Guiding principles for Best Practices in Communication

1
Strategic Communication Best-Practices for
Improving Health Behavior and Service Quality
Michelle Heerey Sr. Program Officer for Quality
and Performance Johns Hopkins University/Center
for Communication Programs
2
12 Elements of Strategic Communication

• Science-based
• Client-centered
• Service-linked
• Participatory
• Multi-channeled
• Benefit-oriented

• Technical quality
• Advocacy-related
• Expanding to scale
• Sustainable
• Results-oriented
• Cost-effective

3
Address both supply and demand factors for best
results
Client Satisfaction
Effectiveness
Quality
Correct Use
Job Satisfaction
Informed Choice
4
Interpersonal Communication

• Address both client and provider communication
  behaviors
• Reinforce skills and knowledge gained through
  training
• Implement multiple, complementary interventions

5
Reinforcement interventions improve and sustain
provider communication, Indonesia
Percentage of provider facilitative
communication
40
Peer Support Groups
35
Self-Assessment only
30
No Reinforcement
25
20
Post-Training
Reinforcement (4 months)
Pre-training
Source JHU/PCS Indonesia Self-Assessment Study,
1998 Notes No reinforcement group baseline
n123 post-training n121 follow-up
n119 Self-assessment baseline n141
post-training n142 follow-up n142 Peer review
group baseline n133 posttraining n143
follow-up n142
6
Smart Patient coaching

• 20 minutes
• Right to seek information
• Asking questions
• Expressing concerns or opinions
• Asking for clarification

7
Impact of Smart Patient coaching by client
assertiveness, Indonesia
Utterances
The impact of Smart Patient coaching was
significant among less assertive women.
N768, Plt.05
8
Contraceptive discontinuation 8 months
post-intervention, Indonesia
Health concerns side effects are lead reason
for discontinuation among new clients (68).
N745
9
Community Participation

• Include community client perspectives in
  definition of quality
• Use systematic process to facilitate dialogue for
  joint identification of priorities and strategies
• Community actions integral to response
• Build processes tools for community
  evidence-based decision making

10
SECI Community-based health information system,
Bolivia
The monthly process

• 1. Promoters collect household data.
• 2. Providers collect service utilization data.
• 3. Team consolidates data.
• 4. Team shares data with the community.
• 5. Community analyzes and plans relevant
  actions.

11
Improved processes and community capacity, Bolivia

• Capacity for monitoring and evidence-based
  decision making
• Service provider and community interaction and
  coordination
• Leverage resources for health services

12
SECI Impact on health behaviors in first year,
Bolivia

• Case Control OR
• 
  
• Complete vaccinations 11 3 4.78
• Polio - 3rd dose 30 12 3.04
• Measles vaccine 39 20 2.59
• Breast-fed 1hr post-part 26 12
  2.62
• Have a health card 45 28 2.12

13
National Scale Interventions

• Use a systems approach
  (e.g. management, training, supervision, etc.)
• Develop leadership
• Implement quality certification schemes
• Model health behaviors and supporting social
  norms via mass media

14
Egypt Gold Star context

• 1988- FP Systems Development Project
• Improved management systems
• Decentralized FP service administration
• Increase sites offering FP (e.g. training,
  equip,...)
• Mobile clinics
• 1992- CPR began to plateau after decade of steady
  increase
• 1995- Gold Star Quality Improvement Project

15
Communication strategy for quality improvement

• Train staff in IPC/C improve IEC tools
• Certification criteria include IPC/C indicators
• Raise community expectations
• Model norms client-centeredness team spirit
• Recognize providers and sites associated w/
  quality logo

16
Gold Star Units
17
Trend in Current Use of Family Planning, Egypt
1980-2000
18
Trend in Total Fertility RatesEgypt 1980-2000
19
Nepal Communication Strategy Radio
Communication Project, 1995-pres.

• Improve FP service delivery
• Service Brings Rewards
• Distance Ed Serial
• Generate demand for FP and FP services
• Cut Your Coat According to Your Cloth
• Drama serial for general population

20
Client flow at two sentinel health posts in Dang
District Nepal, 1994-1997
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21
Trend in Current Use of Family Planning, Nepal
1991-2001
NFHS, 1991 1996 NDHS, 2001
22
Trend in Total Fertility RatesNepal 1991-2001
NFHS, 1991 1996 NDHS, 2001