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Vol. 2, No. 3

ugandahealthcom@yahoo.com

April 5, 2009

Radio Health Journalism: Could It Be Better? Reporters Visit Mpigi to Observe Village Health Teams

More Ugandans get news from radio than from newspapers and television combined, making radio potentially one of the country’s most powerful tools for improving health. Unfortunately, it underutilised. UHCA convened a group of radio journalists and two scholars to look at the forces shaping radio health coverage. Some conclusions: better pay, improved working conditions and increased corporate social responsibility would lead to higher quality. Page 2

Other News: Health economics: In setting budget priorities, policy makers should consider not just the burden of various diseases, but the costeffectiveness of strategies to address them. Such analysis leads to some surprising results. Page 3

During a recent tour organized by the World Health Organization and UHCA, NTV reporter Irene Namyalo watches as a Village Health Team member pays a house call.

Before we cast stones: A group of communications professionals learned an important lesson about stigmatisation at a recent workshop in Gulu: Even those who consider ourselves enlightened can hold prejudices without knowing it. Page 5

New Content Manager: Vincent Akumu is joining UHCA as our content manager. A 2003 graduate of Makerere University with a bachelor’s degree in Library and Information Sciences, Vincent will help design and manage a website for UHCA. He also will play a big role in putting out this newsletter and in tracking down background resources related to our workshops and other health issues. Welcome Vincent!

A new fellowship opportunity, plus a new malaria resource:

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Covering Health for Radio: An Uphill Struggle Mass communication clearly could be an important tool for improving public health, but serious barriers keep it from realising its full potential. That was the conclusion that emerged from a focus group UHCA organised for a group of radio journalists on 2nd March. The reporters, who represented Capital Fm, Radio One & Two, Radio West, Vision Voice, Sanyu Fm, Mega Fm and Uganda Radio Network, were joined by Dr. Freddie Ssengooba, a lecturer from the Makerere University School of Public Health and Harriet Sebaana, a graduate student at the university’s Department of Mass Communication. They painted a bleak picture. Dr. Ssengooba complained that journalists rarely follow important stories up. Change, he argued, only comes when messages are delivered repeatedly, but Ugandan journalists rarely follow-up their stories. “I would love to see a sustained series of stories that generate debate,” Ssengooba said. “Radio being the biggest media in the country would mean you are doing the greater part of the population good.” Journalists cited big barriers to deeper coverage. News departments don’t have health beats, so health only becomes a priority when crises arise, like the Ebola outbreak in 2007. Reporters rarely have enough time to prepare health stories. And when stations devote just five minutes to news bulletins, health stories, which often come at the end of bulletins, often get cut before they are aired.

At 1,000 UgShs a story, how much depth could you afford? The journalists also cited poor remuneration and a heavy workload. In some cases, reporters are paid just Ushs 1,000 for a story. Some produce as many as five stories a day, making in-depth reporting a luxury that few can afford. In fact, many radio journalists avoid health reporting because it requires specialised knowledge and more work than some other kinds of stories. All these problems undermine the quality of health reporting. One result is a deep distrust between journalists and health professionals. The solutions? The journalists said establishing health beats would help. So would sensitising media owners to see high-quality health reporting as part of their corporate social responsibility. Some called for more training, especially in sourcing stories, using the Internet as a research tool, and packaging radio stories. Others called for an awards programme to encourage establishment of health beats. Nobody seemed to have the perfect answer, but we’re working on it. Stay tuned.

Radio Journalism Training Online For some do-it-yourself training in radio journalism, try News University. Among its wide array of online courses is one on the audio reporting process that covers the basics of audio reporting and editing. It stresses finding courses well suited for audio, how to elicit strong interview clips, and how to gather interesting sound. You must register to enroll, but it is free. The course requires Flash 8 or higher, but it can be downloaded free. http://www.newsuniversity.org/courses/course_detail.aspx?id=nwsu_soundStory07 The BBC offers online training modules that originally were developed for its own staff. Some of the topics offered include interviewing for radio, microphones and sound, and Cool Edit Pro (an editing software for radio). www.bbctraining.com/onlineCourses.asp Also, try Newscript.com, an online tutorial on the craft of radio journalism, with particular emphasis on script writing. The site includes some audio samples. www.newscript.com

Uganda Health Reporter

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Cost-Effectiveness: A Key to Better Medical Care Just about everyone knows that Uganda has one of the highest maternal mortality rates in the world. So we need to invest more in delivery services, doctors and hospital facilities for mothers. Right? That may seem like the obvious solution, but it actually may not be the best approach. If you take a closer look at the problem, it turns out that some 70% of the pregnant women who are dying are teenagers. We actually may do more to bring down the deplorably high maternal mortality rate by providing adolescents better family planning and other health services. That is the view of Dr. Peter Okwero, senior health specialist for the World Bank, who spoke at UHCA’s January 28 workshop on primary health care. Dr. Okwero brought an economist’s perspective to decision-making about health policy. When setting health budget priorities, he said, policy-makers need to consider not just the burden of disease in the country, but the costeffectiveness of strategies to address them – that is, how much suffering we can reduce for each shilling spent on various health care programmes. To do that, we need a common unit of measurement – something that will enable us to compare a shilling spent to treat cancer with one used to combat malaria, for instance. The “disability adjusted life year” (DALY) does just that: It gauges how many years of disability-free life result from different health-care measures. Cost-effectiveness can then be measured by comparing the savings in DALYs to the cost of different treatments.

Poor countries like Uganda don’t have to wait for economic growth before they can achieve big gains in health The results show a huge difference in the cost effectiveness of various health strategies. Dr. Okwero showed, for instance, that treating latent tuberculosis (cases where a person has contracted tuberculosis but hasn’t yet developed symptoms) costs US$9,450-16,867 per DALY saved, compared to just US$55-82 to vaccinate a child against tuberculosis. Similarly, coronary artery bypass surgery to treat heart disease costs US$37,000 per DALY saved – much more than the per capita income of most countries. But a polypill, which combines several medications designed to prevent heart disease in the first place, costs just $409. Disease Control Priorities The World Bank reports on the cost effectiveness of countless treatments in a book called “Disease Control Priorities in Developing Countries.” The book and reader-friendly summaries can be found at http://www.dcp2.org/main/Home.html. The book shows that poor countries like Uganda don’t have to wait for economic growth to achieve big gains in health. Some of the “best buys” in health care – policies that achieve the biggest gain in DALYs for a given level of expenditure – are inexpensive and simple (see box, next page). Big health gains gain be achieved, for instance, through routine childhood vaccinations, and child mortality could be cut significantly simply by training mothers and birth attendants to keep newborn babies warm and clean. Of course, cost-effectiveness probably cannot – and almost certainly should not – be the only basis for choosing how to invest health-care funds. Fairness also needs to be considered. Because people who live in cities are easier to reach, it generally is more cost effective to treat them than widely-scattered people in rural areas. But few people would argue that rural people should be denied services as a result (although in practice, they actually do receive far fewer services, and the higher cost of reaching them is a big part of the reason).

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Economics (continued) There also are practical considerations. Using DALYs to estimate cost effectiveness only works if countries have reliable data. And even an accurate determination of the most cost-effective health strategies may falter if countries lack the capacity to follow them. Still, Dr. Okwero argued, Uganda needs to start thinking more about such issues. At the moment, he said, there is too much focus on “interventions,” and too little on “strategies”. His presentation offers lessons not only for policy-makers, but for journalists too. When we write about government programmes, do we ask whether they are cost-effective? Do we ask officials to explain why they choose one intervention over another? How closely do we track the government’s decisions about setting priorities in health spending? And when non-government organisations offer us tours to demonstrate their good works, do we ask about the cost of their programmes, or how feasible it would be to bring them to scale? If you would like to see a copy of Dr. Okwero’s PowerPoint presentation or one by Sarah Kiguli, head of the Department of Pediatrics and Child Health, Makerere University Faculty of Medicine, who explored whether Uganda and its donors are making a sufficient commitment to primary care, please contact us at ugandahealthcom@yahoo.com.

The “Best Buys” in Health Care The World Bank’s Disease Control Priorities Project (DCPP) has identified the following 10 health interventions as the most cost effective (meaning they produce the greatest reduction in death and disability for the amount spent on them): 1. Vaccinate children against tuberculosis, diphtheria, whooping cough, tetanus, polio and measles. 2. Monitor children’s health to prevent or treat pneumonia, diarrhea and malaria. 3. Tax tobacco products to increase consumer costs by at least one third. 4. Prevent the spread of HIV through coordinated approaches, including condom use, treating other sexually transmitted infections, providing antiretroviral medications to pregnant women, and offering voluntary HIV counseling and testing. 5. Give children and pregnant women essential nutrients, including Vitamin A, iron and iodine to prevent maternal anemia, infant deaths and long term health problems. 6. Provide insecticide-treated bed nets, household spraying of insecticides and preventive treatment for pregnant women to reduce malaria in areas where it is endemic. 7. Enforce traffic regulations and install speed bumps at dangerous intersections. 8. Treat tuberculosis patients with short-course chemotherapy. 9. Teach mothers and train birth attendants to keep newborns warm and clean. 10. Promote use of aspirin and other inexpensive drugs to prevent and treat heart attack and stroke.

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Small Test, Big Revelations Concerning Stigma By Lydia Namubiru Stigma against people with HIV/AIDS is far from vanishing from Uganda. A 30-minute exercise at a media workshop in Gulu proved that even among supposedly enlightened people like journalists stigma still prevails. The workshop, sponsored by UHCA and the Health Communication Partnership, brought together 24 journalists and health advocates. One topic was stigma and discrimination against HIV-positive people. Participants expected to gather information that they could use later to highlight the issue. But Venansio Ahabwe from the Health Communication Partnership had another idea. He gave every participant a sheet of paper with drawings depicting a pregnant woman, a young boy in tattered clothes, a woman in a mini dress, a man donning a suit, a teenage girl in school uniform, a soldier, a man carrying a hoe and a mother with a baby. He then asked the journalists to cut out each picture and tape them on a chart separating the “innocent” from the “guilty.” The pregnant woman, the young boy, the mother and the farmer were acquitted unanimously. But others were condemned. “I put this woman on the guilty side because her dressing is provocative,” one journalist volunteered, explaining that only prostitutes dress like her and they are the ones who spread HIV. Another noted: “Soldiers rape and there is always a lot of HIV in the places where soldiers are. That is why this soldier is guilty.” A health specialist spoke angrily about the man in the suit. “These rich men are the ones who give young girls money and infect them with HIV,” she fumed to general agreement. Then she turned her ire to the school girl. “She is the one who is going to go to the rich man,” she said.

Most people who stigmatise don’t even know they do it. Others came out to defend the ones they consider innocent. “This young boy is not going to go looking for a woman. His only concern is where to sleep and eat. He is innocent,” defended one advocate. “The pregnant woman is innocent,” argued another. “Women give HIV to their newborns but they don’t intend to.” Some in the room agreed with her, but others didn’t. “Some sleep with men and get AIDS even when they are already pregnant,” one participant said. With that some of those who had voted her innocent moved her to the guilty side. There was one dissenting voice. “Look we cannot blame anyone. HIV is got through sex and it is a natural act. We should have sympathy for any one who gets it,” says Obote Vien of Radio Wa. “But not for the rich man,” the health worker shot back. Finally, Ahabwe cut in to settle the matter. “See what we have just done here? Whenever you blame someone for HIV, you are stigmatising them. The fact is that most people who stigmatise do not even know they do it. They do it unconsciously,” he lamented. At the final count, 86% of the people in the group had shown that they unconsciously or otherwise stigmatise people with HIV. Ahabwe’s point was made. At the very least, he demonstrated stigma is widespread – even among people thought to be well sensitised to the issue. Lydia Namubiru. a reporter for Saturday Vision, is the editor of this newsletter.

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Other Health Communication News HIV/AIDS Training Opportunity: The Journalist to Journalist Project of the National Press Foundation will conduct a four-day training programme on HIV/AIDS in Cape Town, South Africa 15-18 July. The training will be immediately prior to IAS 2009, the 5th IAS Conference on Pathogenesis, Treatment and Prevention, which will run 19-22 July. This biennial conference brings together HIV scientists, policy-makers and global stakeholders in HIV/AIDS. Fellowships that include air travel, lodging, per diem, and most meals are open to journalists who have covered HIV/AIDS or health for five or more years. The application deadline is 20 April 2009. Fifty fellowships will be awarded to qualified print, broadcast, and online journalists. Applications are encouraged from reporters with experience covering the social, economic and larger societal impact of HIV/AIDS, as well as the science and medicine. Applicants must have a clear ability to speak and read English. The fellowships include air travel to and from Cape Town, lodging, per diem and most meals during the training, and lodging and per diem during the conference. Applicants must submit: ! ! ! ! !

Application form Cover letter explaining why you should attend, with emphasis on AIDS issues particular to your geographic location. Brief biography (for sharing with other fellows if you are selected) Letter of support from a supervisor (if you are an independent journalist you may include a letter from a pervious supervisor. Two samples of journalistic work (clippings, CD, DVD, VHS, audio tape, digital sound file). If you are an editor, send samples of work you have edited.

Applications will not be returned. E-mail application materials as attachments to programs@nationalpress.org or mail to CAPE TOWN TRAINING 2009, National Press Foundation, 1211 Connecticut Avenue NW, Suite 310, Washington, DC 20036. E-mail is preferred. Applications must be received by Monday, April 20. The National Press Foundation, a U.S.-based, non-profit independent journalism education organisation, is organiing the training in collaboration with the IAS 2009. Funding is provided by the Bill and Melinda Gates Foundation and others. For more information, contact Ms. Maha Masud at maha@nationalpress.org.

Malaria Map: A multinational research team funded by the Wellcome Trust has developed a new global map that indicates the risks of contracting malaria in different parts of the world. The map shows that more than 70% of the 2.4 billion people at some risk of infection live in areas where technical obstacles to malaria control are relatively small, but that almost all populations at medium and high levels of risk live in sub-Saharan Africa. A paper on the project is available at http://medicine.plosjournals.org/perlserv/?request=getdocument&doi=10.1371/journal.pmed.1000048 . Maps can be downloaded from www.map.ox.ac.uk/map_download.html For information, contact: Juliette Mutheu, Public Relations Officer, Malaria Atlas Project, KEMRI-Wellcome Trust Programme, Nairobi T: +254 (0)20 2720163; 2715160 E-mail: jmutheu@nairobi.kemri-wellcome.org

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Uganda Health Reporter Newsletter: Vol. 2 No.3  

This issue of the Uganda Health Reporter Newsletter focuses on how to make radio a more-effective tool for improving health, looking more cl...

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