cost of TB testing to encourage participation.

However, there were some crucial elements of the program that were not dissected and thus resulted in loss of income, and physical and emotional stress:

• the health center did not boast clear signage, and therefore potential patients were left roaming around a large building trying to locate the specific TB clinic area.
• the health center was open ‘business hours’, which was totally incompatible with the population they were trying to reach- mostly farmers working 14 hour day.
• the free testing was only available during the middle of the day and almost certainly required the patient to take an entire day off work to get to the clinic, receive testing, and return home.

The way forward?

The story and context detailed above could be equally applied in most communities in the world, switching farm worker for fisherman, and switching TB for HIV/AIDS and so on. We oft move too quickly in our planning to focus on the outcomes we wish to achieve, and spend frighteningly too little time understanding our intended audience of our campaign to create an intervention that is both meaningful to the consumer and appeals to their needs and desires, while also reducing barriers to encourage participation.

While, I cannot offer a comprehensive solution or technique that will insulate the most well meaning campaigns from the challenges that have been touched on above, I endeavor that in our respective fields and roles as advocates and professionals within public health, and international development that we remain mindful of the DILO. This perhaps will reduce health disparities and promote equitable access to health and social programs and services.

Women are drivers of development – yet the poorest women pay the highest price with their health, well-being and ultimately their lives, particularly in a time of financial crisis. Investing in women’s health is an investment in their wellbeing, their family’s wellbeing and their community; yet again this year over half a million women and girls will die unnecessarily in pregnancy and childbirth, tens of millions more will suffer illness, injury and disability.

The World Bank states that investment in family planning can reduce maternal mortality by 40 per cent. Likewise, meeting the unmet need for family planning will reduce maternal morbidity and the burden of disease and illness caused by sexual and reproductive ill-health.

Health is a human right and cornerstone of social and economic development. No one should die or suffer from preventable causes for lack of basic health services. Yet, support for population and reproductive health programmes has significantly declined as a percentage of overall health aid, from about 30 per cent in 1994, to just 12 per cent in 2008. This global crisis further threatens much of the progress made towards improving the health of poor women in poor countries during those years.

Yet even current levels of investment in sexual and reproductive health from national and donor governments are threatened by the current crisis. Girls count and women matter, yet too often they are overlooked. Now is the time to increase our efforts, not decrease them, otherwise the escalation in poverty and the impact on both present and future generations will be dramatic.