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Update #48: May 12, 2003 (Part I, Part II, Part III)

- Correction – URL for Emergency Contraception Toolkit
- Featured resource: The Gender Guide for health communication programs
- Request for Information on Community Monitoring of Health Care Quality
- Request for Low Literacy Info/Illustrations for Patients Receiving AntiRetroviral Therapy
- Parents Forum
- CARE Publications Available Full Text Online
- Information on Capacity Building for AIDS Prevention

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Emergency Contraception Toolkit
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CORRECTION: We accidentally printed the wrong URL for the Emergency Contraception Toolkit in HCMN #47. The correct address is under ‘community health programs’. For more information contact:
Linda Simkin
Sr. Program Officer
Academy for Educational Development

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The Gender Guide for Health Communication Programs
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Full text:
The Gender Guide is easy to use when designing a program or developing materials. It follows five steps for developing a health communication program: 1) Analysis; 2) Strategic Design; 3) Message /Materials Development, Pretesting & Production; 4) Management, Implementation, & Monitoring; and 5) Evaluation. The guide provides questions to identify and address gender issues to ensure that gender awareness is part of a program’s design, implementation, and evaluation. The questions are designed to promote a dialogue in communities that will lead to increased understanding of gender issues. The guide is flexible; questions for each step can be used independently of other steps at any stage of the program.

- - - - - - - - - - - - - - - - - - - - - - - - - - -Request for Information on Community Monitoring of Health Care Quality
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John Shaji writes:
I am looking for some material on "community monitoring of health care quality". I would appreciate it if you could cite some recent work -field experience, NGO projects, literature review etc. in this area especially from South Asia.
Mr. John Shaji
Address: B 1635 Indira Nagar, Lucknow, Uttar Pradesh India
TEL: 9415030725

Can any HCMN members suggest resources? A quick search of POPLINE suggests a couple of recent articles below. POPLINE can be searched online for free at If you have other suggestions, please send to HCMN or directly to John Shaji.

Title: Participatory evaluation of reproductive health care quality in developing countries.
Author: Bradley JE; Mayfield MV; Mehta MP; Rukonge A
Source: Social Science and Medicine. 2002 Jul;55(2):269-82.
Year: 2002
Abstract: Participatory approaches are becoming increasingly important in the field of health, and many organizations, governments and donors have recognized the need to increase stakeholder involvement to ensure sustainable and real change. However, commitment to participation is often lacking and participatory processes, if applied, tend to be short-term and discrete, especially in institutional settings. Rarely, for example, are stakeholders involved in long-term monitoring and evaluation activities, due the time-consuming nature of participation, and to perceptions on the part of donors and other decision-makers that participation lacks the rigor and objectivity of external evaluation. This paper describes the strategies used by an international reproductive health organization to collaborate with local stakeholders in a long-term participatory approach to quality improvement, focusing on defining quality of care, identifying problems in health facilities, setting goals and seeking solutions to those problems, tracking changes in over time, and feeding this monitoring and evaluation information back into the quality improvement process. The paper also illustrates how greater participation was achieved over time as local stakeholders moved away from traditional models and relationships and started working together to meet their quality improvement goals. The paper argues that participatory techniques are essential if the real needs of clients are to be met through sustained change and continuous quality improvement at the site level.
Document Number: PIP 168396

Title: Better health for women and children. End-of-the-year report.
University Research Company. Calidad en Salud
Source: Bethesda, Maryland, University Research Company [URC], 2002 Jan 15.65, [43] p.
Year: 2002
Language: English
Abstract: In Guatemala, the Calidad en Salud program developed specific actions focused on creating conditions to improve the health of women and children. In close collaboration with both the Guatemala Ministry of Health (MSPAS) and Social Security Institute (IGSS), project activities revolved primarily around: 1) increasing access to and improving the quality of family planning services, and 2) achieving national-level consensus for the implementation of the Integrated Management of Childhood Illnesses. This end-of-year report highlights the contributions and results of those activities undertaken or supported by Calidad en Salud during the year 2000. Included is a description of the status of key US Agency for International Development / Guatemala monitoring indicators. A summary of key MSPAS and IGSS results is also presented, specifically related to each of the five Result Packages under Calidad en Salud: use of maternal child services (MCH); improve household health practices; MCH and nongovernmental organizations are better managed; community participation and empowerment; and increased use of MCH services by IGSS.
Document Number: PIP 169866

Title: Action research to enhance reproductive choice in a Brazilian municipality: the Santa Barbara project.
Author: Diaz M; Simmons R; Diaz J; Cabral F; Bossemeyer D :355-75.
Source: New York, New York, Population Council, 2002. In: Responding to Cairo. Case studies of changing practice in reproductive health and family planning, edited by Nicole Haberland, Diana Measham.
Year: 2002
Language: English
Abstract: This book chapter describes a broad experiment to improve the quality and quantity of reproductive health services provided by the municipal health sector in Santa Barbara d'Oeste, Brazil. An intensive participatory process was initiated to involve providers, their supervisors, municipal authorities, community members, and researchers in a guiding executive committee. The committee reviewed diagnostic research revealing substantial barriers to access, deficiencies in quality, and inefficient use of medical personnel. Moreover, the committee identified and instituted key interventions to address these problems.
Document Number: PIP 169285

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Request for Low Literacy Info/Illustrations for Patients Receiving AntiRetroviral Therapy
- - - - - - - - - - - - - - - - - - - - - - - - - - -Susan Dunigan
HIV Educator
Yale School of Nursing/CAETC
100 Church St. South, New Haven CT 06539 USA
Seeking low literacy (illustrations?) information for patients who will be receiving anti retroviral therapy. Patients are currently enrolled in a TB DOTS program. For example: We would like to provide a depiction of side effects associated with ARVs so that patients would have a better understanding of anticipated side effects. This understanding could affect adherence.

- - - - - - - - - - - - - - - - - - - - - - - - - - -Parents Forum -

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Eve Sullivan of Parents Forum writes:
“It is really wonderful to see the variety and richness of projects people in HCMN are working on. If you haven't visited our site lately, please take a look. Thank you for your work in reweaving the fabric of social and community life.”

PARENTS FORUM is a network of people concerned about family life. It is a group of parents and others who come together to practice good communication skills in order to be more responsible in their families and more involved in their communities. With respect and honesty, they try to work through the conflicts and strong feelings that arise in family and community life. PARENTS FORUM organizes workshops and book & toy exchanges in Cambridge, Massachusetts (USA) and cooperates with many Boston-area agencies.

- - - - - - - - - - - - - - - - - - - - - - - - - - -CARE Publications Available Online
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CARE has just made available online as PDF files several publications that HCMN readers would find useful. They include:

* Promoting Quality Maternal and Newborn Care: A Reference Manual for Program Managers - English, Spanish and French
* The Healthy Newborn: A Reference Manual for Program Managers - English
* Embracing Participation in Development - English, Spanish and French

Other publications are also posted and there will be additional ones in the future.

Thanks to Jaime Stewart, , of CARE for this information.

- - - - - - - - - - - - - - - - - - - - - - - - - - -INFORMATION ON CAPACITY BUILDING FOR AIDS PREVENTION
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In our last e-mail, Dr. Hitendrasinh G. Thakor of India asked for materials and literature on capacity building for AIDS prevention. Jeffrey Bernstein of the Center for AIDS Prevention Studies suggested the following:

“Your request has come to my attention. The Center for AIDS Prevention Studies has recently sponsored a conference at which a recent research study in India was highlighted. I hope the following information is useful. If you have further question please contact the Center for AIDS Prevention Studies at”

Developing Programs: A Decade of HIV/AIDS Research in India Maria Ekstrand, PhD, Krysia Lindan, MD MSc , Monica Ganhdi, MD MPH, CAPS, Mannu Setia, MD,
CAPS, LTMG Hospital, Mumbai CAPS has been working on prevention programs in India for 10 years, where poverty, illiteracy, the sex trade, status of women, stigma, and lack of resources make prevention challenging. This panel describes the evolution of projects from working with sex workers, their male clients, MSM, transgenders and HIV infected persons. Examples of similar programs in Southeast Asia are introduced. We will facilitate a discussion with the audience on how these issues coincide with similar US populations and share prevention approaches. Link to download presentation: or

Additional resources:
Needs assessment: Capacity building for HIV Prevention among injecting drug users in India.
The purpose of this consultancy was to undertake a needs assessment as a preliminary step to the development of a capacity building intervention for HIV prevention among injecting drug users in India. Outputs of this consultancy included the development of a strategy and action plan, and a design for the capacity building project.

CDC: Building Capacity, Technology, Transfer Efforts, and Sustainability for HIV Prevention.
Background: HIV prevention capacity building is a process by which individuals, organizations, and communities develop abilities to enhance and sustain HIV prevention efforts. The goal of capacity building is to foster self-sufficiency and the self-sustaining ability to improve HIV prevention programs, processes, and outcomes. Capacity building involves a variety of delivery mechanisms: 1) technology transfer; 2) technical/capacity-building assistance; 3) training; 4) skills building; and 5) information dissemination.

Jeffrey Bernstein, MS
California Technical Assistance Project Manager
Center for AIDS Prevention Studies
University of California, San Francisco
74 New Montgomery, Suite 600
San Francisco, CA 94105
415.597.9210 / 415.597.9213-fax

- Organization for Women & Children Development
- New HCMN Members

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Organization for Women & Children Development
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Greetings from Pakistan!

Organization for Children & Women Development (OCWD) was formed and is run by the women though we have some committed male members also. We have taken a humble start and focusing on the most neglected and underprivileged women and children in Pakistan.
We are focusing women and children residing in distant rural localities and urban areas, which are neglected and suffering from gigantic problems.
We are enclosing here with our aims and objectives for your consideration and look forward for a good relationship and cooperation.
We want to become members of HCMN for the following reasons,
i. We want to learn as much as can be possible to create awareness regarding prevention from STDs and HIV/AIDS.
ii. There is a drastic need to train female Traditional Birth Attendants (TBAs) and Health Councilors regarding creating awareness among illiterate people of rural areas as well as urban localities of low-income people. In both the above mentioned areas TBAs can play a vital role as they are closely associated with the females and in our society it is very, very difficult to discuss about Reproductive Health issues, contraceptives, STDs and HIV/AIDS, particularly with the women and female youth.
iii. Through need assessment study of some of above-mentioned we derived some ideas, which we want to materialize by submitting a concept paper / project proposal to JHUCCP, if it does support. (as we got this idea from the " What's New" and your website)
iv. We want to establish a training/resource center for Reproductive Health issues, Contraceptives, STDs and HIV/AIDS, (not for commercial purposes) in Pakistan and in this regard we request other fellows in the listserv, to contribute in either way.
v. We wish our ideas, work, address and information to be available in the HCMN listserv.
Waiting for a positive response from you as soon as possible or at your earliest.
With best wishes and regards,
Yours truly,
Liaqat Masih
Projects Director

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Janneke Visser
Organization: Schorer Foundation
Address: P.O. Box 15830, Amsterdam 1001 NH, The Netherlands
TEL: + 31 20 5739444
Interests: General Health
The Schorer Foundation is the Dutch information center specializing in gay, lesbian, bisexual and transgender health issues. Our target groups are LBGT people themselves and health professionals. This includes doctors, social workers, clinics for STDs, etc. As an employee of the Schorer Foundation, I produce flyers and other materials aimed at LBGT people themselves and at health professionals.

Tasha Allen
Address: 300 S.W 42nd St , Loveland, CO 80537 USA
Interests: Student Health Education

Connie Page
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Organization: Butler School
Address: 90 White Street, Belmont, MA 02478 USA
Interests: General Health, Environment, Infectious Diseases, Nutritition
I am a school nurse in an elementary school in the New England area. I am looking for health materials to educate and interest children (especially posters). Thank you.

Dr.Ratan K. Srivastava
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TITLE: Associate Professor Community Medicine
Organization: Government Medical College
Address: P.O. Box 22, , Nanpura, Surat Gujarat 395001 India
TEL: (0261)2244713
Interests: Adolescent Health, Infectious Diseases, Sanitation/Hygiene
I am a teaching faculty member in a Medical College of India and I am also involved in projects of local benefit to the community and medical students. Recently participating in a large national multi-centric study in India where some 84 centres are participating in the country. I will certainly like to interact with this group to share as well as to learn many things.

Dr. Nadeem Tarique
- - - - - - - - - - - - - - - - - - - - - -Organization: Bhatties Environment for Population Health
Address: B-13 near (GPB school) Taj Colony, Nawabshah 674450 Pakistan
TEL: 92-0241-60086
Interests: Reproductive Health

Toni Sittoni
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Development Communications Advisor
Organization: Intermediate Technology Development Group
Address: P.O.Box 5777, Nairobi 00200 Kenya
TEL: 611351
Interests: I am a development communications consultant with an international NGO, working in nine countries, focusing on alleviating poverty through technological interventions.

Dhakshinamoorthi Srinivasan
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Title: Reproductive Endocrinology
Organization: NGM College
Address: 1,Chellam Theatre Road, Pollachi, Coimbatore, Tamil Nadu 642001 INDIA
TEL: 04259-222845
Interests: Reproductive Health
We are working in the field of reproductive endocrinology in the areas of the anti-neoplastic drug ciprofloxacin causing infertility in males. I kindly request you to send any study materials for the above this source. Thanking you.

Elefterios Sardeis
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Organization: Public Health Institute
Address: 110 Oud Diemerlaan, Diemen 1111 HL, The Netherlands
TEL: 0850
Interests: General Health

A K Zaman
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Chief Development Officer
Daffodil Multimedia
H-7, R-14 (New), Dhanmondi, Dhaka 1229 Bangladesh
Tel: 88-018242110
Interest: General Health

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PO Box 27035, Agodi, Ibadan, OYO STATE 234 NIGERIA
Tel: O28103548
Interests: Adolescent Health, General Health
We sensitize the society and promote reproductive health.

Jana K. Hofer
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Encargada de IEC
Food for the Hungry, Int'l
Casilla 879
Sucre, Bolivia
tel: 011-591-4-642-1883

In working with health communication and material development with FHI here in Bolivia, I am continually looking for new resources and networking options. I am very interested in the HCMN and would like to apply for membership. FHI has been working in health in Bolivia and many other countries around the world for many years. I believe that we have a vast amount of experience and I would enjoy contributing that other international organizations.

Albina Alimerko
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Address: Rr. Jul Variboba, Nr.4, Tirana Albania
phone:+355 4 340275
cell: + 970
My name is Albina ALIMERKO, I work as Information-Education and Communication Officer for John Snow Inc/ TASC project funded by USAID in Albania.
An acquaintance of mine suggested to me to visit your website and I learned about the HCMN forum. I am writing to you to request my participation in this forum as I view it as a good medium for me to know and learn from my colleagues contributions and -as the world is so relative- this will help me to better evaluate and improve my work for the health com in Albania. I modestly believe that I will also have interesting things to share. Looking forward to hearing from you, Albina

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Tel: (0272)235196
Interests: Reproductive Health, Adolescent Health, General Health, Environment, Infectious Diseases, Nutritition
ARPAN is an NGO working in the rural tribal area of Gujarat. Presently we are mainly working on the issues of intervention on HIV/AIDS with tribal sex workers. We also work on reproductive and child health in the slum area of Himatnagar town. We have established 150 self help groups of tribal women and also run referral system in tribal blocks.

Falana Martin-Mary
- - - - - - - - - - - - - - - - - - - - - - - -Title: Programmes Manager
Organisation Name: Kids & Teens Concerns
Address: P.O.Box 294, Ado-Ekiti, : Ekiti State Nigeria
Phone: +234-30-250787
I hope to contribute by sending pictures of some activities and materials developed with the community/target audience for any particular project.

Ayman Ramsis
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CARE International Egypt
2, Abul Maaly St. Mokbel, Beni Suef, Beni Suef Egypt
Tel: 46
Interests: General Health, Environment, Nutritition, Sanitation/Hygiene
The project that I supervise in Beni Suef is a multi-sectoral environmental health, health, literacy and income development project. The project focuses on building the capacity of NGOs to carry sustainable development responsibility at the community level after end of CARE Project.

Susan Dunigan
HIV Educator
Yale School of Nursing/CAETC
100 Church St. South, New Haven CT 06539 USA
Seeking low literacy (illustrations?) information for patients who will be receiving anti retroviral therapy. Patients are currently enrolled in a TB DOTS program. For example: We would like to provide a depiction of side effects associated with ARVs so that patients would have a better understanding of anticipated side effects. This understanding could affect adherence.

Noah Nash
i wil be grateful if I am considered a memeber so that i can help to improve the running of the union in aids campaigns.

Essay by Oyebisi B. Oluseyi -

Extension As An Effective Tool For Disseminating Health Information In Developing Countries: A Case Study Of Rural Communities In Africa

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Oyebisi B. Oluseyi, The Conservators, P.O. Box 29439 Secretariat, Ibadan, Oyo State Nigeria.

This paper is intended to set the general scene on investing in extension to disseminate health information by allowing some common assumptions and precepts to be discussed which might otherwise pass unstated. It is also a prologue to discussion on fundamental ways in which extension can be conceived. It neither defines in the narrow terminological sense nor reports on major new work that leads to some reformulation of basic issues; to define adequately the complex and varied ideas that are encompassed by the term extension as this relates to rural health development. It shows the importance of extension as a means of helping rural people to attain a satisfying healthy life.

The need for development in rural areas is one of the dominant issues of concern in today's world. It is only relatively recently however that the crucial importance of this has become widely recognized and accepted. Development involves the acceptance by people (rural and urban) of the possible often-new ways and means of developing their economies, which in the case of rural people, implies the development of their agriculture (defined in its broadest sense to include all uses of the land and many directly associated productive activities). But this is largely a means to a greater end. Development also embraces an active concern for improvement in the welfare and well being of all rural inhabitants. Rural inhabitants even in times free from crises such as famine or other disasters include a high proportion of the world's poorest people. It should therefore be noted that among the critical issues, therefore, are how to ensure that the basic needs of life are available to the rural populace and how to enable them gain at least adequate livelihood by means which are equitable and sustainable, to enjoy ways of living which are culturally appropriate and satisfying, and to ensure that these have a capacity for further improvement.

The rural class is more susceptible to disease attacks than the urban class due to unavailability of health information and facilities. A large variety of factors are involved which are both complex in themselves as well as in their interrelationships. These can be (and in recent years have been) analyzed and discussed from many disciplinary and ideological perspectives and at different theoretical and conceptual levels. Many forms of policy and policy implementation, which aim at ameliorating the health conditions of the rural class, have been devised and tried by authorities ranging form international agencies and national governments to local communities initiating their own activities. In practice however, whatever view is held and whatever kind of intervention or action is attempted, much of the development that is possible depends on the rural people themselves as communities, families and individuals. Given that their basic requirements for survival are satisfied (health status inclusive), they then need to be enabled to improve their living conditions in ways that are compatible with their own ideals, their culture, and environment.

The picture is grim; the statistics harrowing from one end of Africa to the other. State of health care is pathetic. Africa is racked by preventable diseases, long forgotten in the developed world. While other continents are moving forward, Africa wallows deeper in diseases. Consider the statistics. In 1990 malaria afflicted 250 million Africans; schistosomiasis, 141 million; lymphatic filatiasis, 28 million; river blindness 17 million; and leprosy as much as two million. In Nigeria, around 1 million children die every year as a result of diarrheal diseases. Another 200,000 children die or become permanently disabled as a result of measles, which strikes 3.6 million children every year. Next is malaria, which kills about 750,000 children each year with yellow fever taking around 2,000 victims. The latest report by WHO, given that 50% of Nigerians are suffering from malaria, estimates 20% infant mortality and 25 % maternal mortality. Malnutrition is also on the increase.

Beyond this are other chronic ailments. For example, one in every four Nigerian is a sickle cell trait carrier with the attendant and the growing problems of managing this life-long affliction, particularly of caring for the 60,000 new born suffering from sickle cell anemia. Three million Nigerians as of 1990/91 suffer from asthma according to the Asthma Research Council founded in 1986. Some 45 million sexually transmitted infections occur yearly in Africa, the most important of which are gonorrhea, chlamydia infection and syphilis. Africa continues to be the continent most affected by the immune deficiency virus (HIV), which often leads to the acquired immune deficiency syndrome (AIDS) disease. It is now accepted that more than half of the estimated global total of adults currently infected with HIV is close to six million, more than double the figure published in 1987. Once confined to the urban areas of the African countries, the disease is now spreading like wild fire in rural areas where the majority of the population lives. River blindness is also a major public health problem in 32 countries. By last count 17 million people are said to be suffering from this preventable diseases in Africa. A report by the World health Organization gives a succinct portrait of the situation. Sub-Saharan Africa has an estimated 25.3 million infected with AIDS and has become the epicenter of the epidemic. In this region alone 2.4 million died from the effects of AIDS in the year 2000, which is 80% of the worldwide total. Africa is vulnerable, most especially its rural population beleaguered by malnutrition, lack of clean water, chronic illness and immovable disease long forgotten in the developed world. Until the entire population of African countries has access to health services, including information, and to the most needed drugs and vaccines, Africa would continue to be a continent of misery. Dr Hiroshi Nakagima, Director General of WHO (Rtd) reflected this in his address to the 44th World Health Assembly. He said, "What is needed is a new paradigm for health, to enable WHO member countries to achieve the goal of health for all." In most parts of Africa, the aphorism "Health is wealth" is still a vain song.

One of the important (though often neglected) ways by which developing countries, most especially the rural people, can be asserted in this is through extension work. Extension as defined by the Advanced Learners Dictionary of Current English is the process of making something cover a wider area or larger group of people. Better still it could be defined as an informal out-of-school educational service for training and influencing the rural/urban community (families and individuals) to adopt improved practices. Extension is simply put as the art of taking relevant information needs to the doorstep of the people, hence bridging the gap between research and those who need it (targeted audience). Traditionally the activities of extension workers have been largely confined to agriculture, but now comparable approaches should be adopted increasingly to assist people with many other facets of their lives. In essence, extension work involves a collaborative relationship between the people and extension workers (and thereby the agencies to which they belong) in a deliberate process. Ideally the aim is to offer relevant, reliable, and usable information, advice and guidance to the people on acceptable technological, socio-economic and other ways of overcoming their problems or of realizing betterment in their lives.

I recently observed in a study I conducted on the evaluation of extension media in the diffusion of forestry innovations in Oyo State that, in reality, one or two problems commonly recur. First, the necessary information is not known and in this a matter which requires research or investigation. Secondly the strategies, methods, and relationships by which information and advice is conveyed to people are insufficient, or not sufficiently effective, to persuade them to its efficiency. Extension has become one of the main resources, which is being used in order to support and assist the development of other rural resources - the people, their natural environment, and their capacities.

The role and practice of extension, which now starts in an entirely fresh way, has thus evolved through historical development and adjustment to the varied and changing internal conditions in a country or area and to external pressures. Of special importance in this have been the values, norms, knowledge, ideas and aspirations of specific societies. Thus it is when the range of expectations which exist, in society about extension services and in extension organizations about their staff and of rural people about extension workers - is appreciated in the health sector and inculcated into health information dissemination that the rural class would be full armed with health tips. The provision of new technical information in itself enables rural people improve their productivity, health and other aspects of their lives. Health information should be properly originated from institutionalized scientific research. It should however be noted that health information's by this institutionalized scientific research well propagated through extension is necessarily superior to the knowledge already available to and used by rural people. Extension system take new information (health) developed at research (health) stations and pass them in a top-down fashion to the rural populace. The importance of taking health information to the doorstep of the rural populace cannot be overemphasized. Due to the lack of basic social and rural infrastructure it has become very difficult for the rural class to have access to health information; coupled with the fact that they are hard to reach, it is necessary therefore to question not only how extension can best serve the health sector but also how the health sector functions to generate the information and innovation which are the main goals, and the implicit role of extension and related services in disseminating them. One can ask by whom is health research determined and how was its program and results matched to the need of the rural class and their families? The answer put simply is that there has been a substantial erosion of the simple belief that the health research information services invariably and inevitably produce technically sound and economically profitable possibilities for change in health systems. Doubts have also grown that the incorporation of health information into national knowledge system, and their acceptance by rural people, are both retarded by inadequacies in the proper dissemination of information. The wide spread of preventable diseases across Africa in recent times may not be unconnected with the fact that the necessary precautions to be taken are not well disseminated, thereby not actually reaching targeted audience and achieving goals.

Both the concept and practice of extension have increasingly been applied in areas of rural life outside the strict confines of agriculture with positive results. Institutionally, this development has sometimes taken place within agricultural extension agencies under the name, for example, of home economics. But the principles and methods of extension work are now being deployed in diverse institutions, both within government departments and in non-governmental organizations. This should cause no surprise. Examples of the value already noted in agriculture are sadly common in health and nutrition problems, which especially affect the old, young and disadvantaged people in the society. Relatively simple preventive and curative measures are sometimes available, though unknown and unused until a health worker or nutritionist is deployed among the communities concerned. Extension services, either general or more specialized, exist in many countries to provide information, advice and education relating to many facets of rural life and its improvement, and in some cases extend to small businesses and other forms of income earning activities open to the rural population from non farming sources. Extension work is based mainly on a managed activity (which could be agriculture, health information, etc.) arising from policy decisions with an emphasis on planning and deciding how to implement and operate the work aided by assessing and evaluating the outcomes, leading to modified, adapted and new forms of work. The resulting patterns of extension, it should be noted, vary considerably within and between countries. We have now encountered some of the often-unstated assumptions alluded to at the beginning of this paper. It should well be noted that the provision of new technical information in itself enables rural people to improve their productivity health or other aspects of their lives. In a wider concept the role of extension is far more responsible than the communication of knowledge. Its fuller task is to comprehend the social, economic and technical environment of the producers, which may be classified under the aim with which extension work is to achieve is it in terms of agricultural or health development and their objectives, resources, existing methods and difficulties to represent their needs to the administrative apparatus as well as to the rest of the knowledge system; and to help convey the products of that system and options derived from them to producers. The extension worker then becomes an active participant, close to the frontline in the process of change in the rural space.

In order to design realistic health policies and dissemination of useful health information's, policy makers and people in the health sector (professionals) need a good understanding of the situation of the rural class. Good extension workers have much of this information, but not all policy makers and professionals in the health sector are interested in learning from them.

When you think of extension programs on health information for the rural community, what comes to mind? A group of smiling women is gathering around a health worker demonstrating how to breastfeed? A group of small boys and girls, men and women leaning about the dreaded AIDS disease? All who have worked with the rural population in the dissemination of health information would at least have one favourite image that instantly springs from memory when asked that question. But as we take a more searching look back, at the end of the rural people's decade, can we smile with satisfaction of the progress made towards improving the health of rural people? In spite of occasional evidence of some success, the plight of most rural men and women is not improved over what it was years ago. Why have so many well-intentioned rural development programs made so little lasting impact on the rural community they were supposed to benefit? One of the main reasons for failure, or at best limited success, is that the rural community and their real health needs have seldom been actively taken into account when projects are planned. What then can I now suggest from my experience as an extensionist as guidelines to follow when planning extension programmes on health information appropriate to rural communities in order to ensure their usefulness and relevance to those they are meant to serve.

(1) The planning of extension programmes must be based on an accurate and appropriate data, which reflect the true status of the information being passed across, and health needs.

(2) Health sector development must be viewed as part of the development of the whole community and must be provided with adequate resources at all levels.

(3) The rural community requires information to prepare them for their involvement in development and relevant information needs must be adequately supplied to aid development.

(4) Educational and extension activities for dissemination of health information must meet their needs for increased managerial, organizational, and entrepreneurial and decision making skills along with technical skills related to good health.

(5) Health extension programmes must recognize and address health, nutrition and family planning issues in each particular country or community.

(6) Planning for extension programmes to disseminate health information should include strategies for increasing integration and collaboration within self-help efforts such as primary health care, community health education.

(7) Health extension programmes must reach the 'unreachables' and those most deprived of access to education and services through new media technologies as well as traditional media.

It is imperative for those in the health sector to see arming the rural populace with health tips on disease prevention, symptoms etc. as an effective way of helping the "rural place" out of the doldrums of disease attack. Extension agents are familiar with the rural populace, they know so much about them and they would serve as a better source of rural data collection and more importantly as an effective tool for disseminating health information to the rural community.

Since the field of extension is all about communication from a top-down fashion to its audience the skills and methods to be used in disseminating this information is the "professionalism" in extension.

However, it is relevant to say that in the areas where extension has been used as a means of information dissemination particularly agriculture much achievement have been made with all credits given to extension.

In discussing the relationship between health information and extension work, this paper has been able to offer few answers to the issues raised. But, it is important to bring the issues into open debate as a basis for considering the validity and value of extension activities in the dissemination of health information in developing countries.

In preparing this paper I have profited from comments by OYEBISI ADEKEMI on an earlier draft.


Peggy D'Adamo

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