Communication & Negotiation

Azienda Ospedaliera San Camillo ForlaniniUfficio Governo Clinico

Obiettivo e Strumenti

Health Communication

Advocacy

Negotiation

Introdurre il concetto di comunicazione sanitaria, dove nasce, quando nasce e perchè, e degli

strumenti o metodi utilizzati nell’ambito della Health Communucation

Health Communication - Definizione

• “L’arte e la tecnica di informare, influenzare e motivare individui, istituzioni e l’opinione pubblica su importanti tematiche sul tema salute. L’health communication include prevenzione delle malattie, promozione della salute, politiche di benessere, e promuove il business della salute come miglioramento della qualità della vita e la salute dell’individuo nella comunità” - Healthy People 2010

• “Area teorica, di ricerca e pratica legata alla comprensione e all’influenza delle interdipendenze tra la comunicazione (interazione simbolica nella forma di messaggi e significati) e credenze, comportamenti e atteggiamenti nell’ambito sanitario.” Cline, R. 2003

• “La Health communication è un approccio multiaspetto e multidisciplinare per raggiungere differenti contesti e per condividere le informazioni legate alla salute con l’obiettivo di influenzare, promuovere e supportare l’individuo, le comunità, le professioni sanitarie, gruppi speciali, politici, e il pubblico per introdurre, adottare, sostenere un comportamento o una pratica o una politica che possa migliorare la salute.” Schiavo, R. 2007

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Cosa è la Health Communication?

• Comunicazione, nella quale il contenuto è salute• Il modo in cui parliamo, e condividiamo

informazioni sulla salute• La combinazione di esperienze e insegnamenti

che portano ad adottare dei comportamenti spontanei in tema salute e sanità

• Elemento cruciale nella prevenzione delle malattie e nella promozione di campagne di benessere e salute

5

La Health Communication è…

• “Where good health promotion and good communication practice meet.”

Da: Rootman, I., & Hershfield, L. (1994). “Health Communication Research: Broadening the Scope” Health Communication, 6(1), 69-72.

CommunicationHealth Promotion HC

L’importanza della Health Communication

• Potenziale per ridurre i costi della sanità• Aiuta nelle operazioni di organizzazione

sanitaria• Informa il pubblico su benessere e salute• Contribuisce alla scelta di decisione per

un cambio di atteggiamento volontario

Healthy People 2010Capitolo 11: Health Communication

• Le 6 aree principali:• Diffusione di Internet• Qualità di siti Internet sulla salute• Health Literacy• Provider-patient communication• Ricerca e valutazione di programmi di HC• Centri di eccellenza in HC

Un pò di storia...

• Anni ’70• ICA-division of health

communication• Social marketing campaigns• U.S. academic programs• Federal and private funding

• Anni ’80• Refinement of social marketing

campaigns• Academic journals dedicated to

health communication issues

Un pò di storia...

• Anni ’90

• CDC Office of Communication

• NCI Health Communication Branch

• Increase in health communication journals

• MPH health communication courses

• MS/PhD programs, specialization in health communication

Un pò di storia...

• XXI Secolo...

• Health Communication/Health Informatics streams/concentrations added to MPH programs

• Health Communication Units

• Health Communication Research Laboratory at the Saint Louis University School of Public Health

• NCI Centers of Excellence in Cancer Communication Research

• University of Toronto’s The Health Communication Unit

• Etc.

Un pò di storia...

Forme di Health Communication

INTERPERSONALE

• Tra chi fornisce assistenza e pazienti

- Medici, Infermiere, Farmacisti, Nutrizionisti, etc.

MEDIA

• Social Marketing

- Annunci di servizio pubblico su salute e benessere

• Media Advocacy

- Supporto sull’importanza della attività fisica (e.g., increase recess time; improve trail safety)

• Risk Communication

- Etichette di avvertimento su mix di farmaci

• Education Entertainment / Interactive Media

- messaggi tramite media e internet

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I livelli della comunicazione

Advocacy

Indica l'insieme di azioni con cui un soggetto si fa promotore e sostiene attivamente la causa di un altro. Nel campo della salute in particolare, consiste nello sforzo di indirizzare o modificare le politiche pubbliche e la destinazione di risorse in una direzione favorevole alla salute dei singoli cittadini e della comunità.

Il Ciclo dell’Advocacy

1- Identificare il problema:

2- Ricerca ed Analisi

3- Pianificare

4- Agire

5- Valutare e Controllare

Il ciclo dell’Advocacy

1- Identificazione del problema

Strumenti:

- Chatting e Listening- Semi-structured interviewing (con KOL)- Focus Group- Comunity Mapping- Prioritaze need

Il ciclo dell’Advocacy

2- Ricerca ed Analisi (info)

Strumenti:- Force Field Analysis (Positive & Negative): Politico, Economico, Sociale, Tecnologico- Timeline of Key Events- Analisi Contestuale (Force+Timeline)- Economic and Political Power Triangle-Problem tree and why analysis-Assessing Information (bias, usefull...)

Il ciclo dell’Advocacy

3- Pianificazione

Strumenti:- Identificare il traguardo- S.M.A.R.T.- Stakeholder Analysis e Mapping- Allies & Opponents Matrix- Scegliere il Metodo di Advocacy- Risk Management- Gantt Diagramm- SWOT/BEEM Analysis

Metodi di Adovocacy

43

ADVOCACY TOOLKIT PRACTICAL ACTION IN ADVOCACY

© T E A R F U N D 2 0 0 2

PlanningC3METHOD EXPLANATION COMMON USE EXAMPLES

Networking(SECTION C4.2)

Building alliances with asmany people as possible

Creating a movement forchange

Speaking directly to thetarget to explain in detailthe problem and theproposed solution

Informing people of thesituation so that they areaware of the issues

Often the first step in anadvocacy process

Closely connected withawareness raising andmedia

Involves harnessing‘public pressure’ so thatas many people aspossible will contactdecision-makers and callfor change

For any long-termadvocacy activity to makeit sustainable

When you do not havethe skills or strength innumbers

When target is open andwill listen to facts andcareful argument

Meeting othercommunity leaders

Sharing information viaemail

Joint conferences

Meetings

Phone calls

Briefing document

Public meetings

When information ishidden

When issues are complex

To build confidence

Training

Community meetings

Church services

Posters and leaflets

When policy-maker canbe swayed by publicopinion

To show strength offeeling

To use strength innumbers andorganisation

Letter writing by public

Marches and rallies

Lobbying(SECTION C4.3)

Raising awareness(SECTION C4.4)

Mobilising(SECTION C4.5)

Using the radio,newspapers andtelevision (owned byothers as opposed tousing your own media,eg: newsletter)

When you cannot getdirect access to policymakers

To reach those outsidethe local area

Radio phone-in

Press release tonewspaper

Briefing a journalist

Media(SECTION C4.6)

Advocacy methods

Il ciclo dell’Advocacy

4- Azione

Strumenti:

- Networkig- Lobbyng- Raising Awareness- Mobilising- Media

Il ciclo dell’Advocacy

5- Valutazione e Controllo

Un semplice metodo di valutazione:

76

TOOL 35 A basic procedure for evaluation

1 ACHIEVEMENT OF OBJECTIVES To what degree did you achieve your objectives?

2 KEY INFLUENCES What contributed most to the success or failure of your initiative?

3 CHANGES What needs to be changed or done differently next time?

In terms of ongoing advocacy, there are three main options:

! Keep going with the strategy.

! Modify your approach based on the evaluation.

! Stop this particular initiative and learn from your mistakes next time.

T E A R F U N D R O O T S R E S O U R C E S

EvaluationC5 ADVOCACY TOOLKIT PRACTICAL ACTION IN ADVOCACY

YES

NO YES

What changesneed to be madeto the strategy?3FINISH

START

NO

Did weachieve ourobjectives?1

Why?2Why not?2

Is theremore work

to do?

Negotiation - Definizione

� È un processo di risoluzione di un conflitto� Tra due o più soggetti� In cui si cerca di stabilire cosa ognuno dovrebbe dare e

ricevere � In una transazione specifica finalizzata al raggiungimento

di un accordo mutuamente vantaggioso

Rubin, Brown, 1975

Negotiation - Processo

La negoziazione: il processo

PRIMA- definire SET DI OBIETTIVI min/max - cercare TERRENO COMUNE- VANTAGGI DA ACCORDO - COSTI DA DISACCORDODURANTE- evitare di trasformare ASPETTI RELAZIONALI in obiettivi negoziali- cercare convergenze di interessi/di valori a monte delle posizioni divergenti- cercare soluzioni innovative-costruite per definire accordi comuni/ espliciti realizzabili (evitare accordi apparenti/compromessi)DOPO- trasferire in co-responsabilità accordi/vantaggi comuni- imparare dalle difficoltà incontrate (fare analisi di problema)- controllare/ipotizzare effetti immediati/futuri dell’accordo GESTITO sul rapporto

Il Dilemma del Prigioniero

�2 persone, sospettate di aver commesso un grave crimine insieme, vengono arrestate

� la polizia non ha sufficienti prove per dimostrare la loro colpevolezza

� e quindi può solo incriminarli per reati minori

… a meno che uno dei due confessi!

Il Dilemma del Prigioniero(Von Neumann e Morgenstern 1944)

Chiusi in celle separate a ciascuno dei due prigionieri viene fatta una

proposta:

“se confessi il crimine ed accetti di testimoniare

contro il tuo compagno, ti libereremo!”

Una Proposta

�se entrambi accettano la proposta, si discrediteranno a vicenda agli occhi del giudice, ed incapperanno in una dura condanna; ma non massima (visto che entrambi confessano)

�se nessuno dei due accetta, la pena sarà molto lieve per entrambi.

Prospettiva Interessante ma...

Prigioniero BPrigioniero B

Non parla

Confessa contro il

compagno

Prigioniero A

Non parla

Pena molto lieve per entrambi

Scarcerazione per B, massima

pena per APrigioniero A

Confessa contro il

compagno

Scarcerazione per A, massima

pena per B

Pena piuttosto

severa per entrambi

Il Problema è plurisoggettivo

Nel 90% dei casi, la strategia che minimizza il rischio risulta essere

quella di tradire.

�si viene scarcerati, nel caso in cui il compagno non confessi a sua volta;

�si evita la pena massima, nel caso in cui il compagno tradisca.

Ma la scelta è individuale...

Case Studies

• Female Genital Cutting in Nigeria• Influenza Aviaria in Egitto• XDR-TB in Sud Africa

FGC* in Nigeria

*Female Genital Cutting

Strategic Communication Changes Norms,Intentions Related to FGC in Nigeria

H e a l t h C o m m u n i c a t i o n P a r t n e r s h i p Impact!

To learn more contact:Anna Helland!"#$"%&'())*+,"-'%.,//%0123.4++56#"$#"Stella Babalola77!'8,0*#"'9,:,%"+.'())*+,":;%;%/#/23.4++56#"$

Health Communication Partnership;%:,1'%<'=#.0:'>#5?*0:'@/##&;,"$8+.##/'#)'!4;/*+'>,%/<.'7,0<,"')#"7#&&40*+%<*#0'!"#$"%&:'AAA'B%"?,<'!/%+,-'84*<,'CAD'@%/<*&#",-'B%"E/%01'FAFDF-'G8HI,/J KLADM'NOPQNCDD'R%SJ KLADM'NOPQNFNNT,;:*<,J .<<5JUUVVV63.4++56#"$WQ&%*/J #"1,":23.4++56#"$

COMMUNICATION

Women from the Akpamanyahamlet in the Nimbo communitycelebrate at a yam festival. Thisgroup of women participated ina formative research healthsituation analysis for theNdukaka Project in EnuguState, Nigeria

In Nigeria’s Enugu State, girls typically have some oftheir genitalia removed during infancy, a culturalpractice, known as female genital cutting (FGC).Various cultural factors and beliefs influence thepractice including the fact that women who have notundergone the procedure are believed to bepromiscuous, unclean, and not likely to get married.The cutting of the clitoris is thought to reduce thenatural tendency for promiscuity in women.Another important belief that supports the practiceis that FGC makes female genitals more beautiful.

While considerable efforts have been made inEnugu, support for FGC persists in many parts ofthe state. Against this background, the HealthCommunication Partnership (HCP) in collaborationwith two Nigeria-based nongovernmentalorganizations–the National Association of WomenJournalists (NAWOJ) and Women Action ResearchOrganization (WARO)–designed a multi-tiered,multimedia program aimed at helping eliminateFGC in Enugu State. Entitled Ndukaku (Igbo for“Health is better than wealth”), the program focusedon three local government areas (LGAs) in EnuguState: Uzo-Uwani, Isi-Uzo, and Enugu South. Afterone year, researchers found that both support fordiscontinuing FGC in Enugu State and theintention not to perform FGC on daughtersincreased significantly when compared to a controlarea.

FGC is the collective term used to refer to anypractice that involves the partial removal, total

removal, or other injury to the female genitals. Likemale circumcision, FGC is found throughout historyand in many cultures, but there is no definitedocumentation of when or why this practice began.

The World Health Organization classifies FGCinto four categories. Type I involves removing theprepuce, with or without the removal of all or partof the clitoris. Type II includes removal of theclitoris with partial or total excision of the labiaminora (the inner vaginal lips). Type III is the mostextreme form and involves the partial or totalremoval of the external genitalia and infibulation(stitching or narrowing of the vaginal opening with asmall opening to allow for flow of urine andmenstrual blood). Type IV covers a variety ofprocedures including angurya cuts (scraping of thetissue around the vaginal opening), “gishiri cuts”(posterior cuts from the vagina into the perineum),stretching of the clitoris and/or labia, cauterizationby burning of the clitoris and surrounding tissue,and introduction of corrosive substances into thevagina.

About 30 million Nigerian women haveexperienced FGC. According to the 2003 NigeriaDemographic and Health Survey, FGC is mostcommon in the southeast and southwest regions. A1999 survey revealed a prevalence rate of 59% inEnugu State and 76% in Ebonyi State. The mostcommon forms were Type I and Type II. In Enuguand Ebonyi States, FGC commonly involvesremoving the prepuce and/or the clitoris with partialor total excision of the labia minora. While Types Iand II are the least invasive forms, the potentialhealth and social complications are numerous. Suchcomplications range from short-term side effectssuch as severe bleeding, infection, and shock to long-term complications, such as problems withpregnancy or labor.

Challenging Long-Held Beliefs

The Ndukaku Initiative aimed to decrease thenumber of families in high prevalence communitiesthat practice FGC on their daughters. HCP’sapproach to this highly sensitive topic was non-confrontational, with a goal of creating an opendialogue on FGC that enabled people to makeeducated decisions. Ndukaku used a multi-pronged

Impact!IImmppaacctt!!June 2005 • Number 18

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approach that challenged individuals andcommunities to examine their beliefs andvalues around FGC and encouraged individualand community action toward the eliminationof FGC.

The multi-channel approach of Ndukakucombined community capacity strengtheningand mobilization with targeted advocacy andmass media interventions across three levels:hamlet (the smallest unit of socialorganization), LGA, and state.

WARO led the community actioncomponent, which relied on the CommunityAction Cycle (CAC) to strengthen existingwomen’s groups to identify and address theirmost pressing health issues. Developed by Savethe Children, the CAC works through a coregroup of community members that firstidentifies and explores health priorities andthen leads a process of community-wideplanning and action to achieve improvementsand meet community needs. WARO assistedthe core groups in identifying their healthpriorities, provided information on communitymobilization, and conducted technical sessionswhere FGC and other maternal health issueswere discussed and analyzed. Core groupmembers then developed action plans for theelimination of FGC in their communities withactivities that included meeting with traditionalleaders and ruling councils to garner theirsupport as well as organizing larger communitymeetings to discuss the dangers of FGC. Thecore group disseminated information learnedduring the WARO technical sessions throughtheir community and traditional leadermeetings and through health seminars and peerhealth education sessions.

Activities at the LGA level included theviewing of Communicating for Change’sdocumentary film, Uncut - Playing with Life,at community gatherings and conductingadvocacy visits to traditional leaders. NAWOJimplemented statewide activities, includingregular newspaper columns, radio call-in shows,and public forums on FGC. Additionalactivities included anti-FGC discussions at the

annual tribal “Home and Abroad” meetings,LGA town forums, and regular networkingmeetings among local partners.

ImpactResearchers evaluated the program using acontrol-intervention design with pre- and post-intervention surveys. For the purpose ofassessing the impact of program activities, HCPselected Ebonyi as the control state. Ebonyi issimilar to Enugu State in terms of ethnicity,cultural practices, and socio-economicconditions. HCP conducted a baseline surveyin three LGAs in Ebonyi and Enugu in 2003.In 2004, HCP conducted a follow-up survey inthe same LGAs and enumeration areas as thebaseline.

Exposure to program activities wasrelatively high: 67.1% of men and 61.4% ofwomen in the program LGAs reportedexposure to at least one program activity. Thedata further showed that while the attitudinaland behavioral indicators relevant to FGCeither became worse or remained stagnant inEbonyi, they improved significantly in Enugu.For example, the proportion of women thatbelieved that there are benefits to FGCdeclined significantly (from 42.1% at baselineto 24.6% at follow-up) in Enugu, while thisindicator did not change much in Ebonyi(from 33.9% to 28.4%). Similarly, whileperceived social support for FGCdiscontinuation either declined or stagnated inEbonyi, this perception became morewidespread in Enugu (see Table 1). The datafurther showed the following improvements inEnugu but not in Ebonyi: decreased personalapproval for FGC, increased perceived self-efficacy to resist the pressure to perform FGC,a decline in the belief that FGC is a religiousobligation, and increased personal advocacy infavor of FGC abandonment. Furthermore, thedata showed the intention not to perform FGCon daughters increased considerably in Enugu.In Ebonyi, the situation remained the same asat the baseline (Figure 1).

Other AccomplishmentsNdukaku’s success was exemplified by localaccomplishments as well. In Ohuala Amede,the core group gathered more than 100community members to discuss FGC andencourage discontinuation. The traditionalruler of Ohuala Amede, Igwe Ogbuebo, offeredsupport, acknowledged the importance ofstopping the practices in Ohuala Amede, andpledged to give his support to all future coregroup resolutions.

The traditional ruler of Eha Amufu, IgweSamuel Ede, made a public pronouncementagainst FGC and banned FGC in his domain,with the annual circumcision ceremonyconducted without actual cutting. Hispronouncement triggered statewide action,leading to a health bill that included languageon the elimination of FGC taken to the EnuguState House of Assembly.

Most importantly, women in the projectareas became empowered advocates and changeagents on health issues and FGC through theCommunity Action Cycle. Referring tothemselves as the “Ndukaku Women”, theyacquired a level of awareness that has placedthem in a ready position not only to campaignactively against FGC but also to replicate theCAC in other communities.

Communication Makes the Difference!

June 2005, Number 18H e a l t h C o m m u n i c a t i o n P a r t n e r s h i p Impact!

“Who says that women should not betrained? Most inspiring is the women’swillingness to put into action whatthey’ve learned.”

– Igwe Obeagu (Igwe-elect, Ohuala Amede)

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In Nigeria l’ FGC è una pratica culturale: si crede dia meno problemi dal punto di vista igienico, oltre ad

essere un segno di bellezza

Circa 30 Milioni di donne hanno avuto un FGC, con effetti patologici a lungo e breve termine

In seguito a programmi di HC, circa il 65% è venuto a conoscenza degli effetti, le donne che non credono più negli

effetti del FGC è sceso dal 41% al 24%

Influenza Aviaria in Egitto

February 2007, Number 22

COMMUNICATION Summarizes research and programmatic findings from the Health Communication Partnership (HCP) and other bilateral agreements.

Based at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs. HCP partners include the Academy for Educational Development, Save the Children, the International HIV/AIDS Alliance, and Tulane University’s School of Public Health and Tropical Medicine.

HCP is supported by the United States Agency for International Development

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on AI. !rough these meetings, volunteer committees were set up to disseminate AI health messages, to screen all the households breeding domestic birds, and to facilitate the closing of shops that sold live birds in their villages as per government policy. Pharmacies, often the front-line health service delivery venue for the majority of Egyptians, also proved to be a critical source of public information on AI. !e program distributed hundreds of thousands of AI informational flyers for providers and consumers through the Ask-Consult pharmacies, and pharmacists received 30,000 informational posters to display on their storefronts.

The Egypt Health Communication Survey

CHL had already scheduled a national survey (the Egypt Health Communication Survey or EHCS) for May 2006 to assess the reach and impact of its family health communication activities. !e program augmented the survey to assess the reach of the AI campaign and its impact on knowledge of transmission and symptoms, and initiation of protective practices. !e survey used a nationally representative sample (n=4052) of 15- to 49-year-old adults in 21 governorates.

RESULTSKnowledge

!e EHCS 2006 data showed that three months after the launch of the national AI campaign, the vast majority (86%) of respondents could recall a message from the TV spots and programs. !is in turn helped produce an impressive increase in knowledge concerning the disease. Eighty to ninety percent of respondents reported that they had learned about modes of transmission, symptoms in humans, and symptoms in birds of avian influenza (Figure 1).

Protective Behavior

!e campaign messages also increased the practice of protective behaviors against AI. Seventy-eight percent of respondents who could recall campaign messages reported that they had taken at least one action to protect themselves or their family from avian flu, compared to 55 percent of those who could not recall any campaign messages. Respondents who could recall a message were significantly more likely to report the following protective behaviors: handling poultry di"erently, washing their cooking utensils more thoroughly, washing their hands after handling birds, avoiding birds, and keeping children and the elderly away from birds (Figure 2). People who

could recall two or more messages were even more likely to report these protective behaviors.

An Integrated and Sustainable Response

Egypt was in a unique position to respond swiftly and e"ectively to the AI crisis because of the partnership and cooperative mechanisms established between the MOHP and the MOI/SIS through the CHL Project, implemented by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP) through the Health Communication Partnership (HCP). All of these partners were able to mobilize their e"orts according to the practical communication strategy developed by CHL under the auspices of the national AI committee, chaired by the MOHP with representatives from all the concerned national bodies (including the MOI and the Ministry of Agriculture) as well as international partners (such as USAID and WHO). Because the AI threat will likely remain in Egypt indefinitely and at varying levels, CHL and its partners are continually refining and adapting the communication plan to identify and address threats and gaps that exist or might develop in the future.

Source: MOHP/SIS/CHL Egypt National Health Communication Survey 2006, n=4052 Chi-square (df=4,4048), p<.0001, Controlling for respondent’s education, employment, urban/rural residence, age, and whether or not live birds are kept in the household

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Communication Makes the Di!erence!

Figure 2: Protective behaviors reported in past three months, by number of campaign messages recalled

A Quick Response to an Avian Influenza Outbreak

Within hours of the confirmation of the first cases of the H5N1 “Avian Influenza” (AI) virus in Egypt on February 17, 2006, all the major state-owned television channels were airing an informative TV spot showing families how to protect themselves from the deadly virus. !e Communication for Healthy Living (CHL) Project, whose core partners include the Ministry of Health and Population (MOHP) and the Ministry of Information/State Information Service (MOI/SIS), worked well before any outbreak, under the “Your Health Is Your Wealth” Program, to develop an integrated package of communication interventions. !eir goal was to develop a quick, unified and e"ective response to any outbreak. As a result of this concerted e"ort, which included broadcast and print materials as well as community outreach activities, 86 percent of the adult population—an estimated 38 million people—were able to recall messages from the campaign. Seventy-eight percent of those—nearly 30 million people—reported taking at least one protective action, including avoiding contact with birds, keeping children and the elderly away from poultry, and washing their hands and utensils more carefully after preparing poultry.

TV Spots

In addition to the initial TV spot, CHL collaborated on the production of three other TV spots on AI with more specific messages on modes of transmission, hygiene and safe preparation of poultry for consumption, safe handling of live poultry, keeping children safe, and promoting a national AI hotline. !e AI hotline received close to 300,000 calls in the first three months. CHL also produced a public service announcement on AI as a joint activity with Alam Simsim (the Egyptian version of Sesame Street), with special messages on keeping children safe from exposure. !ese spots were aired regionally via satellite.

Wide Distribution of Print Materials

!e TV spots were only one component of the larger communication strategy. Addressing AI in the Egyptian context required producing specific messages for specific audiences. !erefore, the campaign included messages to address the health, agricultural, and environmental sectors. For example, poultry is a very important source of income for many families—especially rural—in Egypt. Nearly a third of the population own poultry in Egypt. Pre-testing of preliminary avian flu communication materials showed that rural groups as well as the general public wanted more information on signs of flu in poultry and its means of control. In response to the pre-testing results, CHL and the Ministries produced fliers with messages on AI prevention and protection for families with and without poultry and distributed them before the outbreak via channels such as the MOHP’s 5000+ clinics, outreach workers from the government and NGOs, and the national “Ask, Consult” network of 13,000 private pharmacies. !e materials are available on the CHL website (www.healthcom-egypt.info).

Community Mobilization

Volunteers in CHL’s community programs used the existing program structure, including regular community meetings, to mobilize communities

February 2007 • Number 22

A scene from Egypt’s Communication for Healthy Living Avian Influenza television ad campaign

Communication for Healthy Living’s Campaign Improves Response to Avian Influenza in Egypt

To learn more contact:

Program Officerbsafi@jhuccp.orgor Doug StoreyAssociate Director for Communication Science and Researchdstorey@jhuccp.org

Health Communication Partnershipbased at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs111 Market Place Suite 310Baltimore, Maryland 21202, USATel: (410) 659-6300Fax: (410) 659-6266Website: http://www.jhuccp.orgE-mail:orders@jhuccp.org

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70

80

90

100

8490 88

Mode oftransmission

Symptoms inhumans

Symptoms inbirds

Type of knowledge

Perc

ent

Figure 1: Percentage of respondents that learned about Avian Flu transmission and symptoms from the CHL Campaign

“Your Health, Your Wealth”—Communication for Healthy Living and Egypt Ministry of Health & Population

A seguito del primo caso di H5N1, tutti i maggiori canali televisivi sono intervenuti per spiegare come

proteggersi

Imponente comunicazione tramite attività divulgative, Media, e materiale stampato

86 % della popolazione raggiunta dal messaggio;38 Milioni di persone raggiunte;

Il 78% di queste, circa 30 Milioni di persone, hanno adottato almeno un metodo di prevenzione

CHL Communication for Healthly Living

Il ruolo dei media sul problema xdr-tb* in sud

africa

*Estensively drug-resistance tubercolosis

La risposta del OMS sul tema XDR-TB

nota del WHO precedente al “meeting di esperti consulenti sulla XDR-TB”in sud

Africa

TB “virtualmente intrattabili”

XDR-TB I maggiori settimanali

Newsweek Sept. 13, 2006 –

WHO recently issued a warning that deadly new strains of tuberculosis appear to be

spreading around the globe… HIV sufferers are particularly vulnerable because of their weakened immune systems. TB, already the world’s fourth most fatal infectious disease, could wreak havoc with AIDS

treatment programs

XDR-TB I maggiori settimanali

XDR-TB ...e le maggiori testate africane:

New TB strain in SA: 'No time to wait'

07 September 2006 The extreme drug-resistant

tuberculosis (XDR-TB) in KwaZulu-Natal must be dealt with urgently, international

health experts said in Johannesburg on Thursday.

"There is no time to wait before we embark on decisive action,"

said the World Health Organisation's Dr Ernesto

Jaramillo, explaining that an epidemic could have a deadly

impact.

XDR-TBtestate internazionali:

XDR-TBTitoli in Testate Internazionali:

Deadly TB strain spreading across globe

Global alert over deadly new TB strains

Africa: "Extreme" TB Bug Prompts Calls for Rapid Action

South Africa: Action plan developed to combat drug resistant TB

TB strain with extreme resistance to drugs creates nightmare scenario

WHO urges South Africa to curb TB killer super-bug

TB experts will grapple with deadly new strains: WHO

Experts call for urgent steps to battle virulent TB strain

XDR-TB New York Times & Int. Herald

Tribune

EXTREME TUBERCULOSIS SEPTEMBER 14, 2006

TB is outrunning us. In the last few months, 53 patients in the South African province of KwaZulu-Natal were found to have a form of the

disease resistant to enough existing drugs that it is virtually incurable. All but one of those patients have died…

Stinginess created this problem. Generosity is needed to fix it.

xdr-tb in africa

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In numero di messaggi e campagne è aumentato negli ultimi anni

Purtroppo il problema rimane tutt’ora critico...

Grazie dell’attenzione

Risorse di Health Communication

• WHO Internet Site:http://www.who.int/management/general/communication/en/index.html

• Journal of Health Communication:http://www.gwu.edu/~cih/journal/

• http://www.action.org/

In Italia...

Ministero salute - Novartis

• acquisto diretto di 24 milioni di dosi di vaccino. Costo: 184 milioni di euro, iva inclusa.

• art. 1: vengono definiti i cosiddetti "sforzi commercialmente ragionevoli" attorno ai quali ruota l'intero contratto; Novartis è sì obbligata a produrre e a rispettare il contratto ma solo fino a quando ciò sia "ragionevole". Se ci riesce bene; altrimenti lo Stato paga ugualmente:

• art. 2.2 e 2.7: Il ministero riconosce di non acquisire alcun diritto sui marchi commerciali e Novartis non concede alcuna licenza sui diritti di proprietà intellettuale; il ministero non è altresì autorizzato ad apportare modifiche alla confezione né a oscurare marchi su di essa;

• art. 3.3: qualora il ministero si trovi nell'impossibilità a ritirare il prodotto Novartis potrà rivenderlo ad altri clienti o fatturare al ministero quanto non ritirato, con la possibilità di rivenderlo comunque dopo 90 giorni;

• rt. 4.2, 4.3, 4.5: la responsabilità di Novartis è limitata al difetto di fabbricazione: escluso il danno di altro tipo derivante dalla semplice assunzione del vaccino;

• rt. 4.6: il ministero è tenuto a indennizzare Novartis in conseguenza di danni provocati dal vaccino, salvo ove tali danni siano provocati da un difetto di fabbricazione;

• art. 5.2 e 5.5: il prezzo per ciascuna dose di vaccino è pari a 7 euro. Totale: 168 milioni di euro più iva. Il ministero dovrà pagare entro 60 giorni dall'emissione della fattura, su un conto corrente del Monte dei Paschi di Siena;

• art. 8.3: le cause di "forza maggiore" che limitano le responsabilità di Novartis vengono estese a situazioni che dovrebbero invece essere garantite da Novartis, come "epidemie e pandemie", "atti di qualsiasi autorità pubblica", "atti di enti sopranazionali (ivi compreso l'Oms");

• art. 9.3: nel caso in cui il vaccino non sia consegnato per mancato ottenimento dell'autorizzazzione all'immisione al commercio e/o di prove cliniche positive, il ministero riconosce forfettariamente a Novartis a titolo di partecipazione ai costi la cifra (al netto dell'Iva) di 24 milioni di euro;

• art. 10.1: le parti si impegnano a mantenere assoluto riserbo sulle informazioni riservate;