Health Strategy and approach

Transcription

1 Health Strategy and approach This paper outlines BBC Media Action s approach to Health and our strategy for achieving impact in this area. This paper builds on the significant advances in our Health practice, research and policy initiatives since the last approaches and strategy paper in

2 1. BACKGROUND GLOBAL HEALTH, MEDIA AND COMMUNICATION Globally people s health is improving and there have been large gains in life expectancy over the past twenty years. The Millennium Development Goals (MDGs) galvanised action around some of the key health issues affecting people in low income countries with some impressive results, especially for children under five years old, even though ultimately the goals were not met. 1, 2 At the same time, there is a growing body of compelling evidence for the role media and communication can play in improving health i and wellbeing. 3 We know more about what works than at any other time. 4 Health communication has become a unique, specialised field underpinned by a range of social science disciplines, such as behavioural economics, anthropology and sociology. Combined with the proliferation of media and communication technologies there are tremendous opportunities for harnessing media and communication for health and global development. Going forward, the Sustainable Development Goals (SDGs) aim to build on the momentum around global health improvements, with a broader focus than the MDGs. Health is seen in its broadest sense as a state of physical, mental and social wellbeing. There are 13 targets for achieving the overall health goal of ensuring healthy lives and wellbeing for all, at all ages. These reflect the continuing shift in the global burden of disease and demographic change. There are targets around non-communicable diseases (NCDs) ii and a stronger focus on some of the risk factors for ill-health such as weak health systems, malnutrition (both under and over nutrition) air, water and soil pollution, as well as poor water, sanitation and hygiene. There is also strong emphasis on leaving no one behind and equity. There is a full list of the targets in an appendix at the back of this paper. Regions and issues The focus of BBC Media Action s work to improve people s health will be guided, though not dictated, by the SDGs. It will also be guided by the specific priorities of the places where we work, alongside our organisational experience and knowledge of where media and communication can make most difference. In Asia and sub-saharan Africa, the regions where BBC Media Action s health work is concentrated currently, the shift away from a high burden of communicable diseases iii towards a greater burden from NCDs and chronic conditions is well underway. Overall, Asia is further advanced in this shift than sub-saharan Africa. That said, overall the balance is still tipped towards the traditional causes of ill-health - child and maternal conditions, communicable diseases, poor water and sanitation. Therefore this is where BBC Media Action s work will focus, though also reflecting the shift towards a higher burden from NCDs and chronic conditions, as the opportunity and need arises. i The World Health Organization describes health in broader terms than simply the absence of disease, as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. ii NCDs cannot be passed on person to person. They include diseases such as cancers, cardiovascular diseases, diabetes and chronic respiratory diseases. They generally last long and progress slowly and are sometimes called chronic conditions. iii Communicable diseases are also called infectious diseases and are caused by micro-organisms such as bacteria, viruses and fungi that are passed on either directly or indirectly from person to person. They include malaria, HIV, tuberculosis, diarrhoeal diseases, pneumonia, measles, rubella, polio, ebola and so forth. 2

3 In the Middle East and North Africa the health profiles of many countries are now similar to western countries, with the leading causes of death and disability down to NCDs and chronic conditions in adults. But in the lower-income countries, such as Iraq and Yemen, there is still a considerable burden from communicable, nutritional, maternal and newborn conditions. 5 Meanwhile in conflict-affected countries both in this region and elsewhere where access to healthcare highly disrupted and living conditions are falling people s health is deteriorating. Internally displaced people and refugees have specific health needs over and above those of general populations. For instance, respiratory problems caused by very crowded living conditions, gastrointestinal problems because of poor water and sanitation, as well as a range of mental health disorders and injuries from different forms of violence, including sexual. Interventions in these areas will link closely to work under BBC Media Action s other themes, particularly Resilience and Humanitarian Response, since food, shelter, clean water and sanitation are key to improving the health of displaced people. 6 A final area of focus for BBC Media Action s work will be around preparing and responding to the outbreak of diseases that threaten to spread rapidly across large populations. With more people travelling, urban centres growing fast and rapid population increases in many countries, there is an increasing threat from epidemics and pandemics. 7 In recent years, avian influenza, Ebola, Zika, yellow fever, and several respiratory syndromes, such as SARS and MERS, have all threatened global health. 8 Media and communication are integral to preventing this. Again, interventions will link closely to our humanitarian response work, drawing on what we have learnt from Lifeline programming. While BBC Media Action s work will be guided by the specific health priorities of the countries where it works, it is also influenced by their current demographic profiles. All our regions currently have large young populations (under 15), though the Middle East and Asia are starting to experience a demographic transition with lower fertility rates, meaning less births going forward. Approximately 40% of the population is under 15 in Africa and around 30% under 15 in Asia and the Middle East. 9 Africa is also still experiencing a rapid increase in its youth population (15 to 24 year olds). 10 Overall, this means there are large numbers of children, adolescents and young people where we work. As a result we will have a particular focus around sexual, reproductive, maternal, newborn, child and adolescent health (RMNCAH) and wellbeing. 2. Strategy Our goal and how we will reach it BBC Media Action uses media and communication to inspire and empower people to think, feel and act more positively in relation to their health. Our work is powered by creativity and we constantly seek innovative responses to complex health issues. Our long-term goal is to improve the health and wellbeing of the poorer and more marginalised populations where we work. We want people to live longer, healthier and more prosperous lives. 3

4 We do this by supporting the development of healthier behaviours, supportive social norms and stronger health systems around specific focus areas of health. A. Focus areas We will focus on the issues that most affect the health and wellbeing of the poorer and more marginalised people where we work and on issues that we know we can achieve results. These are: Maternal, newborn, child and adolescent health Sexual and reproductive health, with a focus on adolescents Water, hygiene and sanitation (WASH) Communicable diseases, such as HIV, TB, polio and malaria Malnutrition our work will address all forms of malnutrition to prevent stunting and underweight, as well as overweight and NCDs, such as diabetes Non-communicable diseases and chronic conditions, such as heart and lung disease, diabetes and their relevant risk factors in our countries. In addition to malnutrition, these risk factors include smoking, indoor air pollution and lack of physical exercise Disease outbreaks that threaten significant numbers of people Health systems strengthening, with a focus on health communication and accountability iv Wellbeing and mental health - Within this framework, we will view health as more than about death, physical disease or illness and include mental health and emotional wellbeing where appropriate. While we acknowledge that the concept of wellbeing is broad and ill-defined, encompassing notions of quality of life, how we re feeling about our lives, our economic and social situations and so forth, for the purposes of our health work, we will contribute to wellbeing by addressing relevant mental and emotional health issues. In practice, this could mean projects that aim to improve maternal health include addressing postpartum depression, or discussion around emotional changes women can experience around times of pregnancy and child birth. Projects focusing on adolescent sexual and reproductive health would include the emotional aspects of this age, ranging from mood swings to physical symptoms of mental ill-health, such as self-harm or eating disorders. Finally, conscious efforts will be made to address the stigma and discrimination associated with many diseases and conditions, including mental illness, that have such negative effects on people s health and wellbeing. We will encourage a positive portrayal of people affected by different conditions across all our work, deepening our audience s understanding. Gender the norms, roles and responsibilities assigned by society on the basis of whether a person is male or female or other - strongly underpins people s health and as such will be taken into account in all our projects. For instance, in countries where we work, boys and men may be encouraged into taking risks or behaving in a way that effects their health, such as smoking and excessive alcohol consumption, or suppressing emotions and feelings. Meanwhile, in countries where iv The concept of accountability in health can appear straight-forward, incorporating ideas related to checks on power, increased oversight and improved responsiveness to the needs of healthcare users. However, in practice the term is often poorly understood and defined. The current literature - and BBC Media Action s work - draws on definitions of accountability that incorporate concepts of both answerability and sanctions and answerability and enforcement. 4

5 a woman has much less power than men, her ability to make decisions around her own health might be limited, including about whether to see a health professional, or even when and how to have sex. All our health projects will carry out gender analysis to inform their strategies and where relevant, specific gender-related issues, such as violence against women, will be addressed. B. Cross-thematic issues As well as health, BBC Media Action uses media and communication to addresses governance and rights, resilience and humanitarian response. Resilience and Humanitarian response People s resilience and health are intimately connected. People unable to earn a living suffer worse health outcomes than their richer counterparts. Food and water security have a direct impact on people s nutritional status as well as the levels of diarrhoea and other diseases in a community. It s a vicious cycle. People who have poor health are often more vulnerable to economic insecurity, their ability to thrive impaired, with long term effects on their families. Therefore, where appropriate, we will consider health and resilience together. For instance, actively working to improve people s nutritional status when planning an agricultural intervention that is trying to improve food and economic security. Or actively encouraging the use of clean water for drinking, cooking and family hygiene practices in addition to agriculture when addressing water security. And of course, people s health needs are a major source of concern following a humanitarian disaster, such as an earthquake. Governance and rights Governance and rights also underpin people s health. By working to improve people s health, we are working towards making a fundamental right a reality. v A part of ensuring we improve the health of the poorest in societies is around improving their access to health services and building stronger health systems, which have strong accountability components. Media has a role in ensuring that public resources are spent appropriately within the health system and they can support the management and delivery of health services to higher standards. Media can provide a space for ordinary people to participate in building a health system that meets their needs. Crucially, media supports governance by ensuring those in power in relation to health services are answerable for their actions. C. Key audiences Our work in health seeks to engage the poorest and more marginalised where we work because that is where need is greatest. Within this cohort, there are key audiences we will aim to include, understand and serve better. Women and girls we are committed to supporting the empowerment of women and girls to have greater control over their health. Women and girls have very specific health needs that relate to their potential role as child-bearers, yet are often much harder to reach and engage because of gender inequality. The low standing of women and girls in many places where we work manifests itself in high rates of maternal deaths, high levels of violence, that can include female genital mutilation, high rates of malnutrition among adolescent girls and so forth. We will work creatively to engage both women and girls and men and boys v Building on the right to health and well -being outlined in the 1948 Universal Declaration of Human Rights, the right to the highest attainable standard of health for every human being is enshrined in the constitution of the World Health Organization. 5

6 within our projects to overcome barriers that effect their health and wellbeing, including transforming gender relations. Young people as outlined, in most places where we work young people make up large proportions of the population. We will build on our existing work to address their needs and give them a voice and space. Harder to reach we will make particular efforts to engage those who are harder to reach. This may be because of their poverty, gender, or sexuality, age, disability and location. These groups might be isolated because they are rural or nomadic, elderly or female. Or they could be populations living in informal settlements in rapidly expanding cities or in countries affected by conflict. Projects will conduct detailed audience analyses to support the development of clearly defined strategies for engaging these key audiences. We will use a broad range of research tools and techniques to find out more about what influences their health, behaviours and norms as well as how best to use media and communication to influence change positively. In addition we will make efforts to include those affected by particular conditions and issues, and encourage positive portrayal, in recognition that they may hold the key to potential solutions. For instance, projects addressing HIV will include those affected by the virus, while projects considering mental health will include those who have experienced mental illness. D. Aims BBC Media Action has a strong track record of delivering complex health projects that achieve their aims. We know more about what works than at any other time and will harness this knowledge, and more, to shape our work in coming years to improve people s health and wellbeing. This is reflected in our aims below. We will also work to strengthen our position in the field of global health communication so we really are practice and thought-leaders. Between 2017 and 2020, BBC Media Action health work will have the following specific aims: Engage with the more marginalised and socially excluded of societies to support everyone s right to health. Mainstream gender throughout our health work and contribute to gender equality. For example, ensure that women and girls have equal access, representation and participation in health projects and address gender norms that negatively affect their health. Improve our ability to apply relevant theoretical frameworks (for instance, social norms theory and behavioural economics and other emerging frameworks) to project design, delivery and evaluation. Use the most appropriate media and communication platforms and formats for our audiences in combination with each other. Increasingly, this can be expected to be digital and mobile phone-based and we will seek to innovate in this space. Make community-based discussion and engagement a central part of projects, developing partnerships where necessary to do this at scale. This could be face to face and/or digital. 6

7 Contribute to the global evidence base for health communication with robust impact 6. evaluations for more of our projects and by identifying and filling specific gaps in the evidence base. We will also endeavour to get more of our work published in relevant journals and media outlets. 7. Consider and contribute to health governance and accountability through our projects in relation to the supply and functioning of health services. 8. Improve BBC Media Action s and our partners ability to respond to disease outbreak through preparedness work Build greater local ownership and leadership of health communication work through capacity-development and policy work with partners. Much of our work will be delivered through partnerships with a raft of media, governmental and non-governmental organisations with existing links to the grassroots and hard to reach audiences. Ensure teams and partners are fully equipped to fulfill these aims, in part through the provision of high-quality, in-depth training around: - Health communication, using Pulse toolkit - Sensitive issues, such as attitudes around gender, sexuality and violence. 3. Our approach BBC Media Action puts audiences at the heart of its work. We immerse and engage ourselves in their worlds through different types of qualitative and quantitative research. What we learn is then translated into engaging, relevant communication activities to support the development of the healthier behaviours, supportive social norms and stronger health systems. A. Areas of influence We understand that people s health is influenced and determined by multiple overlapping factors, not just biology. These include where a person is born and lives, the wealth of their family, their education, gender and sexuality, their occupation and the environment, as well as individual, community and societal beliefs and norms. Social and political systems also have an influence, along with health systems, policies and services. 11 Our work therefore engages with these difference areas of influence: Populations individuals, families and communities Practitioners people, such as health workers, producers and creatives, who through their work can individually, or collectively, positively influence the health of populations. Organisations the entities that influence our audience s lives. This includes media, government agencies, non-governmental organisations, private 7

8 sector health providers and academic institutions. Systems our work is designed to bring about lasting change in the formal and informal structures that influence people s lives. This could include health systems, policy and legal environments, as well as cultural and social systems. Influence might be direct, or indirect. B. Partnerships We work in close partnership with stakeholders to mutually increase the reach, impact and sustainability of our work. Partners include media organisations, local and national government, as well as local, national and international development agencies, including UN agencies and the private sector. Many, but not all, of our partnerships are underpinned by different forms of capacitystrengthening. C. Driving change Numerous theories have been developed over the years around why people do what they do and therefore what might drive change to improve health. As described, people s health is influenced by multiple factors and there is no silver bullet. Social and behaviour change is complex and humans are often far from rational. Our activities are not based solely on the delivery of a set of health messages focussed on the individual. Our approach, based on evidence from some of our recent work, recognises the need to go beyond informational messaging to foster discussion, increase understanding of issues, foster positive attitudes towards new behaviours and influence beyond the individual. We use media and communication activities to influence some of these multiple factors that can improve health. We have summarized these into a set of 10 key drivers of change, which have an effect on our four areas of influence. Not every project will seek to influence every driver of change. Each project develops a bespoke theory of how change might happen appropriate for that particular context, with formative research used to highlight which is likely to be the most significant for a particular behaviour or issue. BBC Media Action has a toolkit, the Pulse, to help teams with the design and implementation of health communication projects, translating this approach into reality. 8

9 Our approach to health Inspiring activities Content and tools TV, radio and online dramas, factual shows, PSAs Social media and mhealth Posters, billboards Outreach Discussion groups Roadshows Screenings communication Capacity- Influence drivers of change across different areas Populations, practitioners, organisations and systems Knowledge and understanding Attitudes and beliefs Efficacy Skills Observation Motivation Norms Social support Discussion and dialogue Participation Healthier behaviours Supportive social norms Stronger health systems Improved health and wellbeing strengthening Media NGO and government Formative and pre-testing Monitoring and assessing Evaluation RESEARCH 9

10 Drivers of change Knowledge and understanding: Media and communication have an important part to play in building people s knowledge and understanding around health-related issues, including rights, with accessible, accurate and relevant information playing a key role. Information also influences social norms and culture by increasing awareness about what other people are doing. Attitudes and beliefs: How people think or feel about a practice, behaviour or issue can have a profound effect on what they do or do not do. For instance, beliefs might focus around the causes of disease, which in turn influences treatment-seeking. Attitudes and beliefs may also relate to a person s risk of perception which in turn affects what they do. Social norms are what an individual believes that others in their group (this could be family, community, society etc.) are doing, combined with the pressure they feel to go along with the opinions and actions of others. Social norms, such as marrying girls off young, or violence against women and children, or norms relating to how men should behave can have highly damaging consequences for health and wellbeing, while those who do not conform may face serious sanction. Efficacy: This relates to the belief an individual or groups of people have about their ability to do something, given available resources and potential obstacles. It includes concepts of empowerment, confidence and agency. Levels of efficacy are also thought to be a predictor of how motivated a person is to do something. Motivation: is our drive and determination to do something. We are far more likely to be motivated to do something if that behaviour seems easy, as well as desirable and attractive. Skills: A person s likelihood of adopting a new behaviour can depend on whether they have the skills to do so. This includes both the practical skills (for instance, being able to use a condom correctly), but also what might be called psychosocial competencies, such as decision-making and problem-solving; critical and creative thinking; communication and interpersonal relationships. Observation and sparking innovation: People learn how to behave, in part, by observing the actions of others, observing the apparent consequences and envisaging the consequences for their own lives. This is true for health-related behaviours as well. Observation can happen through listening as well as seeing. Dialogue and discussion: Evidence suggests that these factors are important in improving health. The extent to which individuals discuss a practice, along with the nature of that discussion, is often closely correlated to the adoption of that behaviour. Social support: An individual s thoughts and actions are directly influenced by the opinions of others, especially when a situation is uncertain or ambiguous. Practically, for our work, this might mean that it is important to engage whole families and communities around an issue that affects an individual s health, such as around breastfeeding practices. Participation: Media and communication can make it possible for people to participate in the decisions that affect their health and health system. For example they can take part in programmes where they can articulate their needs to those who shape services. This can support improved accountability, with those in power or responsible for the delivery of services required to explain and answer for their policies and actions. 10

11 4. Our activities We take a human-centered, adaptive, learning approach to work, modifying projects and their theories of change throughout a project lifecycle if things are not working in the way we thought they would. We continually test and monitor our progress to enable this to happen. We consider our projects to have been successful when they have achieved what we set out to achieve. For instance, if those who are exposed to our projects are more likely to be carrying out a specific healthy practice compared with those who have not been exposed when the only difference between the groups is whether or not they have watched or listened to our programmes. A tale of two projects Between 2012 and 2016, BBC Media Action reached millions of mothers and mothers-to-be, along with their husbands and mothers-in-law, in Bangladesh and the Amhara and Oromia regions in Ethiopia with radio and TV programmes. We focused on a number of key practices known to improve maternal and newborn health, such as antenatal care (ANC), safer delivery practices and essential newborn care. In Bangladesh 32 million watched our family TV drama, factual show and public service adverts. Women who watched were 2.5 times more likely to have attended ANC than those who did not watch In Ethiopia 21 million people listened to our two radio magazine shows. Women who listened were 1.4 times more likely to have delivered their baby in a health facility. Our activities can be grouped into four areas: 1. Research understanding why people, communities, organisations and systems behave as they do and to gain insight into what might drive change is key. We use a wide variety of qualitative methods, as well as desk research, to ensure that people, behaviour and norms, rather than didactic health messages, are firmly at the centre of project design. We also use research to uncover what media and communication access and habits our audiences have. While formal qualitative research is carried out by trained researchers, it is also important for our producers, writers and creatives to immerse themselves in the worlds of their audience. All health projects strive to be robustly evaluated, using mix-method approaches (quantitative and qualitative) wherever possible. 2. Capacity-strengthening BBC Media Action works with practitioners and organisations with responsibility for communicating around health to strengthen the field of practice, to reach those who are harder to reach and to leave a legacy. Where possible, we strengthen the capacity of local media around health communication through the co-production of content, embedded in training. We work with government departments and NGOs to support their efforts to improve their capacity for planning and implementing health communication interventions, including supporting frontline workers to communicate around health. We understand capacity-strengthening to go much deeper than delivering one-off workshops. 11

12 3. Media content we use the most appropriate combination of radio, television, online and mobile platforms and formats to engage the audiences we want to reach. Drawing on the creative traditions of the BBC, content could include drama, factual programming, challenge shows, comedy, quiz formats, music and public service announcements. Evidence, including from BBC Media Action s work, shows that the more ways that people are reached around the same issue, the greater the impact. 12 Shaping demand and practices in India From 2011 to 2015 BBC Media Action collaborated with the Bill and Melinda Gates Foundation, the government of Bihar and others to improve family health. Activities included TV public service advertising, radio broadcasts, street theatre, communication tools used in village health events and three mobile health (mhealth) services. Communities were engaged through multiple, complementary channels of communication. This was underpinned by support to strengthen the capacity of Bihar s government to use communication effectively to improve health. Almost 100,000 frontline health workers were trained in communication skills and to use the different mhealth services. This intensive capacitystrengthening enabled the transition of the communication products and training to the government. Exposure to the interventions was associated with healthier behaviour among mothers with children aged six and eight months old and improved health worker performance. For example, mothers were 1.5 times more likely than those unexposed to have washed their hands with soap before feeding their child and over 1.5 times more like to have adopted family planning methods to limit the size of their families. 4. Face to face and networked communication (outreach) encouraging sustained dialogue and discussion is central to achieving health. 13 We do this through community listening/viewing and discussion groups, road shows or community events and supporting health worker communication. We also use online and mobile. Face-to- face outreach is also central for engaging marginalised, harder to reach groups who may not have regular access to media platforms. While a number of studies have also suggested that combining mass media with interpersonal communication or other on-ground communication activities, has a greater impact than mass media interventions alone, 14 interpersonal communication has its own, unique role in the change process. Partnerships between BBC Media Action and other NGO and government bodies have been successful for enabling face to face communication. 15 These can also help BBC Media Action to achieve face to face communication and discussion at scale. 12

13 Adding value through listening groups in Ethiopia As well as being broadcast, two maternal and child health radio shows were listened to in community groups, facilitated by health workers. Members came from Ethiopia s health development army ordinary people tasked with sharing health information to five other families. Members reported gaining new and valuable knowledge. Research also showed the groups added value by providing a space for group members to discuss and seek clarification on issues from the shows, bolstering learning. In several cases members have gone on to create a community cooperative to help support pregnant women. 5. What we don t do BBC Media Action is not an advocacy organisation. While we believe in the power of media to bring positive changes at scale in relation to people s health, we do not campaign on individual issues. Except where the evidence is indisputable, we do not persuade populations to take specific actions but rather to make their own informed decisions. For example, handwashing with soap is proven to help prevent diarrhoeal diseases and therefore an action we encourage throughout our projects. However, we would never advertise the use of a particular soap product, or other branded health products or medicines. In relation to our capacity-strengthening work, we do not deliver very short-term fly-in-fly out training because of the limited long-term impact this has. Rather, the training we deliver is embedded within a broader capacity-strengthening approach that takes the full context into account. Finally, wherever we work we try to contribute to the development of media markets, rather than undermining them. For example, wherever possible we avoid paying for airtime. Instead we work with our partners to support the long-term development of creative, trusted, practical and inspiring content and broadcasting. Conclusion At the core of BBC Media Action s health work is the belief in the power of media and communication to inform, connect and empower people to embrace healthier behaviours and norms while strengthening health systems. It is hoped that the principles, aims and approach outlined in this document will support the organisation to harness this power to its most effective. Ultimately, this will help to reduce poverty, bringing the chance of health and wellbeing to some of the poorest and most vulnerable in today s world, leaving no one behind. 13

14 Appendix Sustainable Development Goals Goal 3 Ensure healthy lives and promote wellbeing for all at all ages Targets: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol By 2020, halve the number of global deaths and injuries from road traffic accidents By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all 14

15 Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks ENDNOTES 1 Between1990 and 2015 the numbers of women dying as a result of pregnancy or childbirth and the numbers of children dying before their fifth birthdays halved. Lancet maternal health series Death rates from malaria fell by almost a half between 2010 and World Health Organisation (2016) Malaria fact sheet. 2 Global Burden of Disease Study This is the conclusion from a systematic review of interventions in Naugle D & Hornik R. Systematic Review of the Effectiveness of Mass Media Interventions for Child Survival in Low- and Middle-Income Countries Journal of Health Communication. There is also evidence emerging from a randomised control trial by the organisation Development Media International in Burkina Faso, as well as BBC Media Action s own evidence. 4 For instance, analysis of BBC Media Action s RMNCH projects in Ethiopia and Bangladesh provide strong evidence that media and communication can improve behaviours and norms, with greater impact where a combination of formats is used. The underlying drivers of healthier behaviours from these projects are knowledge and discussion, attitudes and perceptions around what other people are doing. 5 Institute for Health Metrics and Evaluation, Human Development Network, The World Bank. The Global Burden of Disease: Generating Evidence, Guiding Policy Middle East and North Africa Regional Edition. Seattle, WA: IHME, Medecins sans Frontiers (1997). Refugee Health. An Approach to Emergency Situations. MacMillan. 7 For example, Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine 8 World Health Organisation. Disease Outbreak News. Webpages Accessed May These statistics come from World Health Organisation country profiles for the countries where BBC Media Action has offices in Asia and Africa at the end of United Nations. Department for Social and Economic Affairs. Population Division. Population Facts. Youth Population Trends and Sustainable Development McLeroy, K, Bibeau, D, Steckler, A, and Glanz K (1988) An Ecological Perspective on Health Promotion Programmes. Health Education Quarterly, 15(4): BBC Media Action Draft reports. Ethiopia and Bangladesh country reports for RMNCH. Also Wakefield, Loken, Hornik. Use of Mass Media Campaigns to Change Health Behaviour Ibid 14 Betrand J, Babalola S, Skinner J (2012). The Impact of Health Communication Programs. In Obregon, R Waisbord S (eds) The Handbook of Global Health Communication. Oxford. UK. 15 Sophia Wilkinson (2017) A bigger splash partnering for impact. Practice briefing. BBC Media Action 15