(WP)KED/ICP/IEH/001-E
ENGLISH ONLY
REPORT ~GIONAL
~ ,
WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE
Convened by the
REGIONAL OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEALTH ORGANIZATION Manila, Philippines 28 November - 1 December 1989
Not for S"ale Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines March 1990
NOTE
The views expressed in this report are those of the participants in the Regional Workshop on Health Education in Primary Health Care and do not necessarily reflect the policies of the World Health Organization.
This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for governments of Member States in the Region and for the participants in the Regional Workshop on Health Education in Primary Health Care held in Manila, Philippines, from 28 November to 1 December 1989.
CONTENTS
1.
INTRODUCTION.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
1
2. 3..
OBJECTIVES OF THE WORKSHOP ...••••••••••••••••.•••.....••.. METHODOLOGY OF WORKSHOP ........................................ 10 .. .. .. .. .. .. .. .. .. .. .. .. .. ..
1 2
3.1 3 .. 2
Learning from experience of others.................... Learning by doing ........................................................................
2 2
4. 5. 6..
OVERVIEW OF REGIONAL SITUATION •••••••••••••••••••••••••••• EVALUATION OF THE WORKSHOP •••••••••••••••••••••••••••••••• RESULTS OF WORKSHOP ..............................................................................
3 5 6
7.
COMMENTS ON THE WORKSHOP AND RECOMMENDATIONS............... ANNEXES ANNEX 1 - OPENING ADDRESS BY THE REGIONAL DIRECTOR...........................................................
7
9
ANNEX 2 - LIST OF PARTICIPANTS AND SECRETARIAT.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ANNEX 3 - TIMETABLE ............................................................................. 11 15
ANNEX 4 - WORKSHOP LEARNING MATERIAL
............................................
17
ANNEX 5 - SITUATIONAL ANALYSIS AND EVALUATION OF WORKSHOP ••••••••••••••••••••••••• ANNEX 6 - SUMMARIES OF COUNTRY REPORTS •••••••••••••••••••. ANNEX 7 - FINDINGS OF GENERAL SURVEY ON CONDITION OF HEALTH EDUCATION ACTIVITIES.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ....
29 41
51
ANNEX 8 - COUNTRY PROGRAMME PLAN SUMMARIES ••••••••••••••••
69
1.
INTRODUCTION
The Regional Workshop on Health Education in Primary Health Care was conducted at the World Health Organization Regional Office for the Western Pacific, Manila from 28 November to 1 December 1989. Dr S.T. Han, Regional Director of the Western Pacific Region of the World Health Organization, opened the workshop. In his open1ng speech, the Regional Director welcomed the participants and expressed his expectation that more effective health education activities would be conducted as a result of the workshop. See Annex 1 for the full text of the Regional Director's opening speech. The workshop was attended by nineteen participants from eighteen countries and areas in the Region: Brunei, China, Cook Islands, Fiji, Kiribati, Lao People's Democratic Republic, Malaysia, Papua New Guinea, Palau, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu, Viet Nam; two participants from the Federated States of Micronesia attended. The Secretariat at WPRO prepared and conducted the workshop. One WHO health education specialist posted in Papua New Guinea was invited to join the Secretariat. The list of participants and Secretariat members is in Annex 2. The workshop timetable is attached as Annex 3. Mrs Vika Q. Tikinitabua, Deputy Director for Nursing, Ministry of Health, Fiji, acted as Chairman, and Ms Marietta G. Bernaje, Chief, Division of Plans and Programmes, Public Information and Health Education SerVice, Department of Health, Philippines as Vice-Chairman. Dr Shirley Wan, Medical Registrar, Ministry of Health, contributed as Rapporteur of the Workshop.
2.
OBJECTIVES OF THE WORKSHOP
The objectives of the workshop were: (1) to review health education strategies currently being implemented by Member States;
(2) to describe problems and solutions in each country in relation to the implementation of health education support to health programmes; (3) to develop draft plans to improve health education in the context of primary health care;
2
3.
METHODOLOGY OF WORKSHOP
Since planning is a difficult subject to understand and learn the workshop was organized around two approaches as described below. ' 3.1 Learning from the experience of others
(1) Each country provided a country report, which was distributed to all the participants. (2) At a plenary meeting, each country presented a summary of the country report, which was followed by discussions. (3) Participants were assigned to work on their individual national plans in groups of Similar countries to allow some discussions on similar problems or solutions. (4) An overview of the situation of health education in the Western Pacific Region was presented by the secretariat from information gathered through consultation visits and a general survey of the participating countries. 3.2 Learning by doing
(1) Each participant was assigned to develop a national plan for health education activities, operations and infrastructure development to be implemented on return to the countries. (2) Participants had been prepared for this assignment while still in their countries. They had been sent information on the workshop, material on planning of health education activities, instruments for gathering basic data for the coming planning assignment at the workshop, and a general survey questionnaire on the situation of operations and infrastructure of national health education units (Annex 4). (3) After the first individual work session to stimulate interest, the concepts, principles and instruments of planning using the systematic Combined Administrative and Behavioural Model was explained by the Secretariat. (4) Individual work sessions and plenary sessions for questions and discussions were arranged intermittently to stimulate effective learning by doing. (5) The product of individual work was reviewed by the secretariat to provide comments and suggestions for improvements and directions.
3
4.
OVERVIEW OF REGIONAL SITUATION
4.1 General Survey on Condition of Health Education Activities by the World Health Organization, Western Pacific Region, December 1989 Apart from country visits, there had been few efforts to determine the health education situation in the WHO Western Pacific Region. The purpose of this survey was to obtain a general view of the health education operations and infrastructure in the Region, to be presented to participants during the workshop. The method used was by sending all 19 participants a questionnaire form to complete before attending the workshop. The questions in the form were based on the specific aspects of health education operations and infrastructure development derived from the Combined Administrative and Behavioural Model for Planning, Implementation and Evaluation of Health Education Activities. 1 There were 14 questions on operations and 4 questions on infrastructure conditions (Annex 5). Five completed questionnaire forms had been received before the arrival of the participants. New questionnaire forms were provided at the beginning of the workshop to those who had not yet completed the forms. Another five forms were received from the participants of the 18 countries and areas before they left the workshop. This general survey was therefore based on 10 completed forms out of 18 countries and areas that participated in the workshop. Four forms were from bigger countries and six from smaller ones. Three of the bigger and one of the smaller countries were socio-economically relatively well-off; the others were developing. The data were compiled manually and analysed and interpreted by the Secretariat. 4.2 Summary of survey findings
(1) Many health education units in the countries were not sure about their status and policies, strategies and objectives for operations and infrastructure development. (2) Many did not have national health education plans; others had one as part of the national health plan. (3) The health education units were not used to functioning systematically in accordance with certain methodologies using models or instruments.
1Soetjahja I., The Planning, Implementation and Evaluation of Health
Education Activities, Vol. I text, Manila 1989.
,
4
(4) The health education activities were conducted because they were easily understood and implemented, and were impressive. (5) Monitoring and evaluation were very much lacking.
(6) Health programmes supported were mostly those that had had strong financial and technical support of their own for a long time (they had developed their own support). (7) Health education intervention programmes were not specially planned or conducted to specifically support certain health programmes. (8) The communication techniques utilized were mostly those that were simple and imp ressive. (9) Health education operations were weak, technically and financially. Health education infrastructure development was even weaker. (10) Efforts for infrastructure development were non-existent in some countries and minimal in most others. (11) All health education related resources were very limited and imbalanced, especially in relation to the real needs of the countries. (12) The present state of health education has impaired health education capability and achievements. 4.3 Recommendations:
(1) An innovative approach for systematic macro planning, implementation and evaluation of health education activities should be applied widely for operations and infrastructure development. (2) Adequate efforts and resources should be provided for health education operations and infrastructure development. (3) Administrative and political support should be arranged for the operational and infrastructure development efforts.
(Summaries of Country Reports are provided in Annex 6.) (The findings of the General Survey are summarized in Annex 7.)
5
5.
EVALUATION OF THE WORKSHOP
Owing to unforseen circumstances with regard to the security in the country, the last day of the programm,e could not be implemented as planned. This included a plenary session for questions and discussions on planning, individual work, the final plenary discussions on the draft plans and recommendations, and the closing ceremony. The participants were instead requested to stay in the hotels and continue working on their assignments. Seventeen completed evaluation forms were received from the nineteen participants. The results of the workshop evaluation were as follows: The workshop did not fulfil the expectations of one participant; it fulfilled expectations fairly well for six, well for nine, and excellently for one participant. The programme approach was found fairly suitable by five, very suitable by eight and excellent by four participants. The supporting materials were considered fairly suitable by three, very suitable by seven and excellent by five participants. The "Planning,' Implementation and Evaluation of Health Education Activities", text Vol.I was deemed fairly suitable by two, very suitable by eight and excellent by five participants. The "Planning, Implementation and Evaluation of Health Education Activities", Manual, Vol. II was considered fairly suitable by three, very suitable by six and excellent by six participants. The "Education for Health, A Manual on Health Education in Primary Health Care" was found very suitable by six and excellent by eight participants. The references were regarded as useful by one, fairly useful by three, very useful by four, and excellent by four. The instruments used were fairly suitable for four, very suitable for nine and excellent for four participants. The time available was regarded as badly inadequate by two, inadequate by seven, fairly adequate by three, very adequate by three, and excellent by only two participants. The advice and gUidance provided was considered not good by one, fair by four, good by eight and excellent by four participants.
6
The chance to impleaent in their c~atries the work produced at the workshop was considered. not load by 0 .... fair by four. load by ten aod excellent by two participants. Two participants felt there waa a fair chance that the work done at the workshop would strenathen health education in their countries: nine felt there was a good chance. and six excellent. Four participants felt there wa. a fair chance that the product of their work at the workshop would support other health programmes. six felt there was a good chance, and seven an excellent chance.
6.
RESULTS
or
WOlllCSHOP
The outcome of the workshop was as follows: (1) Participants learnt about the conditions of health education in other countries, and the steps towards solutions that have been applied. (2) Participants actively participated in macroplanninl of health education activities. They gained theoretical knowledge fro. the reading material and explanations, and practical knowledge through the assignments, discussions, and improvement follow-ups. (3) Each participant from 18 countries drafted a national health education programme plan which will be implemented in the different countries. (Country programme plan Bu.-aries are given in Annex 8.) (4) The participants made useful reco. .endations for the improveaent of health education activities.
7
7.
COMMENTS ON THE WORKSHOP AND RECOMMENDATIONS
The following comments were made during the evaluation of the workshop: 7.1 Comments on the worksho,p ~ The works'hop gav", an insight into programme phnn'iilg~" :. I,
- The guided act:l,vities were good., 7.2 Suggestions for improvement of workshop
- Information On assfgnments in the workshop should ~e sent to participants in advance. - More time should be provided for the workshop two weeks. ~
between one and
- More explanation should be given of the planning model, processes and instruments. - More discussions should be held to exchange, ideas, - Participants work should be presented for discussion. - Participants should 'really implement the' product of 'the workshop from the experiences. on return to the countries and further learn ! ' . • - The implementation of the product of the wbrkshop should be' ' followed up regularly by WHO at regional level, and government at national level, to provide,feedback and adjustments'which will further the learning experiences of the participants. - The participants in this workshop should be heads of their national health education units. 7.3 Recommendations for improvement of health education - A follow-up, regional 'health education workshop every year. ~hquld
be
,~eld
- Similar workshops should be conducted in Member States. - Health educators should apply macro-planning of health education activities more often. - The systematic Planning, Implementation and Evaluation of health education activities using the Combined Administrative and Behavioural Model should be adopted and promoted through publications such as the Expert Reports.
••• • All cOllanl.s UQuld. ill coll• • •Uoa vJ" ... lItO. . . .ltl. to cI._lop .... 1111!"l...at .....!ttl .-c4IUoa til... Ity 1"' •
• Ilaaltll educatora slaolUd ....'" h.tMr tull11.. 1a lI&CJ:o·p.1.••a1na· - .. daalf IUffuaDU aIIIoIald. M ..... Mt_ Maltlt " . U.. a .
llaa1tll praaotl0•• - TJt.. r'1a,1oa batveaa Maltlt. ed~a'loa a~ 1~. If.la'" taclt.a1~. aM &pIIftoacllaa slKll aa laf_Uoa. c:cuu-lcsU.. a" sod.l ..rk.Una alt.a\ald Ita aplalae4 to cl.ar ,,~ c ..f"u....
- '''It''' "lKstloa actlvltl_ alIoI11cl Ita ltaM to coaylac. pollcy . .It..n.
.-..1. M .¥Slue'" s" t .... raault.
- IlwkUopa • • a..u._n aboltl" ... Olr. .a1", to 1"0'" k.y ponons s" polltlcal l ....ra o. -.altll . .atloa.
- Pl.cos for tral.lna 1l0.1tlt. educatolfs 1. tlt.a 1••10a should be ldsatUl...
- WHO sboltlcl c:olla~ato vlt'" c:~atrl.a 1•• o~latl" It..altll educaUoa pol1c:i... aa,d lapl...ati.. t ......
- eou.tlft_ .~lcl k.ov &duestioa .o_l~.t.
It.~
to utl1l •• 1IlO t .."la.
~.t
fat It.oalth
aad practical.
- ...ltlt. oclucatiO. collabotatloa vltlt. couallfi.s alt.ould be reali.tlc - Healtll educatora ahould dovelOP aad ..l.tal. ralatloaa vlth .ach
ot;\'Ot. - • ua10a of Il.. ltll "ucatora h, tile Vastn. "cUle 1..10......uld be .stabllsl1ed to ..clt.a... ld.a. or prQlr......
9 A1fWEX 1
RD's OPENING ADDRESS FOR THE REGIONAL WORKSHOP ON HEALTH EDUCATI01'1 IN PRIMARY HEALTH CARE . 28 November - 1 December 1989 ,
Dear ,participants. Welcome to Manila and the Regional Office. I am happy to see that people from so many parts of the Regi~n
have
been able to come to this Regional Workshop on Health Education in Primary Health Care. ,;
.
Tn 1989, the World Health Assembly adopted a resolution which. urgently called on Member States to develop strategies for health promotion and health education as an essential part ofpr'imaryhealth care. The resolution encourages them to strengthen the infrastructure and increase the resources needed for this purpose at all levels. It als~ ~rges Member States to take whaLever action is necessary to train the health work-force in health promotion and health education. Finally, the same resolution called for the support of WHO for training personnel and developing new and more effective methodologies and strategies in this field. Although many countries have acknowledged the importance of health education and have conducted many health education activities, the impact of such activities is not usually evaluated. Many countries in the Region need to develop their health education infrastructure so that they provide support for all the health programmes. The weaknesses of existing health education programmes have been discussed in many
A.... 1 effective.
10
meetings both at Headquarters and in the Region. Many solutions art; available but few steps have been taken to make health education more
It is time to do some serious planning in this area. so that health
programmes can get the eduC<ltion support they need. This will also enable us to make the best use possible of the funds available for health education. I see that you have a very intensive programme ahead of you. It will expose you to both traditional and innovative principles and practices in planning. implementation. and evaluation of health education activities and infrastructure development. I am sure that after your experience in this workshop. health education development will not only remain with you as a key idea. but will become a well planned. implemented. monitored and evaluated programme of action. I wish you a very successful week.
11
ANNEX 2 REGIONAL WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE Manila. Philippines 28 November - 1 December 1989
LIST OF PARTICIPANTS AND SECRETARIAT 1.
PARTICIPANTS Mr Lionel T. Keasberry Health Education Officer Ministry of Health Bandar Seri Begawan Ms Gao Zhen Public Hygiene Doctor DaLian Health Education Institute 251 Tian Jin Street DaLian. Liao Ning Ms Frances Poppy Apera Health Education Officer Public Health Division Ministry of Health P.O. Box 100 Rarotonga Mrs Vika Q. Tikinitabua Ministry of Health Tamavua
BRUNEI DARUSSALAM
CHINA
COOK ISLANDS
FIJI
KIRIBATI
Mr Kotii Torite Health Education Officer c/o Ministry of Health and Family Planning P.O. Box 268 Bikenibeu Tarawa Dr Niramonh Chanlivong In-charge of Health Education Department of Hygiene and Preventive Medicine Ministry of Public Health and Social Welfare Vientiane
LAO PEOPLE'S DEMOCRATIC REPUBLIC
12
Annex 2
MALAYSIA
Kr Abdul tal1b Bin Hj. Ali Health Education Officer Ministry of Health 50590 Kuala Luapur
MICRONESIA, FEDERAtED StAtES OF
Kr An1uo N1ffang Health Educator c/o Dept. of Huaan Resources trult State Ka Jane E1YllOre FSK Nutrition aDd Health Education Program Coordinator c/o Dept. of Huaan Resources trult State
PAPUA NEW GUINEA
Kr Jubal Aaale Health Education Officer Inserv1ce training Coordinator Division of Health P.O. Box 129 Kt Basen Ms Marietta G. Bernaje Chief Div. of Plans and Programmes Public Inforaation and Health Education Service Depart_nt of Health San Lazaro Compound Sta. Cruz, Manila Dr J ong Bwa Byun Fellow Researcher Korea Institute for Population and Health 42-14, Bulltwang-dong ~
PHILIPPINES
REPUBLIC OF KOREA
13
Annex 2 REPUBLIC OP PALAU Mr Perain Kebekol Health Educator Bureau of Health SerVices P.O. Box 100
!S2!2!. SAMOA Ms Palanitina Toelupe Health Education Officer Health Education Unit Health Department ~
SINGAPORE
Dr Shirley Wan Medical Registrar Ministry of Health College of Medicine Building 16 College Road Singapore 0316 Mr Isaiah Tukuvaka c/o Ministry of Health and Medical Services Box 349 Honiara Mr Malakai 'Ofanoa Health Education Officer Ministry of Health P.O. Box 59 NUku'alofa Mr Thomas Tari Regional Primary Health Care Coordinator Department of Health Private Mail Bag Vila Mr Hoang Trong Quang Member Committee for Coordination of Primary Health Care Ministry of Health
SOLOMON ISLANDS
TONGA
VANUATU
VIET NAM
!!!!!!!!
14
Annex 2
2.
SECRETARIAT
Dr I. Soetjahja Regional Adviser in Health Education WHO Regional Office for the Western Pacific Manila Dr D. Shrestha Short-Term Consultant Regional Team for Programme on AIDS WHO Regional Office for the Western Pacific Manila Ms T. Miller Regional Adviser in Nursing WHO Regional Office for the Western Pacific Manila Dr Barry Karlin Health Education Specialist PNG/IEH/OOI c/o The WHO Representative World Health Organization P.O. Box 5896 Boroko, N.C.D. Papua New Guinea
II
PROVISIOIIAL TDIEI'AlLI UGIOIIAL IIOIISBOP OJ IIJW.tII ElJUCAnOJ III PRIHAlr IIJW.tII CAllE 1Il1O leat_l Office for tbe Veate ... Pacific. IlaaU•• 1'hi11ppl.... 28 IIoYMber - 1 Dec_ber 1989
T1M 0800
Da, 1 (28 lIoyeaber) Tueada, ReaiOJttation
r1M 0800 0815 0830
Da, 2 (29 Moy.,.ber) VedDeada,
0., 3 (30 lIonaber) Thurada, 8. Pl.. ary questloas and 4111CU.1o... (cOlltlouaUOA) 9. Individual vork (cODtlouaUoD)
Da, 4 (1 Dec_ber) Frida,
5. Espl... tlOD of vorld.DI .,.at_ for develOJNIQl of ploa 6. EsploaaUoo of plaoA1D& lUtrulleDta
n ...." questi_ .... d18cuaa1oaa (cootio .. Uoa) 9. IoUyid Del vork (COOtiouaUOD) 8.
7. Iad1Yldual vork aD cGUDtrJ' health educatloD plaD for operation.
to
tDfraseructur. 4eYelo,.eat .-ana .1m1lar aroup. \II .....
CD.
0900 to 0930
1. Open1na c.eremony
0945
COFFEE 1000 1015 1030 to
IlEAl 9. Ind1Y1dual work (cootlo .. Uoo)
.. '"
...
2. 'Ienda/vorkshop 3. Rea1one1 rerlew 4. Coallltr, review - (or
1000
8. Pleoary questlOll!l and d1acu•• lou
9. I041Y1d..l work (cootiouaUoa)
9 COUDtrie8 (10 ada/country)
1200
1100 to 1200
9. I041YU ..l york
----
-
-- LUll C R
--
-
~-
-
B R I! "
I:
1330 to 1430
4. tenantry review for 6 c.ountrie.
1330 1430
9. Io41y1dual work (cootlouaUoo)
9. Iad1yid..l work (cODtlouaUOD)
10. nenar, di.cu•• i ....
COFFEE
BREll 8. PI..." questl.... and d18C11 •• 1ollll (cODtlo... tloo) U. CIo.loa cer_y
!; >01
• w
1445 to 1530
4. Country renov - for 4 cOIlnt.rlea
1445 to
1530
8. nenar, questl.... and dlocu.a10DO (c""tlo_tiOD)
•
""
----
-
17
ANNEX 4
WORKSHOP LEARNING MATERIAL Sent to participants_in countries before workshop. 1. Z. Information Bulletin No.1 Tentative workshop arrangements.
3. Information list for a four-year plan to be determined and brought to the workshop by each participant. 4. Soetjahja I., The Planning, Implementation and Evaluation of Health Education Activities, Vol I, text, Second Edition, Manila 1989. !~~!~_~he_~ginning
of the workshop
5. 6.
Work seminar groupings Workshop instruments
7. Soetjahja I., The Planning, Implementation and Evaluation of Health Education Activities, Vol II, Manual, Second Edition, Manila 1989. 8. WHO Geneva, Education For Health, A Manual on Health Education in Primary Health Care, 1988.
-
18
-
WORLD HEALTH ORGAN I ZA TION !nm
ORGANISATION MONDIALI . DE LA SANTa
4 IlEGIONAL OFFICE FOR THE WESTERN PACIFIC 8UAEAU "'GIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE Manila, Philippines 28 November - 1 December 1989
WPR/IEH/HED(l)/IB/1/lev. 1 14 November 1989 ENGLISH ONLY
IIPORMATIOI BtJU.ETII RO.1 This is the first of a series of information bulletins which will be issued between now and the opening of the workshop. 1. Objectives (1) to review health education strategies currently being implemented by Member States; (2) to describe problems and solutions in each country in relation to the implementation of health education support to health programmes; (3) to develop draft plans to improve health education in the context of primary health care. 2. Dates and site
The workshop will be held from 28 November to 1 December 1989 at the WHO Regional Office for the Western PaCific, United Nations Avenue, Manila. 3. Working language English only. 4. Participants
Participants will be individuals responsible for the development and implementation of health education programmes in support of primary health care in their country or area.
19
RECIONAL WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE 28 November - 1 December 1989 TENTATIVE WORKSHOP ARRAN CEMENTS 1. Soaaiona
Thara will be two types of aaaliona; planary aealionl and work 8.8.iona. 1.1 Plenary sa8aiona: during theaa seasions all participants will ait together for questiona, explanationa, diBculsionl, agreamenta and announcamenta.
1.2 Work sesaiona: - during work seaaiona each participant will work alone on hia/her country's plsn. ~-
- the participants will be grouped together in groups with similar backgrounds or conditions to allow little diacusaiona on problema of aimilar nature. - the participants will be provided instrumenta to facilitate their work which should be atudiad before the work aeaaiona. - the participant a will be provided material (literature, manual a , etc) to aasist them in thsir work. - there will be an advisor to provide advice and guidance. 2. Support services
Drafts from work sessions will be typed daily to enable partcipants to work on it further the next day.
3.
Product 3.1 A draft country national plan for health education activities operations and infrastructure development ahould be completed by the end of the workshop.
20 REaIONA~
WORKSHOP ON HEA~nl EDUCATION IN PRIMARY HEA~TH CAR~
28 NOVEMBER - 1 DECEMBER 1989
Information for a four-year plan to be determined and brought to the workshop by each participant for: 1. Policy: 1.1 The national health policy (usually of the Miniatry of Health) 2.
Obtective: 2.1 2.2 Ten priority health problema/programmes to be supported by health education activities. Main objectives
Main objectives of these ten priority health programmes.
3.
Strategies: of the health education activities.
4.
Methodology: Several health education activities planning, implementation, evaluation inatruments. Ceneral plan: Up to three priority activities in the country related to
5.
5.1 -
recording and reporting
5.2 - solution steps/services of the ten priority health problems.
5.3 - health education support activities 5.4 - project activities monitoring 5.5 - project activities evaluation and review. 6. Detailed plan:
6.1.
up to four essential social aspects in the country that can influence the people related to the ten priority health problems. - customs - cul ture - ethnic preferences beliefs.
6.1. 1 6.1. 2 6.1. 3 6.1.4
21
6.2 condition of the recording and reporting unit the country 6.3 condition of the services of the ten priority health programme a in the country. country.
6.4 condition of the health education unit and activities in the 6.5 condition of health activities monitoring in the country. 6.6 condition of health activities eveluation in the country.
6.7 condition of health activities review in the country. 7. Resources:
Available funds for health education SUpport to health programme a from: - health education unita - government otbe~ ao~cea.
- health education component of the ten priority health programmes. - government - other aourcea. 7.2 FociH ties 7.2.1 Available room apace and furniture for health education activities
- ataff offices - work - storage. 7.2.2 Transport
- cars . - motor cycleo - bicycles, etc. 7.3 Equipment for 7.3.1 Production of material drafting/typing/designinc
-
22
duplicating/printing/recording, etc 7.3.2 Implementation of health education
- projectora/back play decks - etc. 7.~
Supplies for - Production of health education material paper films video tapes cassettes. etc.
7.5 Manpower - Health education storr recruitment/posting - Training, upgrading.
-
23
-
Annex 4
REGIONAL WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE 28 Nov - 1 Dec 1989, WPRO, Manila WORK SEMINAR GROUPINGS
A
BRUNEI MALAYSIA PHILIPPINES REPUBLIC OF KOREA SINGAPORE
B
CHINA FIJI
LAO PAPUA NEW GUINEA VIET NAM
C
CI
COOK ISLANDS KIRIBATI MICRONESIA PALAU SAMOA SOLOMON ISLANDS TONGA VANUATU
CIl
24
Annex 4
REGIONAL WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE 28 November - 1 December 1989 Manila, Philippines
WORKSHOP INSTRUMENT
The following are the items to be considered during the planning of the Health Education Operations and Infrastructure Development programme plan: -
1. 2. 3. 4. 5. 6.
Title of Plan: Scope of plan: Country:Duration of plan: Unit concerned: Introduction: - purpose of plan: - layout of plan: -
7.
Background:
- history health education activities - health education activities in country
8.
Situational analysis:
- eXisting problems of health education - existing health education solutions steps i f any
9.
Policy:
- General health care policy - Specific health education policies
lO.
Goals:
- Summary of consolidated aims of all health programmes to be supported
25
Annex 4
11.
Objectives:
- Main-Sua of objectives of all health programmes to be supported. - Sub-objectives of all thoaain health education activities for support of all the health programmes.
12. 13.
Strategies: Methodologies:
- Ways how objectives and sub-objectives are to be achieved - Explain briefly concepts, principles and instruaents used. (The combined Adainistrative and Behavioural Model) - Health Education Functional framework (Vol II, D1agramme 1) - Operational framework I (Vol II, Diagramme 2) - Operational framework II (Vol II, Diagramme 3) - Information Content Improvement Table concerned with influences related to local conditions for designing (Vol II, Table 1) - Media mix. selection grid. (Vol II, Diagramme 4) - Project Monitoring Grid. (Vol II, Diagramme 6) - Health Education Impact Evaluation Porm Vol II, Diagramme 10)
14.
General Plan:
- Main activities supporting the determined health programmes for (Vol II, Diagramme 5) - recording reporting - health programme ~ctivities
- health education activities - infrastructure development activities to support operational activities - activities related to implementation and monitoring - activities related to evaluation and review of progra. .e plan
26
Annex 4
15.
Detailed plan:
- detailed actions, with dates of completion or start and monitoring grid. (Vol II, List 2, DiagralDllle 6) - preparation, development, approval of plan - recording and reporting of activities - health programme activities to provide the necessary services - health education support activities o advise for health programme services presentation for all health programmes to be supported o community organization activities to support all health programmes to be supported - health programme activities - personal discussions to support public education o public education packages infrastructure development for operations and development o facilities o equipments o supplies o staff
- implementation of plan o preparations o operations (organizational structure of unit and terms of reference of parts of unit) o monitoring 16. Evaluation o process of development o implementation of plan o impact of project
27
Annex 4
- by Health Education Impact Evaluation Form (Vol II, Diagramme 10) - by KAP surveys 17. Budget - each main activity o detailed budgeting of each detailed activity o total of detailed budgets of each main activity - consolidate total budget by each type of expenditure.
-
29
-
ANNEX 5
SITUATIONAL ANALYSIS AND EVALUATION OF WO&KSHOP
Sent to participants in countriea before <,
worksho~
- General Survey Condition of Health Education Activities in WHO/WP&O. Dece.ber 1989.
- Workshop Evaluation Fora.
30
Annex 5
GENERAL SURVEY Condition of Health Education Activities in WHO/WPRO December 1989
There is no doubt very important.
~hat
educational support to health programmes is
This has been shown in many WHO reports of health It has also been
education scd"viti;e~ as well as hea,lth programmes.
reported by the representatives of the countries in the Western Pacific Region in the September" 1989 Regional Committee Meeting. It is therefore important that health education be strengthened as soon as possible. To do this we need to have an idea of the situation We intend to
of health education in the countries of the Region.
collect the important information through a questionnaire to be completed by relevant staff (health education) in the different countries. The questions will be related to health education operations and infrastructure in the countries. Please complete the questionnaire as much as you can. necessary. use additional sheets of paper. The information obtained from this questionnaire will be used for analysis of the situation in the countries and the Western Pacific Region only. Names of countries will not be related to the data when If
used for discussions when so requested by the country.
31
Annex 5 Questionnaire of Health Education in the Countries Date: Since it is vital to collect this important data, we kindly request your fullest cooperation in responding to our questions. Please respond by filling in the boxesc===Jrelated to the questions the sign (x) as appropriate to the health education situation in your country. If it is not applicable or if there is none, please indicate this in the box and skip the second box and space for description to proceed to the next question. When applicable, please describe when requested to do so in the space provided. If the space is not enough, kindly use additional sheets. Name of country: Name of health unit responding: 1. Operations
1.1 What is the national health education policy? 1.1.1 1.1.2
r===J c===J
No/Not applicable. Applicable, please describe:
1.2 What is the name of the national plan for health education? 1.2.1 1.2.2
c===J c===J
No/Not applicable. Applicable, please describe:
1.3 What is the main objective of the national health edacation activities? 1.3.1 1.3.2
c===J
No/Not applicable. Aplicable. Please state the main objective.
c===J
Please state the sub objectives.
32 Annex !i 1.4 What are the national strategies to achieve the objectives? 1.4.1 1.4.2
D
No/Not applicable. Please state strategies:
~ Applicable.
(if necessary please use additional sheet) 1.5 What are the methodologies or instruments or model used for planning or operating the national health education activities? 1.5.1 1.5.2
D
No/Not applicable.
DAPPlicable. Please write down the name of the instruments.
33
Annex 5 1.6 What are the main activities of health education in the country being conducted to achieve the objectives? 1.6.1 1.6.2
~ No/Not
aplicable. Please describe:
~ Applicable.
(if necessary please use additional sheet) 1.7 What are three of the detailed activities of each general activity? 1.7.1 1.7.2
c===J
No/Not applicable. Please describe:
c===J Applicable.
1.
2.
3.
4.
5.
(if necessary please use additional sheet)
34
Annex 5
1.8 How are the activities monitored? 1.8.1 1.8.2
0 0
No/Not applicable. Applicable. Please describe:
1.9 How many health education units are there in the country? 1.9.1
0
No/Not applicable. How many? and where are they?
1.9.2 ~ Applicable.
1.10 What are the different types of functions conducted by the different health education units? (up to 5 units or sub-units) 1.10.10 No/Not applicable. 1.10.2
I
I Applicable. (1)
Please describe:
Types of functions
(2) (3) (4 )
(5)
1.11 How many health programmes are the health education units supporting (directly) now? 1.11.1
I
I No/Not applicable. Please state:
1.11.Z·C====1 Applicable.
3S
Annex S 1.12 How many hea1.th education intervention programmes are the health education units conducting now?
r===J No/Not applicable. 1.12.2 c===J Applicable. Please describe/name: 1.12.1 (1)
(2) (3)
(4) (5) (please use additional sheet if necessary) 1.13 What are the communication techniques used in each of the health education intervention programmes (such as poster, radio, etc.)? Please give the reasons. Techniques: 1.
Reason:
2.
3.
4.
36
Annex 5 1.14 How are the health education activities evaluated? 1.14.1 1.14.2
c===J
No/Not applicable. Applicable. Please describe:
c===J
2.
Infrastructure
2.1 What resources do the health education units already have? 2.1.1 2.1.2
o D
No/Not applicable. Applicable. Please indicate when applicable. If not, cross space or leave it blank. Number - for staff duplication/printing designing writing storages dark room sound laboratory
2.2.1
Room space - Offices - Work
- Training
- lecture - discussions
37
Annex 5 2.2.2 Facilities machine - photocopy machine - printing photo camera - video camera fUm camera - dark room set - microphone - ape akers - amplHier player - tape/cassette recorder " " equipment - binding designing table - designing set - calculator computer storage racks - bicycles - motorcycles - motorcars 2.2.3 Manpower educators - health - technicians support staff - others 2.2.4 Funds Each Total Number Total Number Total
- operational/activities -government -others
$
-
infrastructure development $ -government -others
We thank you for your good cooperation.
38
Annex 5 REGIONAL WORKSHOP ON HEALTH EDUCATION IN PRIMARY HEALTH CARE 28 November - 1 December 1989 Manila, Philippines WORKSHOP EVALUATION FORM Date: Please complete this questionnaire by circling the grade nuaber you feel is correct in answer to the questions raised. (For example: 1, 2, (!) 4, 5) The grading is as follows: - 1=10, 2=40, 3-60, 4=80 and 5=100, where 10 means bad, 40 not good, 60 fair, 80 good and 100 excellent. 1. 2. 3. Did the workshop fulfill your expectations? Was the programme/approach used suitable Were the materials suitable for the workshop? - Text on The Planning, Implementation, and Evaluation of Health Education Activities, Vol I - Manual on planning, implementation, and Evaluation of Health Education Activities, Vol II - Education for Health, a manual on health education in primary health care - References 4. 5. 6. 7. Was the instrument suitable? Was the time adequate? Was the advise and guidance suitable? Do you feel that the product of your work in the workshop can be implemented in your country? 1 1 1 1 1
2
3 3
4 4
5 5 5 5
2 2 2
3 3 3
4 4 4
2 2 2 2 2
5
1 1 1
3 3 3
4 4 4
5 5 5 5
1
3 3
4 4
1
2
5
1
2
3
4
5
8.
Do you feel that the product of your work in the workshop will be useful to strengthen health education in your country? Do you feel tha.): the product of your work in the workshop will be useful to support other health programmes in your country?
1
2
3
4
5
9.
1
2
3
4
5
39/40
Annex 5 Please write your comments that may improve the workshop, if any.
Please write your recommendations that may strengthen health education in your country or in the Western Pacific Region.
Thank you.
41
ANNEX 6
SUMMARIES OF COUNTlY REPOlTS
1.
Vietnam Health education is one of the ten components of Primary Health Care.
It ia presented as health propaganda in support of the six national priority health programmes through techniques such aa radio, television, newspaper, pictures, posters, lectures. Presentation is done with assistance of NGO's to make people understand and carry out preventive and health promotive actions and preservation of the environment for health. 2. Tonga It is
Health education is applied in the countries social context. applied to support health programmes.
The development of a system for operations with planning was started and tested in Tonga in 1988. The health education section plan for 1989 had general objectives among which is the creation of the capacity in the health education section to plan, manage and coordinate a comprehensive integrated nationwide health education programme. The main health education activities in 1989 were related to health education infrastructure development such as staff recruitment and training. Operations include community organization, production of health education materials, use of mass media, school health, development of the reporting system and strengthening of the intersectoral coordination and COllaboration, publications and planning of support programmes. In the future, health education services activities will be expanded to other parts of the country. 3. Solomon Islands
Health education is considered by the Health and Medical Services as a supportive of all the preventive health programmes.
42
Annex 6
A health education Unit has been established to promote and provide comprehensive health information to the population so that they can actively improve and safeguard their own life. The main activities are workshops, seminars for opinion leaders, school health, health education materials production and the use of mass media. Other techniques being used are personal discussions in villages, hospitals/clinics and demonstrations. The constraints are difficult in transport, lack of health education materials, many ethnic languages, lack of equipments and lack of evaluation of health education activities. Improvement efforts are on develop.ent of health education staff since 1983 with local as well as foreign volunteer staff. 4. Singaeore
The health education activities work within the national health policy as stated in the National Health plan, 1983. The Training and Health Education Department (THE) is responsible for the implementation of a planned programme to inform and motivate the population to stay healthy. The strategies used are multi sectoral approach, Ministry of Health Staff involve in the NGO activities using workshops and seminars and faceto-face programmes complemented by mass media. The technique used is healthy life-style promotion. These were conducted successfully mainly on the non-communicable diseases such as lung cancer and hypertension. I I
The activities were monitored and evaluated through records and surveys. 5. Western Samoa The early
The Health Education Unit was established in 1980. activities were nutrition education and breast feeding.
The strategy was improvement of approaches and gradual expansion of activities. The main activities are training of health workers of government and NGOs, school health instructions, production of health education materials, use of mass media broadcasting, newspapers, and some video shows. The use of billboards and health fairs are new. The activities are organized from available feedback. A survey was conducted in 1987 to collect Baseline data from the community.
43
Annex 6
The infrastructure development effort was training of staff locally and abroad. 6. 1987. It operates under the National Health Policy that Health is a basic individual right and to arouse community awareness, mobilizing resources and promoting the means to better health. It operates by providing services related to formulating and implementing plans for public education on health and accurate, public communications of Department of Health policies on health issues. It supports the PHe approach and continues the health education thrust in 1982 to achieve Health for All by year 2000. Its targets for information are: the population, priority services, the unserved and underdeveloped areas, communication campaigns, the programmes, areas and population targets, patient education, the hospitals, clinic and health stations, household education, the puroks, barangays of responsible family members, information dissemination through print and broadcast media, the general public, collaboration on information and health education with government sectors and NGOs, community organization and social preparations in the communities and interpersonal communication to mothers and responsible family members. 7.
Philippine, The Public Information and Health Education Service was created in
!!!.!.l!
Health educators have the important role in educating and informing the community about all health concerns. They are involved during the planning of health programmes especially on the aspects that have to be addressed to the communities. The most important role is the relay of health information from the hospital to the communities for the maintenance of their well-being. The emphasis is on alcohol and drug abuse which has resulted in serious fights, family violences. There is also substantial efforts on AIDS education even no positive cases has yet been determined. The main technique used is television. The programmes are presented in packages based on the adoption steps of target groups: awareness, interest, evaluation, trial and adoption. The health education programmes are produced through research and input of experts and professionals but the implementation is the responsibility of the health education unit.
44
Annex 6 8. Federated States of Micronesia Responsibility for health services is based on the Constitution. The overall objectives of the health services are: to ensure all residents the opportunity to have healthful lives; enhance the quality of health services; improve availability and accessibility of PRC services; to increase the efficiency and cost effectiveness of operations within the Department. Health education has the important role of supporting the services. This it tries to fulfill, by improving the health educators professionally; establishing health information system; "to promote identification of high risk groups in the community; health education as a good model on health and by motivating activities between agencies and programmes. These are conducted through training of health educators, on the top ten leading diseases, on effective speaking and programme management (with assistance of others), the use of audio-visual equipments and materials and community approaches. There are more than 12 health educators. The problems are lack of nearly all infrastructure components, work space, funds, administrative support, supplies, equipments, transportation, training, staff and level of education of staff. 9. Malaysia
The Health Education Unit was established 20 years ago as part of the Division of Health Services. Its main function is to give support in all aspects of health education to the programmes of the Ministry. The main objectives of the health education programme is the attainment of attitudinal and behavioural changes for the betterment of the health of the individual, family and community through their own as well as through organized community efforts. The specific objectives are to arouse among the community interest on the importance o~ good health, awareness of health promotion and disease preventive measu~s available to them, the existing health services and facilities they ~an utilize to protect themselves, and the value of good health and the rdsponsibility for them to take care of it themselves •
• The strategies are by c~nsidering that all health workers carry out health education~ctivities, to support the programmes of the Ministry of Health, to encourage community involvement and participation, to increase the health education staff, to train other health staff, to utilize mass media, to produce and distribute health education material, to upgrade health education staff and to cooperate with other government and nongovernment agencies. II , ,
I' , I
45
Annex 6 The healtt,. education unit has three sections fo!:: production of material and research and development. At the national level, the unit has 6 staff. Operationally, health education is integrated with the general health services. 10. Vanuatu services,
Health education tries to prevent or minimize suffering of the people from the major health problems by preventing diseases and promoting health through primary health care services and developing healthy life styles with effective communication and information. The strategies adopted are the use of mass communication, the Primary Health Care approach, Island Tours and Workshops. Also, by strengthening health workers on health education, close collaboration between activities and health programmes, by utilizing all available measures of application of health education activities, by using a built-in mechanism for planning and implementing other health activities such as communities to carry out activities and cooperative coordination through local workshops for projects. The programmes are community programmes, health education material productions, health education in squatter settlement, workshops on special health problems such as AIDS. The problems are shortage of skillful health staff, funds, and transportation. To improve health education workshops are held to educate and transfer skills to health educators. Also new effective ways and approaches are being sought to improve health education and the PHC concept. 11. Lao People's Democratic Republic Government policy is that health services must be devoted to productivity and national defense. Good health of both workers and soldiers must be ensured in the interest of defense and in order to achieve the objectives of the country's socio-economic policies. Maternal and Child Health Care must also be provided in order to reduce infant and maternal mortality and promote population growth. Health education is administered by the Health Education Unit at central level in the Department of Hygiene and Preventive Medicine of the Ministry of Health.
46
Annex 6
Health education is integrated in all health services and all health staff are involved. The Central Health Education Unit has 2 sections: services, provision and training and the material production. The objectives are: to strengthen planning, management evaluation and supervision, to expand health education services to 8 providers, to promote health education in schools, to train all health staff in health education, and to stimulate self-reliance in production of health education material. These will be achieved through workshops, introduction of health education in schools and universities, health education support to other health programmes, production of health education material, use of mass media such as radio, television and the magazine. The constraints met are lack of trained health educators, absence of proper management, lack of proper training of health education in schools, lack of opportunities to use audio-visual equipments and absence of records. In 1990, the Institute of Health Education with three functions will be created. 12. Kiribati
Health Education Unit was established in 1960. It was then using the behavioural model for operations by only one local and an expatriate staff. In 1980, some local staff were trained abroad. Starting 1982, coinciding with the new planning of the First National Health and Family Planning Services Programme Plan (NHFPSPP 1982-1986) a more systematic programme waS devised for health education using the Combined Administrative and Behavioural Model. With this systematic plan health education operations and infrastructure development was intensified. The purpose ~f health education is to support all national health programmes services by making health as a community asset and in promoting self-reliance, self-determination and community involvement in all areas of health. The policy of the health education unit is to work collaboratively in a well organized way with intrasectoral units, other government sectors, agencies and the general community utilizing local available resources in such a way that it will not conflict with traditions and religions.
, I
47
Annex 6
The objective is to provide optimal educational support for effective implementation of all national health programme services in overcoming the priority health and population problems. The programme staff are educated on proper management and adjustment of all health programmes services, and the teachers, school children, and general public On the causes of problems, their effects on them, possible solutions and how to obtain these solutions. These are done through well organized educational programmes in the whole country utilizing the national radio, newspapers, school health programmes and public education by the health education staff at central level and by field staff with village welfare groups on the islands. The Unit has three functions or sections: one, for health education ssrvices and training; another for material provision; and the third for research. The terms of reference of each Unit has been determined and functional on administrative links within the Unit and with outside units are clear. 13. The ReRublic of Korea
Government has realized that lifestyle of people which can be changed with health education contributed very much to effective disease control. The findings of a study in 1988 showed that the medical cost for 1 month for persons practicing under five health habits and those that practiDe 9 to 10 health habits was 14 to 6 dollars more. The primary goal for health education is to promote health and prevent diseases through raising the people's healthy lifestyles. The problem is that there is no place yet for health education in the administrative system of health services. There is also insufficient manpower and budget for health education. There is only a health education section under the public health bureau of the Ministry of Health. The Ministry of Health and Social Affairs established the National Healthy Living Guide and has distributed much guideline material in 1984. The Government plans to reorganizing the provincial and country level health services at the health centres to strengthen disease preventive and health promotive services. Other activities are: school health education, public education through the mass media, education of industrial workers and the conduct of a health promotion demonstration project in 1991, to stimulate the interest of policy makers.
48
Annex 6 14. Fiji
The Government is very committed to Health for All by year 2000 through PHC which emphasizes among others, motivation and education of people. These are done through techniques related to community level seminars and dissemination of information through the mass media. Personal contact and the development of self awareness through active community participation are also used. The strategies used are the use of community health workers, integration with other sectors and nongovernmental organizations such as school education, police force, agriculture and the Fiji Women's Group. The programmes that are being supported are the EPI, Family Planning, ARI, AIDS and EH. They are supported by information dissemination, training of health staff. The problems are the need of the right policies, inadequate manpower, inadequate funds and realistic targets. 15. Cook Islands
The health education unit was established in 1984 within the Division of PubliC Health. In 1988, a local post for a health educator was established. The techniques used by health education to support health programmes are among others, the mass media, person to person, workshops, seminars,
house viSits, community organization, posters, pamphlets, video shows, banners, free check-ups, weight controls, research, satellite sessions in outer islands, inservice training of health staff through intersectoral and NGO collaboration. The health programmes to be supported are among others, MCH and Family Planning, Child Health, Immunization, School Health, NonCommunicable Diseases, HypertenSion, Diabetes, Communicable Diseases, Environmental Health, anti-smoking, alcohol abuse, adolescent health and care of the elderly. The constraints are funds, lack of skilled staff, language barrier, religion and culture, changing personnel, lack of intersectoral cooperation, multi-purpose projects, transport difficulties, lack of space.
16.
China
The Dalian Health Education Institute is in the City of Dalian in China. It functiqns with the policy of Prevention First.
49
Annex 6 Since 1982, mass meetings were held. In 1987, an education center for popular health science was set up showing posters, specimen and video films. Health knowledge dissemination and health education was conducted for special groups and the public. Starting 1990, planning, implementation and evaluation of health education activities will be conducted with theories and methodologies from the engineering system. In 1983, a systematic general plan for health education for the major groups of the City of Dalian was developed. Several strategies that are conducted are - development of leadership participation and changing people's concept. Socialization of health education by mass participation and social involvement, the use of mass media, training of professionals and outcome observations through health science activities centre and food industries. 17. Negara Brunei Darussalam
The National Health Policy calls for intensification of health education to support health programmes. The Health Education Unit was established in 1985. It is now still in the beginning stages of development. It now takes on a referral role and there is still much fragmentation in the activities of the related agencies. The strategies adopted are flexible and depends on the objectives of the health programmes. Some of them is the support of PHC, to treat education with sexual overtones specially carefully, to conduct health campaigns, to disseminate health information, to involve the community more, to provide the learners realistic appraisals, assist learners to adopt a realistic view, to develop confidence, to correct exaggerated views, providing frequent reminders, to make the community place high value on their health and to recognize their own power to change their lives. Some of the techniques used are: television, radio broadcast, posters, banners, pamphlets, bumper stickers, health badges, exhibitions and balloons. lB. Papua New Guinea
Preventive health services have lower priority than curative services in the country. Health education had formally been started in 1959. The next year it was established to the provinces and a one-year diploma health education course was started at the national level to strengthen it.
50
Annex 6
By 1970 the health education activities were more concentrated to the use of mass media and little field activities. This led to ineffectiveness and the deletion of the health education budget, most of its operation and infrastructure, including the diploma course by government. Since then the provinces receive very little health education support and the national level had little activities by health programme staff and practically no infrastructure. This situation led to the adoption of the approach that all health workers should accept health education as an integral part of their responsibility. In-service training courses were held to train the health stsff in health education and health education materials for person to person education was developed. The main problems were: lack of direction, shortage of resources, negative attitude towards health education, lack of experience in health education and poor coordination. The Government however, later realized the great need in health education and hoped to reestablish the health education units both in the provincial and the national levels in the near future. In 1988, a National Health Education Committee was formed. Several health education activities were conducted such as mass media programmes, campaigns, KAP studies and the development of a National health education development plan. In 1989, health education activities evaluation, workshops, patient education, the PNG Health Newsletter was started and the second annual meeting of the National Health Education Advisory Committee conducted. The future planned activities are recruitment of health education staff, restoring health education activities and units in the provinces and developing a diploma course in health education.
•
• •
51
ANNEX 7
FINDINGS OF GENERAL SURVEY ON CONDITION OF HEALTH EDUCATION ACTIVITIES IN THE WHO/wPRO, DECEMBER 1989.
The findings of the general survey were as follows: Units - The responses on the survey questions were from 7 health units with health education names, and 3 not from specific health education units. Operations 1. Policy - Two countries did not have national health education policies at all. Eight countries had health education policies, four specifically for health education, and six for health care services, but related to health education. 2. National plan education plan. Four countries did not have a national health
Six countries did have some kind of health education plan for the whole country. Two plans were specifically for health education activities. Four others were part of the national health care plan. 3. Objectives: Four countries did not operate with stated objectives for operations. Six countries did operate with objectives. Among the objectives mentioned were: - to support health programmes, by 6 countries. - to support healthy lifestyle, by 4 countries. - to inform on importance of health, by 3 countries. - to inform on health care services, by 3 countries. - to produce health education material, by 3 countries. - to develop the health education infrastructure, by 2 countries. - to create awareness of the public on health activities, by 2 countries.
52
Annex 7
- to deter.ine knowledge, attitude, practice changes in the community, by 2 countries. Other objectives mentioned by one country were: - to make health as a value asset; - to persuade people to achieve their own healtb - to educate the people on their physical, mental and social well being; - to strengthen planning, management and evaluation of health education activities; - to expand health education to the provinces; - to intensify school bealth; - to train health staff in health education; - to develop information, education and communication (IEC) support; - to distribute lEG material; - to improve health education services; - to prevent diseases;
- to create awareness on disease control. 4. National strategies for healtb education. One country did not mention any strategy. The nine otber countries had strategies for operations. The most mentioned strategy was to cooperate multisectorally mentioned by 6 countries. ~ Second were tbe production and distribution of bealth education material mentioned by 4 countries.
The use of mass media was also mentioned by 4 countries. Collaboration with health programmes was mentioned by 3 countries and to support health programmes was also mentioned by 3 countries. Training of realtb staff in bealth education was stated by 3 countries. Other two countries mentioned the development of healtb education programmes. Staff formation; To utilize all means of communications; Community involvement and participation;
53
Annex 7
Family health education in villages; Infrastructure development; and School health. Other strategies mentioned by at least one country were: public education; every health worker to conduct health education; regulation and incentives to encourage behavioural change; health education at hospitals and health centres; health promotion; the development of a recording and reporting system; the conduct of workshops; the use of communication techniques;. the development of a national health education committee; the collection and consolidation of information; the use of mUltimedia; and the development of demonstration projects. 5. Use of models or instruments. Four countries did not mention the use of any models or instruments in conducting their health education activities. Six countries mentioned the following instruments or model. Two countries mentioned the use of the Precede Model and also 2 countries mentioned the use of the Combined Administrative and Behavioural Model for Planning, Implementation and Evaluation of Health Education Activities. Other instruaents mentioned by at least one country were: organization chart; terms of reference of staff; budget allocation.
54
Annex 7
indicators, facilities, list of educational material, a plan, list of staff available, KAP studies findings, planned change, social marketing, the health education process, the mass media, personal contact,
educational techniques, reports,
the use of baseline survey findings,
health programmes, epidemiological findings, and use of health education process. 6. Main activities conducted were mostly Production of health education material by 5 countries, Training by 4, Public education by 3, Radio programmes by 3, and Research also by 3 countries. Two countries mentioned health education activities extension; organizing household study groups in villages; distribution of health education material. , community organization and participation;
55
Annex 7
school health visits; and production of manuals for healthful living. Other main activities mentioned once were: Organizing health education at hospitals and health centres; Collaboration with short term consultants; Provision of health education services; Collaborating with government and non-government organizations; Visits to villages; Visits to persons and organizations; Pilot projects; and Planning, monitoring, evaluation of health education support. 7. Detailed activities mentioned Six countries mentioned the production of health education msterials. Training of health staff in health education was mentioned by 5. Conduct radio programmes by 4. Conduct television programmes by 4. School health activities by 3. Publishing health magazines by 3. Distribution of health education materials by 3. The conduct of research by 3. Two countries mentioned Health education staff development, The conduct of workshops and aa.inars, The training of trainers, Monitoring of implementation,
56
Annex 7
The review of training programmes, Public talks and discussions, Planning of programmes,and The development of policy and principle guidelines. Other detailed activities mentioned by one country were: develop trsining programmes review of programmes group discussions and demonstrations identification of priority areas and target groups support of health programmes. outlining of training needs development of health education components of health programmes community organization planning of health education material production hold meetings receive feedback school dental health hold exhibitions inventory analysis design conceptualization pretesting of production formulate. departmental order guidelines develop direct order guidelines
circulari~e direct order guidelines organize through regions or different levels
• l •
57
Annex 7
selection of health education delegates training health education delegates application of projects develop agreements of collaboration implementation of agreements. 8. Monitoring of activities was not mentioned by 5 countries.
The following ways of monitoring were mentioned only one time by either one of the other 5 countries: collection of information from the field recordings of activities and coverage K.A.P. surveys follow up visits feedback from field workers reports and meetings. 9. Position of health education units. All ten countries mentioned the position of their health education units. Eight countries mentioned central Four provincial and Two regional. Other levels mentioned by at least one country were: district hospital health programme training institution health problem related NGO front line health education workers.
58
Annex 7
10. Functions of the health education units were not mentioned by 3 countries. Seven other countries mentioned the following as the functions of their health education units: Four mentioned health education material provision. Three health education services provision. Two others mentioned conducting training educating data collecting planning and implementing Other functions mentioned by one of the seven countries were: develop/provide guidance on policies. conduct activities programming organizing monitoring meetings/discussions research/evaluation jack of all trades. 11. Number of health programmes supported by the health education units were not mentioned by 2 countries. The eight other countries mentioned Maternal and Child Health by 7 Expanded Programme on Immunization by 5 Communicable Diseases by 5
59
Annex 7
Environmental Health by 5 Tuberculosis by 4 Primary Health Care by 4 AIDS by 3 Nutrition by 3 Anti-smoking by 2 Cardiovascular Diseases by 2 Dental Health by 2 Health for the Elderly by 2 Other health programmes mentioned by one of the 8 countries were: -
HRP Dengue Haemorragic Pever (DHP) Pood hygiene Patient education Vector-borne diseases Pamily life Cancer Healthy lifestyle Health education field units School health Malaria. 12. Health education intervention programmes had not been mentioned by 5 The other 5 countries mentioned the following programaes:MCH by 4 countries AIDS by 2 countries countries.
60 Annex 7
immunization by 2 countries environmental sanitation by 2 countries anti-smoking by 2 countries health education at hospitals and health centres by 2 countries, and health staff training by 2 countries. Other intervention programmes mentioned by one country were: Food hygiene vector borne diseases school health cardiovascular diseases nutrition family health education health education for intersect oral agencies and non-governmental organizations health education campaigns water supply. 13. Communication techniques used were only mentioned by 8 of the 10 responding countries as follows: Posters by 7 Television trailers Radio by 5 Leaflets by 4 Booklets by 3 Demonstrations by 3 Video by 2 Billboards by 2 by 5
61
Annex 7
Newspaper by 2 Manuals by 2 Social contact by 2 and The following techniques by one country: community organization slogans stickers radio jingle talks articles group teaching team building training lecture film show
meetings workshop research. 14. Evaluation of health education activities were not mentioned by 3 countries. Seven other countries mentioned the following as ways of evaluation:KAP surveys by 4 countries, records and coverage by 3, information collection by health staff by 2, response from target by 2, indirectly through health indicators by 2
62
Annex 7
annual reports by 2, follow up by 2, and by one country: feedback, evaluation of study groups, sociologic and other surveys. Infrastructure Offices for health education staff had been mentioned by all 10 countries. One country had 156 but the other 9 countries had between 17 to 1 offices. Workrooms had been mentioned as follows. duplication/printing by 6 countries, deSigning by 5, writing by 6, storage by 7, darkroom by 6, sound laboratory by 1. It seemed that very few had a sound laboratory and about 60% had other work rooms. Rooms for training were as follows: lecture by 5, discussion by 3, Half the number of countries had some kind of lecture rooms and only a few had discussion rooms. Facilities were owned by countries as follows: photo copy machine by 5, printing machine by 7, For:-
63
Annex 7 photo camera by 9, video camera by 10, film camera by 4, darkroom set by 4, microphone by 7, speakers by 7, amplifier by 5, tape/cassette player by 9, tape/cassette recorder by 7, binding equipment by 3, designing table by 4, designing set by computer by 3, storage racks by 2, bicycles by 1, motorcycles by 2, motorcars by 3, Manpower had been mentioned by all the countries. All 10 countries had health educators which vary from two countries with 45 and 25, and the others from 10 to only 1. A few had technicians. Many of them had general support staff. Funds for operations had been mentioned by 6 of 10 countries. governments had allocated for operations in 1989: 1 and 2 million US$ in 2 countries, 15 000 and 16 500 US$ in 2 countries,and 200 and 2000 US$ in 2 countries. The ~alculator
by 6,
64
Annex 7
In 2 countries other sources had provided for operation; 40 000 and 50 000 U8$. Infrastructure development was mentioned by 4 of 10 countries. Four governments had allocated for infrastructure development each 100 US$ included in the health care programmes 12 000 US% 19 100 US$
Two countries received for infrastructure development funds from other sources. - amount not mentioned - 6000 US $.
Conclusion: Since only 10 responses had been received from 18 participating countries, the information obtained did not represent the condition in the countries of the Region. It only provided a general picture of the possible situation of health education operations and infrastructures in these countries as follows: About 30% of the countries in the Region had specific health education units. (1) About 40% of the countries had specific national policies on health education. About 60% had health education related policies as part of their national health care policies and about 20% had no health education related policies at all. (2) About 20% of the countries had specific national health education activities plans. About 40% had some national level health education plans as part of the national health plan and 40% did not have any health educatien plan at all. Health education planning had only been mentioned by 10% o~ the countries as a function of the health education J unit.
65 Annex 7 (3) About 60% of the countries operated with some objectives. Most of them aimed to support health programmes (60%), healthful lifestyles (40%), the i.portance of health (30%), inform the public on health services (30%) and to produce health education material (30%). About 40% did not operate with objectives. (4) Ninety % of the countries operated with certain strategies.
the most adopted strategy was to cooperate multisectorally (60%). Thereafter the use of mass media (40%), production and distribution of health education material (40%), followed by collaboration with health programmes (30%), support health programmes (30%) and training of health staff (30%). ten % of the countries did not work with strategies. (5) Sixty % of the countries were unclear with what model or instruments they were operating the health education activities. Twenty % used the Precede Model for planning and also 20% utilized the Combined Administrative and Behavioural Model for Planning, Implementation and Evaluation of Health Education Activities. Forty % of the countries did not use any model or instrument at all. (6) the main activities of 90% of the countries were production of health education material (50%), training (40%), research (30%) and radio programmes (30%). ten % of the countries were not clear what main activities they were doing. Many countries did not give their reasons for conducting their specific activities and few of those that had reasons that were related to increase of effectiveness and impact. Most of the activities conducted were more related to easy understanding and implementation and an impressive image. (7) the detailed activities conducted by the countries coincide with that of the main activities they support. (8) Fifty % of the countries did not monitor their health education activities. ten % among the other 50% monitored their health education activities with methods that were very simple except for the KAP surveys which would need pre-planning and baseline surveys to be reliable.
66
Annex 7
(9) All countries had health education units. Most had the units at the central level (80%). Some also had units at the provincial (40%) and regional levels (20%). Others again had units at district level, ~ith health programmes, at institutions or agencies and in the field. ~ays.
(10) The health education units in the countries functioned in many Forty % provided health education materials ~hile 30% provided health education services and 10% mentioned being jack of all trades. This could indicate that the units in some countries ~ere not clear in ~hat ~ay to function effectively. (11) The health education units in 20% of the countries did not support health programmes. The other 80% mostly support the maternal & child health (MCH) (70%), expanded programme on immunization (EPI) (50%), communicable diseases (CDD) (50%), environmental health (50%), tuberculosis control (TBC) (40%) and primary health care (PHC) (40%). These ~ere mostly long-term health programmes health education activities of their o~. have ~ith
strong funding for
The AIDS programme that also has strong funding but is ne~ might not ~orked closely yet ~ith the country health education units.
The health education units themselves ~ere not strong enough technically and financially to provide the necessary support for the other health programmes that ~ere not strong in their financial resources. (12) Fifty % of the health education units in these countries ~ere not sure about their ~ay of operations to develop intervention programmes. The other 50% were unclear of their operations and only 40% felt they had health education intervention programmes to support the MCR programme. (13) The communication techniques utilized were those that were simple and impressive; posters (70%), radio (50%) and the television (50%). The others were less popular indicating the need for determination of ways for more effective application of techniques. (14) Thirty % of the countries did not evaluate its health education activities. The other countries did not evaluate their activities systematically. • Forty % evaluated their activities with KAP surveys and 30% with This indicated that not much evaluation had been conducted. Even those conducted with KAP surveys might not have been preplanned or specific. records and coverage.
67/68
Annex 7
(15)
All countries had offices for their health education staff.
Some adequate, mostly not. Most countries 60% had work space for their visual aids production but not the audio production. Some had space for training (40%). (16) Many countries already had some audio and visual equipments except for film cameras and darkroom sets. A few had additional equipment for printing, computers for recording and layout, storage racks and transport facilities. This showed that most countries were still in need of developing their health education infrastructure. (17) All countries had health educators but the number was still inadequate. Technicians were lacking in many countries (only 30%). This indicated that the health education manpower situation was not good and needed serious development. (18) Funding for health education operations was lacking or minimal in many countries (40%), and inadequate in the same number of countries (40%). Only about 20% of the countries had adequate funding for health education operations from government. Some countries even depended on aid funds for operations. Only 40% of the countries had little funds from governments for health education infrastructure development. This showed a serious neglect in health education infrastructure development. Two countries receive funds from aid agencies for infrastructure development.
69
ANNEX 8
COUNTRY PROGRAMME PLAN SUMMARIES
1.
Title Scope Country Duration Unit
Health Education Supports For Health Programmes Improvement National level Negara Brunei Darussalam To be effective for a period of 5 years, 1990-1994 Health Education Unit, Ministry of Health Negara Brunei Darussalam Three-Year National Health Education Development Plan National level Cook Islands 3 years : Health Education Unit Health Education For All Ways of Life Unit People's Republic of China Five Years, 1990-1995 Dalian Health Education Research Institute
2.
Title Scope Country Duration Unit
3.
Title Scope Country Duration Unit
70
Annex B
5.
Title Scope Country Duration Unit
Family Planning Education Programme National Republic of Kiribati Five Years Health Family Planning Education Section Community Health Promotion Demonstration Project Through Health Education Activities and Health Diagnosis Services National level Republic of Korea Five Years, Jan 1991 - Dec 1995 Korea Institute For Population and Health (KIPH) Health Education Support To Health Programmes National level Lao People's Democratic Republic Four Years, March 1990-February 1994 Institute of Health Education, Ministry of Health Vientiane Lao People's Democratic Republic Health Education Support To Health Programmes Improvement
6.
Title
Scope Country Duration Unit 7.
Title Scope Country Duration Unit
B.
Title Scope Country Duration Unit
National Malaysia Six Years, Jan 1990-Dec 1995 Health Education Unit, Ministry of Health Kuala Lumpur
71
9.
Title Scope Country Duration Unit
: National Plan For Health Education Unit National : Federated States of Micronesia Five Years, 1990-1995 Human Resources Department National Health Education Plan National level Koror, Palau Six Years, 1990-1995 Bureau of Health Services Health Education Plan For Tuberculosis Control Programme National level Philippines Five Years (1990-1994) Public Information and Health Education Services (PIHES) Health Education In Support To EPI and CPP Programmes In the Solomon Islands National and Provincial Solomon Islands Five Years, 1990-1994 Health Education Unit and MeH Unit
10.
Title Scope Country Duration Unit
11.
Title Scope Country Duration Unit
12.
Title Scope Country Duration Unit
12
Annex 8
13.
Title Scope Country Duration Unit
National Health Education Programme To Support Health Programmes In the Context of PHC National Plan Kingdom of Tonga Six Years (1990-1995) Health Education Section, Public Health Division Ministry of Health Health Education Unit Development Plan A Supportive Primary Health Care (PHC) Approach National level Western Samoa Three Years Health Education Unit (HEU) Public Health Division, Health Department Four-Year National Health Education Plan (1990-1993) For Singapore National Singapore 1990-1993 (Four Years) Training and Health Education Department Ministry of Health Health Education in Communica~Diseases
j, I
14.
Title Scope Country Duration Unit
15.
Title Scope Country Duration Unit
16.
Title Scope Country Duration Unit
and AIDS
National and regional Republic of Vanuatu Five years Health Education Section, Nutrition and Sanitation.