Background and methodology
There had been no previous evaluation of government health promotion and communication capacity in the CEE/CIS region. This evaluation aimed to assess what was perceived as a serious deficit in public health communication capacity in relation to the failure of supplementary immunization campaigns; the undermining of routine immunization services; the stalling of national efforts towards pandemic influenza preparedness and serious preventable health issues impacting adversely on demographic trends. Evidence was collected through quantitative, as well as qualitative methods. Field visits were carried out to interview key informants from government counterparts, such as Ministries of Health and national Avian Influenza prevention coordinating bodies; Institutes for public health; UNICEF and UN Systems Agencies; the European Union; the World Bank; US Agency for International Development; and private and publicly owned media agencies. The evaluation covered different subregions: Albania and Serbia in South-Eastern Europe; Moldova, Romania and Ukraine in Central and Eastern Europe; Tajikistan and Uzbekistan in Central Asia; and Turkey.
The evaluation found that, although there are a limited (but not insignificant) number of individuals with the skills, intellectual breadth and commitment to make a significant contribution to health systems reform through facilitating effective communications strategies, they are not fully supported institutionally and are without most of the technical and financial resources they require to do this work. Further investments in training and education are essential, but so also are investments that ensure those with appropriate skills are enabled to drive health systems reform.
The evaluation found that while support for health promotion is improving in some countries, health systems reform still needs to overcome hierarchical professional culture that does not value modern notions of public health reforms.
External assistance for health sector reform should strengthen coordination and adequately address the relationship between health systems reform and the reforms of public administration necessary to enable sector-wide health systems reform. However, the increasing emphasis on cross-sectoral interventions and coordination in support of Avian Influenza and HIV/AIDS prevention have created awareness within health sectors that institutional reform is achievable and that modern approaches to public health service delivery are effective.
Leveraging and facilitating a scale up of external support for health promotion capacity development, and for improvements in the way governments approach internal and external communications, presents a very tangible opportunity for UNICEF to bolster, even accelerate, existing reform efforts.
The overarching recommendations are to accelerate health systems reform through developing sustainable professional health communication capacity; establish linkages between national health systems and the private sector, especially pharmaceutical firms, other private service health providers and the mass media; facilitate the introduction of new and best knowledge and practice, in particular behavioral change practice. UNICEF should further support government counterparts to play a greater role in the design and implementation of health promotion strategies. Providing technical assistance for the development of communications media that promote health system reform should be UNICEF value added and niche.
PDF files require Acrobat Reader.