.ANNEX 5 REPORT OF THE TECHNICAL DISCUSSIONS ON THE USE OF HEALTH EDUCATION SERVIC:m IN NATIONAL HEALTH PROORAMMES CONTENTS ~
1
INTRODUCTION
................................................
66 66 66 66
1.1 1.2
Subject ..•..••.•.•.•.•....• , •..•.....•.....••...•.•....
Planning, Preparation and Arrangements for the Discussions .••••........................•....
2
FIRST PLmARY SESSION .•.•••.•••.•••••.•••.•.•....••...•.••..
3
MEm'INGS OF THE THREE DISCUSSION GROUPS •••••••••••••••••••••
71 71 72 73
3.1
3.2 3.3 3.4 3·5 3.6
The Use of Health Education Services ••••••••••••••••••• Pla.tlIling .••.......•.......••..•.•....••..••...•..••.... Organization and Administration •...•..••.•.•••...•.•..• .Education 8.lld Training .................................. . Some Possible Ways and leans ••••••••••••..•••••••••••••
Suggestions for Consideration by WHO •••••••••••••••••••
74 76 79
4
CLOSnlG PrmARY SESSION ...................................... .
80
APPENDIX A - PROPOSED QUESTIONS FOR CONSIDERATION OF THE DISCUSSION GROUPS •••••••••••••••••••••••
83
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OFFICERS OF T1iE TECHNICAL DISCUSSIONS Chairman: Dr C.N. Derek Taylor, Depnty Director (Health Education), Division of Public Health, Department of Health, New Zealand English-language napporteurs: Dr C.J. Ross-Smith, General Secretary, Australian Medical Association, Australia Dr Ako Taua,. Assistant M9dical Officer, Department of Public Health, Territory of Papua and New Guinea French-language Rapporteur: Medecin Colonel ~nenoz, Chef du Service de sante de la Polynesie . franqaise,Papeete DISCUSSION GROUP A Chairman: Dr L. W. Jayesuria, De:puty Director of Medical Services, Malaya Vice-Chairman: Dr Junichi Urata, Chief, Health Center Section, Public Health· Bureau, Ministry of Health and Welfare, Japan Rapporteur: .... Dr R.K.C. !ee, Director of Public Hea.lth and M9dical Activ:l.ties, University of Hawaii, Hon0lulu, Hawaii, United States of America Host·Co~~try
-
Rapporteur:
Dr Hyang Jong Park, Assistant Professor, School of Public Health, Seoul National University, Republic of Korea DISCUSSION GROUP B
Chair::na..'1 : Dr C.K. Chang, Director, Depa.....-tmer.t of' HeaJ.th Adrrl.nistration, Ministry of Intflrior, Taiv.1&l, Republic of Cb.ina
REPORT OF THE RIDIONAL COMMITTEE
Vice-Chairman: Dr C.H. Gurd, Director of Medical Services, Fiji
Rapporteur: Dr Trinid.ad A. Gomez, Chief, Office of Health Education and Personnel Training, Department of Health, Manila, Philippines
,Y
Host Country Rapporteur: Dr Chang Dong Min, Chief, Section of Public Health, Bureau of
Health and. Social Affairs, Special City of Seoul, Republic of Korea DISCUSSION GROUP C Chairman: Medecin General M. Orsini, Directeur de la sante et de l'HYgiene publique en Nouvelle-Caledonie, Noumea, Nouvelle-Caledonie Vice-Chairman: Dr Keo Phann, Medecin Chef de la Direction de l' Eradicati. on du
Paludisme et des Maladies transmissibles, Cambodge Rapporteur: Dr Guy Loison, Executive Officer for Health, South Pacific COmmission, Noumea, New Caledonia Host Country RapporteUl': Mr MOon yong Rhie, Director, Bureau of International Relations,
Ministry of Foreign Affairs, Republic of Korea
Secretariat: Dr A. Helen Martikainen, Chief, Health Education Section, World
Health Organization, Geneva Mr D.C. Johnson, Regional Health Education Adviser, WHO Western
Pacific Regional Office, Manila (Secretary)
66
REGIONAL COMMrITEE~ SIXTEEN'J.'H SESSION
1
INTRODUCTION
1.1 Subject
''The Use of Health Education Services in National Health Programmes
It
was the subject selected for the Technical Discussions in accordance with resolution WP/RC15.R4 adopted during the fifteenth session of the Regional Committee. 1.2 Planning, preparation and arrangements for the discussions Advance planning included preliminary consultations between the Chairman of the Technical Discussions and the Secretariat. Through
•
contacts with public health authorities and health workers in countries of the Region and by way of a questionnaire, information was secured on the uses of health education services in national health programmes. Suggested questiOns and problems were provided by Member governments prior to the meeting, as well as by representatives upon their arrival. in Seoul, Republic of Korea (see Appendix A). The list of working
documents and background material provided appears in Annex 6 of the main Committee report. The Technical Discussions opened with a plenary
session followed by meetings in three discussion groups "arid concluded with a closing plenary session. 2 FIRST PLENARY SESSION
In his opening remarks, the Chairman stated that the topiC of the Technical. Discussions was of great importance to all countries and territories ("If the Region and that the purposes of the discussions were: (1) to exchange information and ideas on what is being done by countries in the Region;
REPOR!' OF THE REGIONAL COMMITTEE
67
(2)
to revievl needs and available resources for future planning, development, and use of health education services in national health programmes within the Western Pacific Region of WHO;
(3)
to offer ideas and suggestions for reference of countries in the future development of the health education services.
The Chairman drew attention to the Annual Report of the Regional Director for 1964, which indicated that considerable progress had been made in countries of the Western Pacific Region during the past fifteen
years.
He noted also that in many parts of the world today medical and
public health authorities have come to recognize that adequate knowledge, understanding, and motivation are required by individuals and the public at large before co-operation, active support, and personal or community action regarding health matters can be realized. In recent years, a great
deal more attention had been given to a more scientific and organized application of the principles of education and the findings of the relevant social sciences to the planning and. promotion of public health services. As a result of the recognition of the need for the social and
educational approach in public health programmes, health education services are now being established along with other basic public health services in national, prOvincial or state, and local health organizations. The Chairman referred to some main points made in his paper entitled liThe Use of Health Education Services in National Health Programmes ".
He stressed: (1) the ~ortance of the principle of active participation of people in health programmes if they are to become
",,6,;;;8~_~____........;R:.::EG:;,,~I:.:ON=l\L=T....;C:::..:O~M:.!i.\IT=.Tl'EE: SIXTEEN'rH SESSI0N
motivated to adopt and to apply desired changes or iIqProv'E)ll!ents in their daily health habits and practices; (2) the opportunities which melllbers of the staff in health programmes have to aF,Ply the social and educational approach in planning and carrying out their respective functions and responsibilities; (3)
the kind and amount of em:9hasis placed on informing people about health services, and motivating people to adopt desired improvements or c~"ges
in treir health
practices, depends on the degree to which the public health facilities are developed in the local area, province or state, or country concerned; (4)
the
i~rtance
of the health programme administrators
bringing the health education services into the early planning stages of programmes in which the understanding and active support of the public or certain population groups are required;
(5)
the iIqPortance of developing co-operative activities 'With ministries or departments of education. All branches of
the health services are vitally concerned 'With school health and health education. It is 'With the school-age
children and. youth that there are mst iIqPortant opportunities to promote desirable health knowledge, attitudes, h~~its
and practices.
The Secretary of the Technical Discussions focussed his remarks on a few of the major questions and developments w~~ch had emerged from
'y his review of the re~orts
received from Member countries and the profes-
sional contacts the Regional Office had had with health officials and health workers throughout the Region. He pointed out that: (1) the need for establishing or improving health education services in national health programmes was recognized by leaders throughout the Regionj (2) there is concern that health education services are still not always an integral part of the planning and development of health services. Therefore, the important element
of motivating people to make more effective use of health services and to participate in was not yet .rell developedj . (3) relev~~t
improvement projects
more study and effort are needed to establish the basis for planning the social and educational aspects of health work and of training activities for health Y~rkers
and othersj the Region
(4)
some encouraging steps were being taken
vathin
to make more substantial and systematic provision for the social and educational approaches in the planning and extension of both curative and preventive health services. This is being done by planning ahead for health education services which can be used. to help carry out functions such as: (a) analysis and study of the relevant social and educational aspects of health problems; (b) planning the educational aspects of various health programmes;
70
mr~ION.AL
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(c)
organization and conduct of educational aspects of basic health services or of specia..l projects directed tOvlard majornealth problems;
(d)
education and training of health personnel in health education and the related social sciencesj
(e)
prepsxation, pre-testing, and production of visual materials;
(f)
evaluation of the effectiveness of health education services;
(g)
studies and research related to health education pra.ctices.
(5)
there is an outstanding potential for giving much more co-operative support to helping prepare school-teachers for the !:l£'.::lY opporttmities t.hey have to influence the heall;h behe.vio\.~
of students.
The
growing interest of
international agencies such as UIiESCO and UNICEF in assisting interested countries to strengthen primary and second.at'y education and teacher training have important technical ~lications
for health ministries
and l1HO in co-operative promotion of school health and health education. It was his view tbat workers in various r~alth ~~
experienced and thoughtful leaders and co~unications,
professions, education, ~~re
related
social scien;es and other fields,
vell aware that much more needs
to be done to extend and to improve the social and educational aspects of health work.
REPORT OF THE
REGI~TAL
COMMrTTEE
n
,
MEEl'INGS OF THE T1lREE DISCUSSION GROUPS
Meetings of the three discussion groups considered problems in the plflnning and use of health education services in national health programmes. SOl!le of the main points made are sl.1llllllBrized as follows: 3.1 T~e
Use of Health Education Services
3.1.1
There was general agreement that the value of using health
education services in health programmes had been 'ltrell demonstrated in many parts of the Region. including: Examples were given concerning many areas
maternal and child health, nutrition, dental health,
vaccination campaigns (BeG, smallpox, measles), poliomyelitis, tuberculosis, environmental health, bilharziasis, filariasis, malaria, yaws and leprosy. 3.1.2 The need for health education services is particularly evident
in the developing countries.
Nevertheless in economically more developed It was noted, that existing health Too
countries, they are also needed.
education services are not always used to the best advantage.
frequently attempts are made to impose coercive regulations which are difficult to iJli>lement, rather than to seek means of enlisting, the, understanding and spontaneous support of the people. It was recalled in one
group that public health moves no faster than public opinion. 3.1.3 In countries with only a single health education specialist, his (a) studies and research of
efforts should preferably be directed to:
relevance to health and health education; (b) interpretation of problems and programme requirements to government officials; and (c) training of tutors who in turn will train other personnel in health education.
3.1.4 A more systematic and effective use of health education services by health administrations could be of very considerable value to
72
RIDIONAL COMMITTEE: SIXTEENTH SESSION
enlisting more effective local participation in and support of existing and developing health programmes. 3.2 Planning
3.2.1 For the satisfactory development of health education services at national, state and local levels of administration, it is essential that both technical and non-technical health administrators understand the modern conce:pt of health education and are convinced of its usefulness in health :programmes. 3.2.2 In particular, the above a:pplies to government officials who
allocate the required budgetary resources necessary for effective health education services. 3.2.3 Adequate finance must be planned for health education services
and it should appear as a se:parate budget item.
In one group, it was
pointed out that too often there is a tendency for the health education budget to be "taken lightly". 3.2.4 Health education services are :part of the overall health :programme
and should be planned and developed along .lith the other basic health services. The health education services should be closely geared to the
available public health services and should. be integrated into appropriate health programmes. It is the responsibility of' the health administrator
to give leadership in deciding programme priorities in consultation with the health services concerned and. to involve his health education services from the early stages of planning health programmes. 3.2.5 The training of health education staff' should be of as high a
professional level as possible.
As staff become trained, it is neces-
sary to ensure that positions are open to them and that projects on
REPORT OF THE REGIONAL COmITTEE
13
which they can begin work are available.
The sta.:ffing position can be
difficult where existing posts are already filled by less highly trained people.
3.3 Organization and. Administration 3.3.1 Important pOints brought out by the groups orere that: (a) there
should be a central health education unit at the national level, (b) this unit should be situated in the health m1nistry, and (c) it shoul': occupy a position at the same level as other major programme activities.
3.3.2 For certain countries, it was felt that the head of the national health education services should, if possible, have a medical background in addition to higher training in public health with specialized studies in health education. This could apply particularly during the early
development of health education services in the country.
3.3.3
The groups gave particular attention to the following services co~tent
which they considered a assist with providing: (1)
national health education unit could
Planning and co-ordination of the health education activities carried out by the various health services within the Ministry of Health and co-ordination of these activities with the health education efforts of departments
ot education, agri-
culture, orelfare, and other relevant agencies of government, as well as with those of hospitals, voluntary health agencies, professional societies and others. The higher the status given to health education, the higher the level at \Thich co-ordination and planning can be carried out and economies effected.
14
SIXTJmIYTH SESSION
Examples 'Were given: (a) of the advantages of co-ordination by a central health education committee with membership from departments and organizations such as those listed above, and (b) of the need for goverrunent health ministries to co-operate more closely .lith voluntary organizations and professional groups. (2) Consultative services to departments, organizations and groups within the health ministry and to other ministries, organizations and institutions.
(3)
Training of all categories of health workers at all levels. Studies and research including sociolOgical studies concerning the beliefs, attitudes and practices of people in relation to health and disease.
(4)
(5)
Information and programme interpretation incl.uding (a) the presentation of health programmes to the public and to government officials in order to promote understanding and to obtain their support; and (b) the provision of general health information to the public including the availability o£ existing health services.
(6)
The planning and carrying out of health demonstration and training projects.
3.4 Education and Training 3.4.1 Health workers at all levels should be prepared in health educa-
tion and the related social sciencies and this training should be closely
REPORT OF THE REGICNAL COMMITTEE
75
geared to their individual requirements.
It was pointed out that even
the less educated sprayman in a malaria eradication programme has a valuable part to play in health education. He should be trained in
simple terms to understand what he is dOing and why so that he can make use of this information in his contacts with the people. These contacts
may be the first indication in a village that the government has a health department. population. Action such as this can help to command the respect of the
3.4.2 Non-technical administrators also need appropriate training in health education adapted to their functions and responsibilities.
3.4.3 Training of health workers in health education is necessary at baSiC, post-basic and post-graduate levels and also during in-service training. The last may be the easiest to plan and to carry out as it
is generally under the control of the health adl!Jinistration.
3.4.4 Every effort should be made to include and to integrate health I~
education in all relevant aspects of education and training curricula for health workers.
3.4.5 There is a need for closer liaison and co-operation teaching faculties
beti~en
the
of training schools and institutions preparing
health workers and the health agencies which are the "consumers" of the services provided by their former graduates. The aforementioned
training institutions would include medical schools, nursing and midwifery schools, and centres for training environmental sanitation personnel.
3.4.6 School-teachers should be provided ,lith opportunities for receiving preparation in health education at basic, post-basic and post-graduate levels.
Rmlcw.L COMML'l"fEE: SmEENTH SESSION
3.4.7 Some participants felt that each country should aim at the planning and development of its Olm facilities to provide education and training. These should include provision for the health education aspects of education and training and be in keeping with existing health needs, local socio-economic circumstances, available staff, teaching facilities, materials and budget. date.
»my examples were given of the progress made to
3.4.8 Qualified staff "lith training and
e~erience
in public health and
health education is necessary to ensure that the above-mentioned functions and training progr8JlDlles can be carried out.
3.5 Some Possible Uays and Means In considering some of the ways and means of planning, organizing
and using health education services in hee+th programmes, several participants stressed the inlPortance of health workers taking into account the educational status, the cultural patterns, and the economic circumstances of the people in any given local area if they were to function effectively in carrying out their duties and responsibilities. Getting people to help themselves was particularly stressed. It was
noted that one of the main aims of health education is to stimulate local leaders to help their o,m people to become more capable of meeting their health problems. They can be aided by health services already ava.1l.able
.
or likely to be made available to them in the future. The groups suggested that some of the ways and means by which this
might be achieved are: (1) Ensure that planning by, and. participation of, the people is carried. on at all levels, as early as possible and continuously.
REPORT OF THE REGIONAL COMMITrEE
77
(2)
All available resources should be used, including voluntary health agencies, hospitals, professional associations and practising physicians. The support of physicians was
considered to be of particular significal1ce because of the considerable importance people in some areas place on the advice and counsel of their family physicians. (3)
Maximum use should be made of trained health education personneL
(4)
Health education activities should be geared directly to the planning and implementation of health programmes.
(5)
Adequate funds and services need to be made available for the health education aspects of any ~alth
programme.
(6)
Where possible, there should be an attempt to achieve more tangible b~!lefits
by the people through their participation Motivation of public and government
in health programmes. I;;
support is easier if such benefits can be readily demonstrated. The
timing of a health programme and of the planning of its For example, people
health education aspects is important.
are frequently motivated to co-operate and to take action during epidemics. (8)
Competition in the promotion of local health improvements can be used to advantage in some cultures. This can usually
be planned for and carried out through the active and direct participation of the leaders and groups in the area concerned. (9) The
planning and production of audio-visual aids for use
in health education activities with each local group should
RmI(J{AL C<H41'lTEE: SIXTEENTH Sl!5SI(J{
be geared to local. needs, languages, and conditions in order to be intelli8ently understood and accepted by the people of the area concerned. Ex:an!Ples were given of some
of the ways and means of fitting in information on health with certain cultural practices such as during festivals. Reference was made also to the value of radio and television under certain circumstances. (lO) Whenever possible, provision for the e':aluation of the health education aspects of a health programme should be made from the earliest stages of progrBllllOO planning. is, therefore, essential during the planning stages: (a) to specify clearly the objectives of the educational aspects of the health programme; (b) to select the criteria for determining subsequently whether there has been any progress made toward these objectives; (c) to decide and develop the procedures which will be used for this evaluation; and (d) to establish base-line data from which it can be gau8ed subsequently whether desired chan8es or improvements have resulted. (ll) A close working relationship is highly desirable with educational institutions at all levels and in particular with primary and secondary schools. Through co-operative It
planning with school and health personnel, lIIOre specific and systematic provision for health educa.tion in schools
REPORT OF THE REGIONAL COMMI'l'l'EE
79
and in teacher training could be ensured.
This would
enable school-age children and youth to become: (a) (b) more aware of important health needs and principles; capable of understanding and using available health services; and (c) motivated to live more healthfully.
Some participants noted that it may be easier for young people to adopt desired health practices than for adults to change habits that have been long established.
3.6
Suggestions for Consideration by
vmo vmo Regional Office for the
Several suggestions were put forward by the discussion groups for transmittal to the Regional Director of the Western Pacific.
It was felt that the suggestions, as outlined below,
could be of assistance to health ministries of Mamber States within the Region in the future planning and development of health education services in national health programmes.
These proposals included the follovTing:
3.6.1
That liHO should endeavour to provide more fellowships for post-
graduate studies in public health and health education, especially for those professional persons serving in teaching institutions for health personnel.
3.6.2
vmo
assistance would be useful in reviewing whether the services
of professional health education personnel, trained previously with fellowship aid, are being used most effectively.
vmo
3.6.3
vmo
assistance is needed to collect, compile and distribute
relevant information to interested health ministries on some of the
80
•
programmes and experiences in Member countries in which effective planning and use is made of health education services.
3.6.4 Continuing WHO support is essential in assisting interested health • ministries to obtain greater governmental support, funds, personnel and equipment needed for the further planning and development of essential health education services within national health progrSllllOOS.
3.6.5 All interested countries within the Region should be invited to assist WHO by making }mown information on any studie's concerning the evaluation of the effectiveness of health education services, particularly those in which the criteria used have appeared to have a demonstrated applicability and value. 4 CLOSING PLENARY SESSION
The Chairman opened the plenary session by inviting the general rapporteur to present a summary report of the first plenary session of the Technical Discussions. Reports were then presented from each of the three discussion groups. In the general discussion which followed the main pOints stressed were the following: (1) the importance of health administrations establishing health education services at the highest possible level in the administrative structure of the health ministry or department and its respective progrSllllOOs, (2) the desirability of developing a sufficient cadre of qualified staff for health education services. Health
administrators may require to draw on a variety of essential skills such as those held by experts in
c1
REPORT OF THE
RmI~AL
COMMITTEE
81/82
community development, methodology of studies and research, public relations, behavioural sciences, and the preparation and production of visual aids, . (3)
tte desirability of WHO helping to provide an international directory of post-graduate schools offering
..,;-.
professional training in health education together ~nth
information on the major aspects of health
education which are emphasized in the teaching curricula of the respective schools. The General Chairman then expressed cordial appreciation to the
host government authorities of Korea and to the Regional Director for the staff assistance and services provided throughout the Technical Discussions. He expressed also a particular acknowledgement to all of
the chairmen and rapporteurs and to the participants who had contributed 60
constructively and thoughtfully to the discussion of the important Appreciation was expressed also t~
,
~
-
subject placed before them.
the
General Chairman by a spokesman on behalf of the participants for his efficiency in leading the Technical Discussions.
REPORT OF THE REGIONAL COMMITTEE
APPENDIX A PROPOSED QUESTIONS FOR CONSlDERATION OF THE DISCUSSION GROUPS 1.
What are some or the problems in making the best use or health education programmes being directed by national or territorial health ministries or departments, such as maternal and child health, school health, environmental sanitation, malaria eradication, etc.? In what ways can VIe get known scientific idormation down to the "grass roots" level in terms convincing enough to bring about desirable i1qprovements in the health practices or people? To what extent are existing health education services contributing to the achievement of public health programme objectives and priorities? What can be done to integrate health education activities into existing health services? How can health education services be used in countries where there is a large illiterate population, where nell economic resources are becoming available to people who have previously known only a SUbsistence economy and where new public health problems are arising due to urbanization? How can we motivate the people who are not interested in bringing about changes in those aspects of their living practices which are detrimental to health? To what extent are existing health education services or national, provincial or state, and local health programmes used to help carry out: (a) (b) (c) analysis and study of the relevant social and educational aspects of health problems; planning the educational aspects or variouc; healtP. programmes; organization and conduct of educational aspects of basic health services or of special projects directed toward major health problemsj education and training of health personnel in health education and the related social sciences; preparation, pre-testing, and production or visual materials;
2.
3.
4.
5.
6.
7.
(d) (e)
RIDIONAL COMMITTEE:
S~TH
SE5SIal
(f) (g)
eval.uation of the effectiveness of heal.th education services; studies and research related to heal.th education practices.
8.
What aspects of developing national. or territorial. heal.th education services need to be given more attention in o~der that health programmes administered by our ministries and departments will be effective in their efforts to motivate and to bring about necessary action on the part of the public? What technical., organizational., and administrative prOvisions are desirable for a health education service to function most effectively? What can be done to ensure training in heal.th education and related social. sciences for all heal.th workers in the Region as an integral. and systematic aspect of baSic, post-basic, post-grad.uate, and inservice training programmes? How can a country make the best use of its trained heal.th education manpo'Wer when this is strictly limited? What are some of the most effective ways to eval.uate the heal.th education aspects of health progra.tlllOOs at yarious administrative levels, e.g. local, provincial or state, or national levels?
9. 10.
11. 12.