Eliana Elias is designing new techniques for improving communication in public health programs, to ensure that the recipients understand the services and information being offered.
The New Idea
Eliana has conceived a systematic and coordinated approach to improving the quality and accessibility of public health information for poor residents of isolated regions in Peru. Her innovative model includes materials to communicate health services, instruments to transmit knowledge of health issues in simple terms, work with national government agencies to incorporate policies for effective communication strategies into health campaigns and policies, and training for health care providers to respond to local concerns. Many poor people in the developing world die needlessly during epidemics and medical emergencies because they do not understand how to apply the measures that could prevent or cure their afflictions. Eliana has identified a need which is fundamental but often overlooked in development programs--communications strategies and techniques for use with poor indigenous groups, and poor women in particular, to make sure that information gets adequately transmitted to beneficiary populations and achieves the desired impact. She is developing a program of her own to promote effective communications in development, focusing on health programs, with strategies aimed at both public policymakers and grassroots communities.
Eliana has identified four strategic points of intervention for improving the provision of public health information: upper echelons of the Ministry of Health and national policymakers, educators and trainers in medical and nursing schools, health care providers (both official and traditional) in rural areas, and the population itself. She has designed a series of initiatives for education and influencing policy with each of these groups, with a view to revolutionizing the dissemination of public health information by teaching them how to communicate in language and concepts that are accessible to the target population. Unlike many other health projects which separate themselves completely from state structures, Eliana's project coordinates with national ministries and takes advantage of available resources. She sees herself as a pivot in the creation of coalitions between the people and national agencies. She is not only promoting training in techniques for effective communication in health, but also working to institutionalize the idea in national policies.
Five years living in Peru's jungle convinced Eliana that vital information on public health and preventive medicine does not effectively reach the population it is intended to serve. Educational materials use terminology which the people do not understand. Because national health materials and policies are designed in Lima, they do not take into consideration cultural beliefs, perceptions, and traditions of local indigenous groups, many of which are isolated throughout the country. Bureaucratic and budgetary demands ensure that Ministry personnel charged with designing public health campaigns never consult with local representatives to determine whether their content is comprehensible. Policies and health campaigns, instead, are designed by personnel with biomedical backgrounds and without any formation in effective communication or education. These policies focus on curative medicine rather than primary health care, disease prevention, and community participation. Citizen organizations have developed programs in rural health in the past, but they tend to be territorial and do not address communications problems on a national level. Because they remain outside of, and often in conflict with, the official state structure, they do not advocate or relate appropriately with national health ministries. Nor are the projects of such organizations sustainable once the funding runs out. Health care educators and local health care providers rarely attempt to resolve these issues, focusing on the technical content of their curricula, rather than emphasizing effective ways to encourage the populations to adopt necessary measures. When health care promoters are trained, they often lose their link with the communities and begin to speak in technical terms. Patients in need of a doctor's care often do not comprehend the technical jargon and become resistant to seeking medical attention. For these reasons the few educational messages which do reach rural populations are often misunderstood, and tend to confuse the population. The end results are misapplied treatments, high mortality rates, and continued poor health conditions in remote regions across Latin America.
Although Eliana has several years of experience in health policies and communications, she always felt limited by her position within other institutions to be a true voice of the people and put forth her own ideas. Thus she formed her own organization in1998, called Minga Peru, to ensure the independence of her ideas, a space for representation of the people, and the institutional base needed to advance her project in Peru. Minga is an organization that finds funding for local counterparts working in Peru's Loreto region, an isolated area deep within Amazonian jungle, to train the local population in health issues using accessible language. Eliana helps them work with people to design and produce materials drawing on local language and customs. Minga has various programs including national and international workshops for a research project on gender, health, and communications; a radio program to disseminate health information; and programs in bilingual education, community promotion, and training for rural women. Through Minga, Eliana reaches the different levels of society needed to implement her strategy--base-level populations, health care providers, and decision-makers. Eliana's primary goal is to ensure that local rural communities are well-informed, understand health materials, and ultimately achieve a healthy lifestyle through positive attitudes and clear knowledge of health practices. She has created packets of materials in the people's own language, including radio programs, brochures, videos, and manuals, translating technical explanations into easily comprehensible terms. Topics include safe sex and pregnancy, avoiding cholera, community efforts in disease prevention, women's and children's health, prevention of contagious disease, and communication for health. A radio program called "Welcome Health" transmits information on health to local populations and has to date broadcast 50 programs. Listeners, mostly women and health care providers, write in about improvements in health conditions and participate in contests for prizes such as mosquito nets, cooking utensils, and other equipment to prevent community health problems. She has received funding to continue radio transmissions for three years. With this funding Eliana will measure the effectiveness and impact of the radio program, including an evaluation to quantify and describe the audience, their comprehension, and applicability of transmitted information.
At the next level, Eliana works with health centers, local health organizations, and universities to train health care personnel in effective communication techniques. She is identifying health professionals in rural areas who were born locally and will stay longer than a year for intensive training in design and promulgation of materials. Through agreements with universities, she is training future health care providers in social communications techniques and forming groups of university students from Lima to do practical exercises in health care communication in coordination with rural populations. Collaborations include a course for Communication in Health for doctors and health professionals in Cayetano Heredia University's Center for Public Health, collaborative efforts with the Peruvian Amazon National University and Iquitos' University, and contact with the communications faculty of the University of Kansas for student and information exchanges.
Eliana is convinced that she must influence decision-makers to affect national policy and incorporate effective communication strategies into official materials on health care. At the local level, Eliana collaborates with the Loreto Regional Health Directorate to promote community participation and communications in health. She is taking advantage of contacts in US universities and with bilateral/multilateral official aid agencies to design case studies, consultancies, and project design agreements with high officials in the Ministry of Health with a view to changing the role of its communications office from public relations to effective dissemination of information in accessible terms. Through her links with international organizations such as USAID, World Bank, Johns Hopkins University Center for Communications, and the Center for Health and Gender Equity, she hopes to bring pressure on Peru's Health Ministry to change its policies and incorporate effective communication strategies into their health campaigns. In 10 years, she sees herself working with other health ministries across Latin America to implement policies for effective communications in health.
Eliana received her degree in communications from the University of Lima in 1992. She immediately began to combine her training in communications with her interest in health issues when the cholera epidemic hit Peru in the early 1990s. With CARITAS she was responsible for the Project on Health, Environmental Sanitation, and Cholera in the Amazon's Loreto region and wrote her thesis on cultural perceptions of health during the cholera epidemic in the Amazon. It was during her five years spent in Loreto that Eliana saw first-hand the inadequacy of health materials distributed by NGOs and the national Health Ministry. She was deeply moved by her experience of watching people die of preventable disease because they did not understand health campaigns. She recognized the importance of producing materials in simple language that the people could understand, respecting their culture and language to effectively transmit health information and services. According to Eliana, through this experience she witnessed "that the difference between life and death for a person can be the result of good or bad communication." Although she comes from a privileged background and has received offers for many lucrative professional opportunities, she is committed to employing her skills to avert such preventable fatalities.