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Communicating Risk as Part of Health Promotion Policy

Communicable and non-communicable diseases, and their consequences, are largely preventable through a variety of primary health care and health promotion approaches and interventions. In this regard, the Government of Eritrea has developed a national health care policy specifically targeted at community based multi-sectoral health promotion interventions aimed at ranging from awareness creation to behavioural changes, including improved health care seeking behaviour. On 27th August, the Ministry of Health (MoH) along with partners, conducted a consensus building and dissemination workshop on National Health Promotion Policy at Embasoira Hotel, Asmara.

The Government of Eritrea has been committed to developing a national policy framework as well as structures for the management and coordination of health promotion and risk communication activities. The Eritrean National Health Promotion Policy has adopted a multi-sectoral approach for planning, implementation, monitoring and evaluation. Respective sectors and partners are expected to develop and strengthen their own capacities to facilitate the implementation of health promotion components of their programs and activities.

Since Eritrea’s independence, the health sector has undergone major transformation within a relatively short time, attaining significant reduction in morbidity and mortality due to preventable diseases. Health promotion, therefore, always addresses the broad determinants of health, the physical environment, education, socio-cultural, political, and economic factors. More importantly, it shall use various approaches and methods including communication for behaviour change, social mobilization, social marketing and advocacy. Health promotion targets strategies which ensure the contribution of all people and create a mechanism for facilitating multi-sectoral collaboration at all levels.
The Eritrean Health Promotion Policy is basically directed at helping individuals themselves prevent from contracting infectious diseases and transmitting them. The policy’s activities will target, among others, the behavioural risk factors related to communicable diseases, non-communicable disease and injuries, hygiene and sanitation, safe sex, physical activities, substance abuse (mainly alcohol & tobacco consumption), etc. Eritrea has embraced Health Promotion as the means for increasing the participation of all levels of society in health care. Eritrea adopted the Ottawa Charter of 1986 which defines as the “process of enabling people to increase control over and improve their health”.

Health promotion activities also target pandemics, natural disasters and man-made emergencies related to pollution or conflict. This causes vulnerable, ‘at risk’, communities significant threats including: loss of life, injury, communicable diseases, psychosocial trauma, social dislocation and food stress.

Risk communication is defined as the real-time exchange of information, advice and opinions between experts or officials and people who face a threat to their survival, health or economic or social wellbeing. Its purpose is to enable anyone who is ‘at risk’ to make informed decisions about how to reduce the harmful effects by taking protective and preventive action. Effective risk communication is a mix of communication and engagement strategies and tactics, through mass media, social media, mass awareness campaigns, health promotion, stakeholder engagement, participatory social mobilization and community engagement, advocacy, as well as peer and interpersonal communication. Risk communication is an interactive process of exchanging information and opinions among individuals, groups, and institutions about the nature of the risk. Effective risk communication creates a meaningful dialogue with affected communities about how they can prepare for emergencies or respond to them.

The National Risk Communication Action Plan (2018- 2022) identifies a wide range of emergencies and related risks that threaten Eritrea and classifies them into slow and rapid-onset emergency categories. The rapid-onset emergencies are fire, flood, storm, extreme temperature, disease outbreaks, hazardous materials, adverse effects from immunisation (AEFI), conflict and landslide. The slow- onset emergencies include drought, famine, food Insecurity, deforestation, pollution and agricultural pests.

These risk events tend to occur ‘at scale’ and affect large numbers of people. At such moments, rapid communication response is required, and the general public needs information immediately in order to protect itself. The Action Plan recognises the importance of giving regular, accurate and verified updates to the affected populations until the emergency is over. Slow onset emergencies tend to occur over a longer period of months or years. They may reflect chronic shortages of food or water that have long-term negative effect on communities, but they give you sufficient time to respond to the situation. In both instances, the appropriate focus of the risk communication is to prepare for a risk event or to mitigate the impact of the risk event.

The Action plan addresses the risk communication in ‘phases’. Phase one should focus on identifying common risks and ways to reduce them before the emergency hits, to help communities prepare. Phase two must focus on promoting immediate life-saving actions that people should take to protect themselves and their communities during the first 48 hours of an emergency when communities are most vulnerable. In this phase of an emergency the aim is to quickly mobilise local and national communication plans and target affected communities with relevant and clear information and messages explaining both the nature of the crisis and the risks. The third phase should respond to new threats that emerge after the initial emergency. The communication, at this phase, focuses on new emerging threats such as diseases that tend to become epidemic. Further, situational assessment of changing risks, threats and consequences help to inform communicators of key priorities and whether communication activities need to be scaled up or down. Phase four addresses the after-emergency responses, when communities are recovering, and the communication response focuses on the actions that communities need to take to reconstruct their communities or to prepare for the next emergency.

Risk communication is identified as one of the eight core functions that WHO Member States must fulfil as signatories to the International Health Regulations (IHR). IHR requires that communication is used to address risks quickly and that harm minimization efforts are based on comprehensive risk assessments. The recent joint national evaluation of WHO IHR (2016) implementation in Eritrea concluded that the Government of Eritrea should conduct an integrated all hazard/vulnerability risk and resource mapping; finalize the National Multi-Hazard Public Health Emergency Preparedness and Response Plan; strengthen existing Emergency Preparedness and Response (EPR) structures; develop relevant Standard Operating Procedures for EPR; and conduct regular emergency simulation exercises to ensure response skills and preparedness are fully maintained.

These important policy positions and recommendations help to frame the strategic direction and the capacity development activities associated with the National Risk Communication Action Plan (2018-2022).

This National Risk Communication Action Plan’s general objective is to establish and sustain a multi-sectoral, society-wide and community-based framework that will guide the development and implementation of integrated interventions for improving the health and productivity of citizens, particularly, to build capacity to understand and respond to risk events with multi-sectoral, timely and effective communication responses. This Action Plan was developed through consultation with national stakeholders on February 2018 as well as a participatory risk communication workshop conducted in the same month. These two events provided important contextual detail on the key risk events faced in Eritrea, and helped identify existing communication approaches utilised to address these risks, vulnerable groups who are ‘at risk,’ and the communication channels/options available to communicators. The Action Plan is also informed by a review of relevant existing documents such as national strategic plans, policies, evaluations and other relevant sources.

The Action Plan is supported by a range of international and national policy commitments. Internationally, all governments have committed to adopting the United Nations Hyogo Framework (UNISDR 2008) on disaster risk reduction. Risk communication is a critical component of disaster risk reduction and is integral to all emergency responses. In the past, the management of disasters has been limited to preparedness and response, with little understanding of the need for risk reduction and post-disaster recovery. However, the 2005 introduction of the Hyogo Framework for Action (HFA) 2005–2015 resulted in a global paradigm shift from limited emergency actions to more comprehensive approaches to disaster management. The Framework promotes: making disaster risk reduction a top national priority, building a culture of safety and resilience to strengthen the response of ‘at risk’ communities and vulnerable populations, strengthening preparedness measures to improve the community risk response and to build community resilience, reducing identifiable risks such as those associated with common rapid and slow-onset disasters, and improving early warning sytems.

To combat the risks and emergencies, the action plan looks forward to giving training on risk assessment research methodologies, risk communication practice and Information, Education and Communication (IEC) for risk preparedness, emergency response and recovery initiatives to all health promotion staff at all levels.

Health Promotion and risk communication practice shall use multiple approaches and strategies including information, capacity building, advocacy, social and resource mobilization and technology to influence positive behavioural change. Most diseases and emergency events require the introduction of interventions targeted at behavioural changes and/or risk reduction. The means for accomplishing this desired behavioural change is a sound health promotion policy with behavioural change on communication strategies. Population, individual and interpersonal approaches including traditional approaches (drama, theatre etc.) and multimedia interactions are to be used.

To ensure effective oversight and quality assurance of this Action Plan, a new National Risk Communication Task Force will be set up to provide high-level strategic guidance concerning the direction of the Action Plan, its implementation progress and technical requirements.

The MoH calls upon all partners in health and economic development, the private sectors, NGOs, community-based organizations, faith-based groups, women and youth groups, to contribute to the development, implementation and financing of the health promotion policy implementation in Eritrea.

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