Principles and Policies of Health Promotion

Annex 1 MSF & forecloseion 17 2 1. Introduction Historically, MSF is touch with IEC (Information, breeding and confabulation) activities or barf since al intimately 10 years. It mainly started in 2 parallel directions Within the human immunodeficiency virus/ help vertical project essential before the introduction of ART? e utilise to develop streak project to reduce the spread of transmittal in the general federation and amongst soft touch groups (mass intercourse campaign to replace the behavior of the comm hearty unity) Within the Water, Hygiene & Sanitation project, hygiene publicity activities were developed to promote the rehearse of the water & sanitation facilities in the communities except in any case to adapt the behaviour of the pop in regards to these facilities In April 2006, an IEC workshop was set up in the OCB in order to structure the IEC activities on the theater of operations1. From there the I. E.C activities deliver been re delimitated and a change of the conditioninology to wellness packaging was adopted. This change in terminology was adopted to avoid mis judgement and confusion with the activities of communication plane section but also to fall at bottom the framework of our checkup activities. This form _or_ system of goernment paper is written in order to explain why MSF is voluminous in wellness forward motion and to set a framework for the wellness publicity activities its not a guide on the implementation of the activities. It lead continuously evolve with the experiences gained over time. 2. some(prenominal) wellness progress definitions . 1 From WHO health publicity is the process of enabling pot to amplify regard over, and to advance 2 their wellness. health forward motion represents a all-inclusive social and political process, it not only embraces pull throughs directed at beef up the skills and capabilities of idiosyncratics, but also action directed towards changing social , environ psychic and frugal conditions so as to alleviate their impact on prevalent and individual wellness. Participation is essential to sustain wellness promotion action. The Ottawa use up identifies three basic strategies for wellness promotion.These argon advocacy for health to hold the essential conditions for health indicated above enabling all people to obtain their full health potential and mediating amid the polar interests in party in the pursuit of health. These strategies ar protrudeed by five anteriority action areas Build healthy public policy, stimulate runive environments for health Strengthen federation action for health, Develop personal skills and Re-orient health service 1 2 For more development see extend on the IEC workshop 2006- Genevieve Loots & Ann Wouters Reference Ottawa Charter for wellness progression.WHO, Geneva, 1986 3 2. 2 From John Hubley, Communicating wellness John Hubley is presenting the HESIAD model which involv es 3 divers(prenominal) comp nonpareilnts into health promotion ? Health promotion chemical element is being use to draw attention to the shoot for nurtureal & political action to repair health 3 Health promotion Health didactics Communication directed at individuals, families and communities to influence Awareness/ noesis, decision making, beliefs/ spatial relation/ say-so of individual and fellowship action/behaviour change community corporationService amelioration improvement Improvement in quality & quantity of function services Accessibility Case management Drug supply Counselling mental faculty attitudes Outreach hearty marketing Advocacy Agenda setting and advocay for healthy public policy Policies for health Income generation paradoxical sleepoval of obstacles, discrimination, inequalities, gender barriers Fig. Components of health promotion (HESIAD)4 3 4 J. Hubley, Communicating health- An action guide to health pedagogy and health promotion- p. 2 J. Hubley, Communicating Health- An action guide to health discipline and health promotion-p. 15 4 3. 3. 1 Health publicity within the OCB Definition As an emergency medical humanitarian organisation, the definition of health promotion, as state by WHO (process of enabling people to take ascendance over their health ) is too wide for MSF actions. It involves a lot of victimisation ideas for example poverty elimination, literacy and general program line, social programs, income generating activities, and so onterathitherfore, within OCB, we are constricting Health Promotion as a set of activities of health upbringing and health services improvement5 that are intending to develop better the use of health manage services ( forbearings & nation). The nation HP onward motion is cerebrate on communities to promote our health structures and to control the epidemics in the macrocosm. The unhurried HP approach is focusing on uncomplaining of and on the adaptation of the health conduct to the heathen behaviours and practices of the community where we are working. Example of health promotion activities 1.HP activities for population Investigate health-seeking behaviour Promotion of available health services Create health-risk awareness some cholera, ebola for example Assure user friendliness clinic longanimous education on human immunodeficiency virus & TB to improve adherence (= word literacy) Providing patient-adjusted selective information on health-issues Stimulate self-management of chronic patients ( authority) 2. HP activities for patients In most of the old IEC called project, the Health Promotion component should be re-orientated towards a support of patients (instead of community) n order to help them to reinforce or adapt a set of behaviour to hitch better & get more capable care. In different organisation as well as in MSF sections you die behind easily hear different names for the Health Promotion activities such(prenominal) I. E. C (Inform ation, education & communication), B. C. C (behaviour change communication), health communication, health education, patient education, etc. yet they all aim at reinforcing knowledge and skills related to health ( distemper, underwritement & cake) in order to allow the patient to take decisions & actions towards his health.Health Promotion encourages comprehensive hindrances that combine approaches such as anthropology, sociology, education, schooling and communication for healthy behaviour adaptation for more information on Behaviour change model, disport refer to M. Varasso Behaviour Change towards human immunodeficiency virus/acquired immune deficiency syndrome and the Health belief Model6. 5 Services improvement could be Improvement in the content of the services e. g improvement of the patient education Improvement in the accessibility of the service e. g timing, positioning & introduction of property & community visits Improvements in the acceptability of services e . enforcement of confidentiality, use of women bowl staff, use of lay field staff, involvement of persons from the target community John Hubley Communicating Health- An action guide to health education and health promotion- p. 15 6 Health Belief Model (HBM) is a mental model that attempts to explain and predict health behaviors. This is do by focusing on the attitudes and beliefs of individuals 5 3. 2 linchpin principles for Health Promotion 1. Health Promotion activities should always be incorporate and serving the medical quarry of the project.It must be apportioned as a transversal approach integrated in the different activities of the project it is not a project in itself. In a logical framework of a project put down it should be situated at the take aim of activities, expected results and indicators. 2. As a particularity, Health Promotion focuses on the health communication with individuals (its not a health job in itself). That is why it applies to different affe ctions (human immunodeficiency virus, TB-treatment, malaria, etc), subgroups (children, young women, patient HIV+), attitudes/habits that we want to influence (access to services & care, promotion of healthy behaviour, etc) 3.The MSFs understanding of the population, sensing of the illness 7 and the health seeking behaviour are essential in order to offer and to improve the development of our health services. Its an essential step to start any kind of Health Promotion activities, its necessary to understand how the population is functioning before delimitate health messages adapted to the culture of the population and patients. 4. The activities of Health Promotion leave vary from one project to another and will always need to be adapted to the context. 5.The Health Promotion/education activities should be through in priority within our health structures addressing patients & care takers in groups or individually 6. Health Promotion activities potbelly also be make at the co mmunities level with specific objectives To promote our services attract people in our structures and explain our services to communities (promotion of the services for victims of sexual violence in the community, promotion of our inoculation sites, etc) To prevent epidemics spreading when there is an outbreak of cholera, hemorrhagic fever, malaria, measles, etc. e should inform the communities at risk how the distemper is transmitted, how to prevent getting the disease and what to do in case of the contraction of the symptoms To supervise a health situation in some context it can help the project to develop a component of community health worker or home visitant network to perk up health surveillance information (mortality, morbidity, MUAC, vaccination, etc) To ensure access of the vulnerable group to our structures when a population/village/specific group determine is not flood tide to our structure and they are at high risk of specific health problem 7 DISEASE is the definit ion of a health problem by a medical expert, ILLNESS refers to the experience of the problem by the patient and SICKNESS is the social role attached to a health problem by the society at large. 6 3. 3 Roles and indites Ideally, we should calculate different profiles to be in heyday of the HP activities the first flesh should relieve oneself in priority an anthropologist or sociologist who will test the ethnic behaviour of the population followed by a social communicator person who will design a health communication outline.However, this rarely happen and one person is usually in charge of the different steps of the HP activities. 3. 3. 1 Anthropologists role in a project To understand the uncollectible practices of the target group linked to the transmission system of a illness, for example to collect information on the behaviour and the cultural practices of the pop. linked to the spread of HIV/AIDS to get information on cultural burial procedure-linked to Ebola etc To restrict the health seeking behaviour of a target population ? wherefore are the pop not coming to our health services?Where do they go for care? Linking with Traditional healer? Sorcery, Witchcraft? To get a better analyse of cultural barriers in the population wisdom of a health problem by the target group, organisation of the society, power, decision giftr, etc. To analyse the knowledge, attitude and practices on a disease or health problem (KAP survey) To analyse and understand how MSF is perceived in the population But also at the level of the service provider, to analyse and understand the staff attitude towards patients/diseases To study the suppositionion of illness Etc. ? He/she will then apply findings into practical recommendations for the project but also for the development of health messages. The anthropologist is NOT going to solve all your problems in the project he needs to have a clear job description. The field needs to identify what they want to analyse and understand and how it will improve their medical activities. Its essential to be specific. He is part of the medical team up and need constant discussion with the medical team/field coordinator.Its possible to require specifically an anthropologist for several months to undertake a qualitative survey. But frequently, the expatriate health promoter will also have a degree in Anthropology or Sociology (or Social Sciences) its more likely to have one expatriate in charge of everything. Rem For the moment MSF is sending anthropologist too late in the map of the project design it would be useful to use the anthropologists competences at some early phase of the project (explo mission or head start of a new project).In project by choice, the sending of an anthropologist can genuinely provide key information on the context, the population and the link with MSF (in 2008 we have send anthropologist in Niger and Lubutu). 3. 3. 2 Health levyrs role in a project Your health promoter could have a communication or nursing or educational background depending of what is available and which profile is exceed suiting the project.To collect datas about the target population To set up the strategies for the HP activities according to the objectives of the project To recruit (if not yet make) and mastermind/coach a team of national health promoter To define the priorities of the health messages according to the risk practices and the health seeking behaviour analyse To adapt the content of the messages according to the culture & target pop (importance of pre examen the materials) To understand how MSF is perceived in the population 7 To develop (or re-use) communication materials (educational games, pictures, osters) and to choose seize channels of communication To monitor the HP activities (including participation to the Annual Review Operation exercise) To evaluate the understanding of the health messages by the beneficiaries and adapt the content of information He/s he is part of the medical team and need constant discussion with the medical team/field. Because the HP activities should be integrated in the project, the expatriate presence on the field should be seen as a temporary phase in order to leave the activities in the hands of national staffs (when available) who usually know better the cultural behaviour of the target pop. nd have easily access to communities. 4. why is MSF knobbed in Health Promotion? Health Promotion activities are usually linked to disease noise 8 activities. To give information and to coach or educate persons on different health field of study & measures is an essential element to avoid individual getting sick, to recognize precedent symptoms and come to be treated but also to ensure patients following(a) treatment procedures. Health Promotion activities want to ensure preventive behaviour in term of health. saloons level and activities9 Its important to differentiate 4 levels of prevention where MSF actions put in place will be protean but also where the Health Promotion activities will differ. Primordial prevention level zero of prevention Activities aiming at diminish societal vulnerability, big(p) individual risk through contextual treatments. Example of activities= poverty simplification, decreasing stigma & discrimination, HIV awareness for the general public, etc.So it concerns risk reduction of a health problem at population (societal) level and MSF will never intervene at this level of prevention. Primary prevention covers all activities designed to reduce the happening and the transmission of an illness (disease free). Primary prevention methods are used before the person gets the disease. ? decrease of the incidence & prevalence of health problem Example of activities done by MSF= immunisation, improve water supply, family be after services, use of condom, prophylaxis during pregnancy, etc.Secondary prevention activities aimed at the recognition of early signs of dise ase and depend for treatment before it ferment serious. Secondary prevention avoids that infection become illness. ? Reducing the morbidity Example of activities = testing of HIV, medical consultations, treatment, vaccination 8 Disease prevention covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its come along and reduce its consequences once established.Reference adapted from Glossary of Terms used in Health for All serial. WHO, Geneva, 1984 Primary prevention is directed towards preventing the initial occurrence of a disorder. Secondary and tertiary prevention seeks to arrest or turn back existing disease and its effects through early detection and appropriate treatment or to reduce the occurrence of relapses and the establishment of chronic conditions through, for example, powerful rehabilitation. Disease prevention is sometimes used as a complemental term alongside health promotion.Although there is frequent overlap between the content and strategies, disease prevention is defined separately. Disease prevention in this context is considered to be action which usually emanates from the health sector, dealings with individuals and populations identified as exhibiting identifiable risk factors, often associated with different risk behaviours. 9 Disease prevention- definition of WHO For more information on Prevention and MSF, please refer to the doc in annex 1. 8 Tertiary prevention Targets the person who already has symptoms of the isease and it includes behaviours that are involved in treatment & rehabilitation (person is already sick) The goals of tertiary prevention are prevent damage and discommode from the disease slow down the disease prevent the disease from causation other problems give better care to people with the disease make people with the disease healthy again and able to do what they used to do Example of activities treatment, patient education, emotional support et c. ? Reduction of the morbidity, suffering & mortality 9 Risk Population General speculative risk thinking(a) population ? ? Specific High Risk ?Healthy ind. ? Early signs ? Diseases ? Death Infected ind. ? Patients (sick) ? Death/handicap Intervention MSF neer or through partners Polio eradication, HIV awareness, etc Not systematic Prevention activities inoculation, Vector control, HP, Family Planning, etc. Always pledgeive & curative Testing, consultation, treatment, screening, health educational activity, etc. Always Curative & palliative care Emotional support, treatment, patient education etc. Primordial prevention Primary prevention (Incidence & prevalence) Secondary prevention (Morbidity) Tertiary prevention (Morbidity& mortality) Depending of the projects objectives, MSF can be involved with variation at the different levels of prevention. 10 5. Health promotion as a transversal axe Health promotion was set up as a transversal axe into the Operational prospect in 2008 a nd in 2009 Health Promotion is integrated into the Prevention transversal axe. It sum the HP activities should be considered into the different operational fields of intervention but also in the others transversal axes (Women health, nutrition, etc). 5. 1 Health Promotion activities to consider per health problem Some Health promotion activities to consider . psychoanalyse & understand the risky practices change magnitude the transmission of HIV/AIDS amongst the population/community & patients 2. Understand the reasons of not coming for testing, for PMTCT (Health seeking behaviour, Stigma) 3. Measure the knowledge, attitude and perception of HIV/AIDS in target group 4. Promote of the services for families members, children and partners 5. Empowerment of patient (patient education on disease & preventive measure, treatment literacy, support group, PLWHA expert, etc) 6. provide support to adherence in health structure and in the community 7.Ensure HIV services adapted to your targe t group of patients 8. Collaborate with Traditional healer, TBA, 1. Analyse and understand the disease perception (fears and stigma) & knowledge in the pop. 2. Promotion of services for TB families & care givers 3. impart patient education & treatment literacy 4. Support to adherence 5. Train health staff on infection control measure 1. Analyse and understanding the disease knowledge and preventive measure 2. Promote the use of the mosquito nets with patients & communities during the succession 3. Training on recognition of symptoms 4.Promotion of the use of our services 5. Develop the component of malaria volunteers 1. Analyse and understand the disease perception and the risky behaviour in the community increasing the transmission 2. Measure the knowledge, perception & attitudes of the pop. towards the disease 3. riddle information on the preventive & disease control measures to the general population 4. Collaborate with key leaders of the community ? visit of the isolation uni t 5. Educate of the patients and families (and neighbour) in order to decrease fears & stigma of the patients 6.Participate to burials to ensure the prize of the tradition (orientation of the body, traditional beliefs, etc). 10 Health thematic HIV/AIDS Reference documents/books 1. HIV/AIDS OCB Policy 2008 chapter on prevention and empowerment & autonomy of PLWH 2. Patient support in HIV/AIDS drawing MSF OCB 2008 3. videodisk Health Promotion communication materials HIV/AIDS thematic OCB 2007 4. Patient Support for HIV Infected children- 2008 D. Goetghebuer & K. Bosteels TB 1. Adherence strategy for TB treatment- MSF OCB 2008 2. DVD Health Promotion communication materials TB thematic OCB 2007 1.DVD Health Promotion communication materials malaria thematic OCB 2007 Malaria Infectious diseases 1. FVH guideline internationalHealth Promotion & Anthropology chapter 2. Ebola, culture & politics the Anthropology of an Emerging disease10 3. Cholera Health Promotion technological briefs 4. DVD Health Promotion communication materials cholera, Ebola, Rift vale fever, OCB 2007 Ebola, culture & politics the Anthropology of an Emerging disease, Barry S Hewlett and BonnieL. Hewlett 11 Some Health promotion activities to consider 1.Analyze and understanding the cultural barriers of the use of the services or understanding the reasons of delivering at home or the KAP on FGM, etc. 2. Promotion of services (ANC, FP, PMTCT, delivery, abortion, sexual violence). 3. Integrated health education for mothers on different reproductive health subject 4. Home visitors to refer ANC visit, follow up of sexual violence 5. coaction with TBA information on dangers of deliveries and referral of complicated cases 6. Collaboration with women groups 1. Analyse of the perception of the malnutrition in the pop 2. spirit cultural practices or beliefs increasing malnutrition of children 3. Analyse the cultural factors in a famine context 4. nutritionary education to mothers develop peer mothers + appetite test 5. Nutritional education to men 6. defaulter tracing support- community support 1. Analyse of the perception of mental health problem in the community 2. Promotion of mental health services 3. De-stigmatization of mental health problems 1. Analyse and understand the concept of violence in the context (cultural versus contextual violence, definition of violence, cultural profile of victims, etc). . Promotion of the services 3. Working with key actors in the community 1. Understanding of the concept of vaccination, fears & taboos about vaccines. 2. Promotion of importance of the EPI 3. Promotion of day of the vaccination campaign, site of vaccination, type of vaccines, etc Health thematic Women health Reference documents 1. DVD Health Promotion communication materials Women Health OCB 2007 Nutrition 1. Anthropological report from Niger- Lieselotte 2008 2. DVD Health Promotion communication materials OCB 2007 Mental Health emphasis 1.Mental Health Pol icy OCB 2008 Link with Brazil Medical Unit Vaccination Niger 2008 Tanganika 2008 12 5. 2 Minimum package of Health Promotion activities There are minimum Health Promotion activities to be integrated in all projects Analysing of the disease/illness perception and knowledge of the target population Promotion of MSF health services (usually at the beginning of the project or when new health activities is being developed) Health education/patient education/treatment literacy in order to ensure that patients understand the symptoms, how to prevent & how to treat his disease . 3 Health Promotion within Operational case of intervention Field of intervention I Assistance to population in violent setting Particularities for this operational field of intervention are The Health Promotion activities are done primary to get closer to the community, to get information on the context, the population but also on their security, on the living condition and on the access to health care. Health P romotion activities in this field are oriented towards allurement of information, investigation and promotion of our services.Several experiences11 have shown good results in developing a home visitors network they seem key persons to get closer to your community and gain trust. Usual HP activities done at the community level with home visitors or community health worker are collection of data (mortality, birth, morbidity, on specific thematic such violence or sexual violence) at household level, defaulter tracing activities (nutritional or others program), promotion of MSF services and health information on a specific disease (ex. malaria explanation because malaria season).In some context, there is a need to extend these communities activities unless and push for a move of the civil society in the non word sense of the problem (Similela and Seruka- sexual violence projects). HP activities in the medical groundwork = health education on different health topic done by the medica l staff or health educators Field of intervention II Extreme health gap Particularities for this operational field of intervention are Health Promotion activities and anthropological components should be more often considered.In post conflict, under served general pop & exclusion there is space and time to gather key information about the population and their health seeking behaviour and it would help to develop the medical strategy of the project. Key activities to consider -Analyse of the risky behaviour & needs of population in term of health & analyse of Health Seeking Behaviour -Look for the correlation needs of pop & offering of medical services -Promotion of MSF services -Health education in medical infrastructures -Consider the possibility to develop some HP activities in the communities to increase patient/individuals empowerment 1 In refugee camps, we often develop network of home visitors. Since 07 In Darfur, we launched several network of HV in city the capitalisation o f the network in Kebkabya will be done in 2009. 13 Field of intervention III Epidemics and endemics See parry with health thematic p. 11 & 12 Particularities Health Promotion activities should be integrated in every disease Field of intervention IV Assistance for victims of natural catastrophes Particularities are the Health Promotion activities are usually integrated into Watsan activities (Hygiene promotion) or linked with mental health activities.The concept of home visit is very important to reinforce link with population. 14 6. Some definitions Health education12 comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are causative to individual and community health. Reference modified definition- WHO Health education is not only concerned with the communication of information, but also with fostering the motivation, skills and assert ion (self-efficacy) necessary to take action to improve health.Health education includes the communication of information concerning the underlying social, economic and environmental conditions impacting on health, as well as individual risk factors and risk behaviours, and use of the health care system. Thus, health education may involve the communication of information, and development of skills which demonstrates the political feasibleness and presidential termal possibilities of various forms of action to address social, economic and environmental determinants of health.Patient education13 The patient education is a process, integrated in the process of care, including a series of activities organized awareness, information, learning and psychological and social assistance on the disease, treatment, care, organization and hospital procedures, health behaviours and those associated with the disease, to help the patient (and his family) to understand the disease and treatment, ca re work, take charge of his state health and foster a hap to normal activitiesPatient support 14 The component of Patient Support covers all the activities aiming at supporting the patient in front of his disease and his treatment, beyond the purely medical aspects of care. The patient support is a continuum of progressive, individualize or peer-supported activities addressed to the patient, and going on all along the program. Rem for the moment within MSF, we are using the component of Patient support for HIV and TB.Main objectives for all HIV patients are To understand and accept his HIV status or disease 12 13 From Health Promotion glossary DECCACHE A. et LAVENDHOMME E. , Information et Education du Patient des fondements aux methodes, De Boeck Universite, Bruxelles, 1989, p. 45 14 For more info, refer to the draft Patient Support document for HIV/AIDS written by B. Laumont & G. Loots in the OCB. 15 To recognize the consequences of the disease in his everyday life To adapt h is behaviour (way of living) To be involved in and adhere to his treatment To achieve all these objectives, the patients have to go through 3 complementary processes 1- Educative process ? Patient Education This is about the patient understanding the infection and the evolution of the disease the transmission of the disease the risky behaviours to avoid the treatment This includes the following activities Health Education, Health talks, Treatment Literacy 2- Process of emotional adaptation?Emotional Support This is about the patient dealing with the loss of his self-image and the loss of the good health dealing with the stress caused by the evolution of the disease, the perspective of death, the uncertainty of the future and the reduction of capacities dealing with the relational changes with his close relationships and occupational environment dealing with the improvements and the changes brought by the treatment This includes the following activities counselling (individu al & group), support groups 3- Process of adaptation to socio-economic consequences?Social Support This is about helping the patient to solve his social problems in order to improve his good adherence to treatment risks of precariousness monetary resources, incapacity, loss of employment risks of isolation, stigmatisation by family and community This includes the following activities social consultation, home visits, networking, etc The Patient Support can be provided through 4 different types of activities Individual sessions individual counselling (pre-test, post-test, follow-up, adherence, etc), social consultation multitude sessions Health Talks, Educational talks, ART preparation sessions, Support Group, etc Group activities bearing and creative activities, party, celebration, excursion, etc Community and Family level actions Home visits, Home Based Care, Defaulter prevention, Defaulter tracing, Community activities, etc Empowerment for health15 In health promotion, e mpowerment is a process through which people gain great control over decisions and actions affecting their health. A distinction is made between individual and community empowerment. Individual empowerment refers primarily to the individuals ability to make decisions and have control over their personal life.Community empowerment involves individuals acting collectively to gain greater influence and control over the determinants of health and the quality of life in their community, and is an important goal in community action for health. 15 From Health Promotion glossary 16 7. Bibliography Anthropologues et ONG des liaisons fructueuses? Humanitaire Hors Serie Numero 4Automne/hiver 2007 editer par Medecins du Monde Communicating Health- an action guide to health education and health promotion John Hubley- 2004 utilize Health Research, Anthropology P. Boonmongkon, P. Streefland, M. L. Tan, etc. Health Promotion glossary WHO CDC, Prevention Education pour la sante, concepts, enjeux, planifications, Jacques A. Bury Information et education du patient, des fondements aux methodes , A. Deccache et E. Lavendhomme of Health and