Chapter 7 - Communication for Development

1 D R A F T1 Chapter 7 - Communication for DevelopmentBy Michael Galway, Commissioned by UNICEFS ummaryThere is limited information about attempts to communicate with families andcommunities about arsenic in drinking water supplies. Despite the global nature of theproblem, little documentation exists about efforts in different countries to communicatewith people about the risk to their health from arsenic. This Chapter fills that void byproviding a synthesis of the global experience to single largest Communication initiative on arsenic comes from Bangladesh. Amulti-media, multi-level Communication strategy was launched by the nationalgovernment, with UNICEF assistance, in four rural areas in late 1999. An initialevaluation indicates that the strategy is raising awareness and villagers are switching tosafe sources of water.

2 Until more results are available, the Bangladesh example offerscommunicators with some best practices for designing and implementing a large-scalecommunication experiences from other countries, such as India, Argentina, Australia and theUnited States, also provide insights into ways of communicating effectively about thearsenic addition to these examples, there is a rich and varied body of literature thatdocuments the global experiences of public health communications. The Chapter reviewscase studies from Asia, Latin America and Africa on how communicators are addressingissues critical to people s health, such as sanitation and hygiene, reproductive health andHIV/AIDS. These experiences reflect a significant evolution in theory and approaches tochanging people s behaviour that are relevant to communicators working on for communicating about arsenicNotions of how to communicate with families and communities about their health arechanging in significant ways.

3 The concept of communicating to someone is giving way tomore democratic and egalitarian ideas of communicating with a person whose health is health education models are being replaced with more participatoryapproaches. Communicators are using more rigorous methodologies to develop of the best practices from private sector advertising are being adopted for effective social marketing . More fundamentally, there is a growing recognition thatcommunication generally needs to address underlying conditions socio-economic,cultural, legal and policy environments that influence why people act the way they number of key principles (Jackson, 1997) derived from the global experience ofpublic health Communication can guide efforts to address the arsenic problem in variouscountries. Levels of knowledge can be raised, but may have little or no effect on Bangladesh, a one-year project with Dutch funding to raise awareness aboutarsenic in six district towns did not achieve its hoped-for breakthrough inbehavioural change.

4 Fifty per cent of families who knew their tubewells werecontaminated by arsenic continued to drink the water, despite access to new or safesources (Hanchett et al., 1999).D R A F T2 Beliefs and values influence how people behave. The roots of people s beliefs andvalues are complex and multi-faceted. In Bangladesh, a belief that I will/will not getsick from drinking arsenic affected water could have several underlying beliefs. It s the devil s water or Allah will decide whether I get sick (Asiatic, 1999a)suggests a sense of fatalism. Likewise, the value a poor person puts on having asanitary latrine, or sending a child to school, may be linked to perceptions ofeconomic cost and benefit, or social status. Beliefs and values do not take place in avacuum, but are shaped and respond to the context of people s lives.

5 Fatalism, forexample, often comes from a lack of viable options and a feeling of lack of controlover one s life. A behaviour is likely to be repeated if the benefit is rewarding, and less likely if theexperience is punishing or unpleasant. A pilot project in Argentina investigated ahome-based solution to the arsenic problem by providing arsenic removal saltsdirectly to poor families. Government sanitation workers followed up with house-to-house visits to show people how to use the salts and to emphasise the importance ofchanging their drinking water habits. The salts effectively lowered arsenic levels by70 per cent. The success of this technology was due to its easy use in the home. Thisfacilitated behavioural change in the short term (Rivero et al., 1999). Unfortunately,the new behaviour could not be sustained because the supply of salts ended with theproject.

6 Individuals are not passive responders, but have a proactive role in the behaviourchange process. Public health officials in the United States use advances incommunication technology to interact directly with people affected by arsenic. Webpages and open meetings on the Internet provides a forum for a two-way flow ofinformation, letting people decide on their role in the Communication process,ascribe meaning to messages and control the process of behaviour change. Social relations and social norms have a substantial and persistent influence onhow people behave. Communication strategies targeting social groups ( , family,co-workers and youth clubs) may contribute to substantial and sustainablebehavioural change. The stronger the affiliation with a group, the more responsive aperson is to the group s norms.

7 The national arsenic Communication strategy inBangladesh, for example, aims to leverage the influence of Muslim imams (religiousleaders) to promote a norm of sharing arsenic-safe tubewell water (Asiatic, 1999b). Behaviour is not independent of context. People influence, and are influenced, bytheir physical and social environments. This principle emphasises that healthbehaviour is influenced by a vast array of biological, environmental, social, physical,spiritual, economic and regulatory factors. In the Indian state of West Bengal, strongresistance to an arsenic removal technology was overcome when villagers travelledto a nearby community to talk to their neighbours who had already adopted the Communication process lessons from BangladeshNo single universal strategy exists for changing complex human behaviour. However, theexperience of developing a national Communication strategy for arsenic in Bangladeshprovides some best practices for planning and managing processes of communicatingabout arsenic in drinking water R A F T3Up until 1998, relatively little Communication work for arsenic had been done inBangladesh.

8 As a result, awareness was low, despite the severity of the problem. Abaseline survey indicated that only 7 per cent of 1,839 people interviewed had heard ofarsenic (OMQ, 1998).There were also disagreements on what would be technically correct tocommunicate. Misinformation was a serious concern. A small working group ofgovernment scientists and technical advisors filled this void by reviewing the availableliterature and coming to a consensus on a set of technical parameters to guide thecommunication strategy see Annex .These parameters ensured that the information communicated was technicallyaccurate, leaving communicators free to get on with the work of deciding how best tocommunicate. The Bangladesh example helps to demonstrate the importance of ensuringthat the information disseminated is accurate and consistent.

9 Time and resources need tobe invested in ensuring that the content of the Communication passes the most stringenttechnical approach to developing a Communication strategy on arsenic in Bangladesh isrelevant to communicators in other countries. While the social, political, economic andtechnical context will be different, the following critical path can inform the developmentof an arsenic number of conceptual models exist for planningcommunication strategies. The Bangladesh strategyadopted the ACADA planning process (assessment, Communication analysis, programme design, action) usedby and behavioural science theory providescommunication planners with a framework for planning astrategy to change behaviour. In Bangladesh, diffusiontheory was applied to identify the various stages largegroups of people pass through in adopting a new behaviourand Communication process began with a rigorousinvestigation of knowledge, attitude and practice.

10 Rapidrural assessments, using standard qualitativemethodologies, were rural appraisal techniques were used to givevillagers a voice in identifying their needs and included mapping exercises to identify local resourcesand special meetings to try to include all the differentgroups in a village to determine how best to communicateabout arsenic. The challenge in Bangladesh, as elsewhere,is to turn over Communication processes and methods tolocal people, putting them at the core of communicationPlan strategicallyIncorporate theoryResearchInvolve peopleD R A F T4analysis, planning and action. This approach relies onaccountable and flexible institutions, considerableresources, trained facilitators and recognition that changingbehaviour is a long-term Bangladesh example demonstrates that a broad, multi-sectoral approach to arsenic is needed for behaviouraldevelopment and social change.