Information, Education and Communication (IEC) Programmes 119
Information, Education
a1
APPENDIX One
Information,
Education
and Communication and
Communi-
(IEC) Programmes cation (IEC)
Programmes
Contents:
and assess the knowledge of different popu- n Essentials of IEC
The essentials of IEC lations about various issues, products and be- n Counselling and the
haviours. Channels might include interpersonal Role of the Counsellor
Information, education and communication
(IEC) combines strategies, approaches and communication (such as individual discus- n Steps in Developing
sions, counselling sessions or group discus- Materials for an IEC
methods that enable individuals, families, Activity
groups, organisations and communities to sions and community meetings and events) or
mass media communication (such as radio, tel- n Undertaking a
play active roles in achieving, protecting and Reproductive Health
sustaining their own health. Embodied in IEC evision and other forms of one-way communi-
(RH) Needs Assessment
is the process of learning that empowers cation, such as brochures, leaflets and posters,
n Field tools for
people to make decisions, modify behaviours visual and audio visual presentations and
Conducting RH
and change social conditions. Activities are some forms of electronic communication). Needs Assessments
developed based upon needs assessments, Good communication between users and pro- n Links to Providing
sound educational principles, and periodic Services, Support and
viders of any service is essential; but it is es-
evaluation using a clear set of goals and ob- Follow-up
pecially important when providing RH serv-
jectives. IEC activities should never be devel- ices, given the sensitive nature of some of the
oped or implemented independently from a issues that are addressed (such as sexual
broader reproductive health programme that violence, female genital mutilation, and pro-
is being designed and executed in the country. viding contraceptives to adolescents). Ac-
IEC activities not only need to have an appro- cordingly, IEC approaches must be carefully
priate context in which they are shaped, but it and appropriately designed and selected.
is crucial that health services providers be
prepared to respond to any demand that may Although good “one-to-one” communication at
be created as a result of effective IEC activi- the point of service provision is essential for
ties. The influence of underlying social, cul- transmitting information and building trust with
tural, economic and environmental conditions the client, communication with other individu-
on health are also taken into consideration in als and groups within the community is also
the IEC processes. Identifying and promoting vital. It is through such communication net-
specific behaviours that are desirable are usu- works that service providers can obtain infor-
ally the objectives of IEC efforts. Behaviours mation about users’ needs, priorities and con-
are usually affected by many factors including cerns. Such informal information gathering is
the most urgent needs of the target population the first step in assessing needs (which can
and the risks people perceive in continuing be supplemented by other more formal
their current behaviours or in changing to dif- means – see section below). It also helps
ferent behaviours. providers better understand the specific set-
ting and context in which they are working,
Health information can be communicated which will be useful in the later development
through many channels to increase awareness of IEC approaches, messages and materials.
120
These types of conversations, or passing on much as words. It is often through such body
information by “word-of-mouth”, has been language that we express our attitudes
shown to be one of the most effective commu- towards an issue, a person or a person’s
nication channels for acquiring knowledge behaviour. Service providers must become
and promoting desired changes in behaviour. skilled in interpreting the body language of
Evidence of this is the speed with which ru- users as this may assist them in understand-
mours spread and the force of their impact. ing users’ needs and concerns more fully.
Field staff should not ignore these informal Service providers must also be aware of their
opportunities to educate the public through own body language and the signals they may
casual conversation with people in the com- be unknowingly sending to users (e.g., move-
munity. ments or expressions that indicate fatigue,
boredom, fear, frustration, indecision). It is
Once a refugee situation stabilises, it becomes
important that the attitude conveyed by the
appropriate to consider the development of
service provider be compassionate and non-
more elaborate and formal IEC strategies. This
judgmental.
requires serious thought and significant alloca-
tion of time and resources. The steps involved
in the development of IEC are outlined here, Service Users
but this is not intended to be an exhaustive
Good communication skills are necessary to
guide. More in-depth information and details
ensure that good-quality services are provided
can be found in the items listed in Further
and that service users are satisfied. It is
Reading. Whatever materials and formal
programmes are developed, it is important to
ensure that the different aspects are
coordinated, and that the content of any mes-
sages and the media used to convey those Good communication skills
messages are complementary. It is also vital to could include the following:
ensure that people are provided with the nec-
essary support and resources to act in the a effective, “active” listening in
manner advised. which the provider gives small
verbal or non-verbal feedback
Communication that indicates to the client that
(s)he is being heard and
Communication can be both verbal and non- understood;
verbal.
a rephrasing what the client has
In verbal communication, the tone of voice said to make sure it is correctly
can communicate feelings and emotions that understood;
are as significant as the words being spoken.
Accordingly, it is important to choose words
a asking open-ended questions,
asking the client to answer
that do not offend in any way and that are eas-
questions with more than one
ily understood. One should avoid using trigger
word answers;
words, jargon, medical or other sophisticated
terms. The use of particular languages may be a making eye contact;
important in reaching all sections of a commu- a providing complete attention;
nity (women may speak fewer languages than
men, for example). a not being curt or showing a
condescending attitude toward
In non-verbal communication, body position, the client.
gestures and facial expression, often referred
to as “body language”, can communicate as
Information, Education and Communication (IEC) Programmes 121
through communication that trust and rapport can also serve as role models for desired APPENDIX One
are established between the provider and user behaviours and actions.
of a service. Emotional support and the com- ¡ Provide these individuals with very clear in-
munication of concern and understanding by formation about what your intentions are,
health staff are often as crucial in providing what you plan to do, and how they can con-
quality services as is clinical care. If there is a tribute as partners. Be specific about what
strong provider-user relationship established they will gain from working with you and al-
in this way, it becomes easier to move towards lowing you access to the community.
open dialogue on more sensitive aspects of
reproductive health. ¡ Provide them with input about your plans
before you proceed, and secure their will-
ingness to participate and to support your
Other Individuals and Community efforts.
Groups
Beyond communication with service users, it is Counselling
necessary to open a dialogue with influential
individuals and groups within the community. Counselling is a key component of an IEC pro-
Such individuals and groups will need to be gramme. In the best of circumstances, a good
identified as early as possible. The nature and counsellor is compassionate and non-judg-
intention of services should be explained to mental, is aware of verbal and non-verbal com-
them and their concerns and priorities discov- munication skills, is knowledgeable concern-
ered and understood. This will not only help ing RH issues, and is respectful of the needs
make the services more appropriate to the cli- and rights of the users. In a refugee situation,
entele being served, but it will help garner fam- there is often a poor counsellor-to-client ratio,
ily and community support for the client in the emergencies are common and the local envi-
reproductive health behaviour being promoted. ronment is not conducive to counselling.
The following are some pointers for identifying However, at a minimum, counsellors should
such individuals and groups: strive to ensure that every service user has the
right to the following:
¡ Familiarise yourself with the community
with the help of someone who lives in the
environment of the refugees and who pro- ¡ Information: to learn about the benefits
vides them with some service, advice or and availability of the services.
protection. ¡ Access: to obtain services regardless of
¡ Identify individuals who are most impor- gender, creed, colour, marital status or lo-
tant in the social structure of the commu- cation.
nity with which you are working. They can ¡ Choice: to understand and be able to ap-
be existing formal leaders (elected or ap- ply all pertinent information to be able to
pointed), but, more often than not, they make an informed choice, ask questions
are informal leaders. This can be done by freely, and be answered in an honest,
asking many people in the community. As clear and comprehensive manner.
certain individuals are named repeatedly, ¡ Safety: a safe and effective service.
it will become clear that they are the true
leaders. ¡ Privacy: to have a private environment
during counselling or services.
¡ Identify individuals who have some influ-
ence within the community, people whose ¡ Confidentiality: to be assured that any per-
opinions are respected. They will make sonal information will remain confidential.
suggestions about how to approach peo- ¡ Dignity: to be treated with courtesy, con-
ple and work with them effectively. They sideration and attentiveness.
122
¡ Comfort: to feel comfortable when receiv-
ing services.
Undertaking a Needs
¡ Continuity: to receive services and sup-
Assessment
plies for as long as needed.
Be careful never to assume that you know
¡ Opinion: to express views on the services what refugees need or want in their lives or
offered. from your projects.
To plan effective interventions, you must find
out what refugees think and know about vari-
ous issues, including their ideas about: what
Although the GATHER method of causes sickness and disease and what main-
counselling may appear simplistic, tains health, health care, traditional medicine,
it is complete and thorough: and reproductive health. It is important to build
a relationship of trust and mutual respect in or-
G reet users der to get accurate and complete information
about sensitive issues such as sexual and
A sk users about themselves reproductive matters.
T ell users about the service(s) It is usually necessary to use multiple methods
available in undertaking a thorough needs assessment.
Focus groups, individual interviews or Knowl-
H elp users choose the service(s) edge, Attitude, Behaviour and Practice (KABP)
they wish to use
surveys can be valuable ways to gather infor-
E xplain how to use the service(s) mation and help develop systems, activities,
materials or messages to support RH interven-
R eturn for follow-up tions. Only after there is an accurate picture of
the refugee community’s knowledge, attitudes,
behaviours, expectations and aspirations sur-
rounding reproductive health can you deter-
mine what programme and messages might
be best suited to its needs.
The Role of the Counsellor
RH interventions and IEC activities and materi-
The counsellor’s role is to provide accurate
als should be based on relevant research con-
and complete information to help the user
ducted through the use of quantitative (how
make her/his own decision about which, if any,
many) and qualitative (what, why and how)
part of the services (s)he will use. The role of
methods. Research and discussions should be
the counsellor is not to offer advice or decide
seen as an integral and ongoing part of plan-
on the service to be used. For example, the
ning and implementation.
counsellor will explain the available family
planning methods, their side effects and for
whom they are considered most suitable. The Quantitative:
user then makes a decision, based on the in- ¡ Use available incidence or prevalence
formation given, about which method she/he rates of targeted problems.
wishes to use.
¡ Knowledge, Attitude, Behaviour and Prac-
Effective counselling requires understanding tice (KABP) Surveys use a series of
one’s own values and not unduly influencing closed- and open-ended questions to de-
the user’s by imposing, promoting or display- termine what people in a community
ing them, particularly in cases where the pro- know, think, believe or do in relation to
vider’s and the user’s values are different. their reproductive health. Findings are
Information, Education and Communication (IEC) Programmes 123
presented in the form of percentages of what people are thinking about certain top- APPENDIX One
people who think or do a certain thing. ics, or why they engage in a particular ac-
These surveys require many respondents tivity.
that are randomly selected from the com-
munity. Interviewers are needed to imple- Field Tools for Conducting RH
ment the survey and they must be trained. Needs Assessments
This is generally considered an expensive
and time-consuming method. Also, this The Reproductive Health for Refugees Con-
kind of survey does not usually gather in- sortium1 has field-tested and finalised five RH
formation about what inhibits or promotes needs assessment tools. These are
certain behaviours, since those factors n Refugee Leader Questions
may arise from the context in which peo-
ple live and not from their knowledge and n Group Discussion Questions
attitudes. n Survey for Analysis by Computer
n Survey for Analysis by Hand
Qualitative:
n Health Facility Questionnaire and Check-
¡ Individual interviews allow the researcher
list
to get deeper insights into a person’s
thoughts and feelings. Using an interview The purpose of these tools is to assist relief
guide, interviewer and respondent talk at workers in refugee/displaced person settings
length about the respondent’s feelings in gathering information to assess attitudes
about a specific service or issue. If trust is toward RH practices and local medical prac-
established and confidentiality ensured, tices/policies, the extent of needed services
the interviewer can often get very valuable and the degree to which current services pro-
information about the interviewee and the vide what is needed.
community, information that might not
It is important to note that not all tools will be
otherwise be revealed.
appropriate for all refugee situations. The
¡ Focus Groups are in-depth discussions, order in which the tools are used may also
usually of one to two hours in length, with a vary. In general, refugee leaders are consulted
small group of people. Members of the Fo- before any information is gathered from the
cus Group should have something in com- larger population. This is often followed by
mon with each other (age, sex, and experi- group discussions, key informant interviews
ence) in the expectation that this will make and facilities review. In some situations, a sur-
it easier for them to talk together. They are vey may be conducted but this is often depend-
representatives of the target group in that ent upon resources, time, skills of available
they are deliberately chosen. The intention staff and whether or not the level of effort
is to make sure different groups within the required by a quantitative survey is warranted.
community are represented within the Fo- A clear needs assessment objective will help
cus Group, or that several Focus Groups field workers decide which tools are appropri-
are held with members drawn from various ate for their particular situation.
The RHR Consortium comprises
sectors within the community. Discussions
American Refugee Committee,
are lead by a facilitator who follows a pre- The information provided by the tools must be CARE, Center for Population
pared guide that allows for probing into the reviewed in the context of the broader objec- and Family Health, Columbia
thoughts and feelings of group members. tive of the needs assessment. Any tool used University’s Mailman School of
This method is often considered cost-effec- should be adapted to the local situation and Public Health, The International
Rescue Committee, JSI
tive, as many people are gathered together resources available. Judgement is required by
Research and Training Institute,
at one time to express their opinions. Find- those applying the tools. In many cases, other Marie Stopes International and
ings are presented in the form of comments resources may exist to support the needs the Women’s Commission for
or extracts from interviews, which illustrate assessment and these should be used. Exam- Refugee Women and Children.
124
ples of additional strategies for collecting in- n Develop the IEC activities and involve as
formation include: camp registration records many other partners as possible. After
(information on women’s ages, marital status, their successful implementation, you
and sometimes pregnancy); clinic, health should be able to have a significant impact
centre and/or traditional birth attendant on achieving the behavioural objectives.
records; in-depth interviews with representa-
n Identify potential barriers and ways of
tives from UNHCR, UNFPA, Ministry of
overcoming them.
Health and NGO staff; camp health coordinat-
ing committees and NGO logistics officers; n Identify potential partners, resources, and
and structured observation at different times other forms of support for your activities
of the day and night in the refugee commu- and gain their sustained commitment.
nity. n Establish an evaluation plan.
The indicators should determine the level of
achievement of the behavioural objectives.
Steps in Developing IEC Having such specific indicators makes evalu-
Activities ating and monitoring the progress and impact
of the activities much easier. Additionally,
The information gathered through the needs process indicators could be established to
assessment provides the framework for the track to what extent and how well the planned
development of suitable IEC activities. Any ac- activities have been carried out.
tivities and materials must always be culturally
sensitive and appropriate. These are the major
steps you should follow when designing an IEC IEC Messages
activity:
n Develop IEC messages. A good message
¡ Conduct a needs assessment. is short, accurate and relevant. It will
¡ Set the goal. This is a broad statement of make, at the most, 3 points. It should be
what you would like to see accomplished disseminated in the language of the target
with the target audience in the end. audience and should use vocabulary ap-
propriate for that audience. The message
n Establish behavioural objectives that will
tone may be humorous, didactic, authori-
contribute to achieving the goal.
tative, rational or emotionally appealing. It
may be intended as a one-time appeal or
as repetitive reinforcement. It is often nec-
essary to develop several versions of a
message depending on the audience to
whom it is directed. For example, differing
An objective must be SMART:
information about contraceptive services
S pecific (what and who) will be relevant to women who already
have three or four children already, from
M easurable (something you can see, that which would be appropriate for ado-
hear or touch – usually expressed lescents who are just beginning to be
with an action verb) sexually active. Their needs and priorities
A rea specific (where) are different, so the IEC materials used
with each group must also differ. Find out
R ealistic (achievable) if materials already exist in the host coun-
T ime-bound (when) try or country of origin, and if appropriate,
use these instead of developing new
ones.
Information, Education and Communication (IEC) Programmes 125
n Pre-testing, by trying out the materials of any message will, in reality, be context-spe- APPENDIX One
with small groups from your larger target cific; often a group of messages will be decided
audience, is an essential part of develop- upon, rather than just one.
ing messages and educational materials.
It is through pre-testing that you will en- Sexual Violence:
sure that people understand the message
as intended. Pre-testing may need to be n The importance for women to seek
repeated frequently until you are sure your medical care as soon as possible
information is being conveyed as desired. n Where to go for counselling if it is
available
n Determine suitable methods and channels
of action and communication. Once the tar- n How to prevent it, particularly in col-
get audience is identified and researched laboration with others in the community
and the key messages have been chosen,
it is time to decide which media and combi- Safe Motherhood:
nations of information channels will reach
the target group. Both formal and informal n The reasons why it is important for
groups can be targeted. Different channels women to seek prenatal care
do different jobs. Each has its own n The need to and how to identify obstetric
strengths and weaknesses, depending the complications and refer immediately
role it will take in the communication pro-
gramme. The choice of messages and me-
n The reasons it is important to breastfeed
dia will be influenced by many factors: cost; exclusively and the importance of
literacy levels; artistic style within the com- maternal nutrition
munity; familiarity with, and extent of pen-
etration of a particular medium for both Sexually Transmitted Diseases
service providers and users; and availabil- (STDs)/HIV/AIDS:
ity of the medium in the target population’s
n How to use condoms and how to dispose
community.
of them safely
The development and refinement of messages n How HIV is and is not transmitted
and the choice of the communication channel
or medium are inseparable. Very different n Means of prevention
messages will be developed for different me- n Common signs and symptoms
dia, for example radio, stories, poems, songs,
posters or flip charts, for the nature of the n Where to receive counselling
medium affects what messages can be suc- n Where to receive treatment
cessfully used. The skills of those using the
materials must also be considered. It may be
n Where to go for support services
necessary to provide training to those staff n Why it is important to inform and involve
expected to use the materials. For example, it all sexual partners
is important to recognise that placing a picture
or poster on a clinic wall at which people may Family Planning:
or may not look is quite different from using a
series of pictures in the form of a flip chart as n How and where to obtain reproductive
an educational tool in a group setting. health services, including contraceptive
supplies
The following are some suggestions for key
n Where to get information or counselling
messages on technical topics that may be
shared. These are presented as examples n How adequate birth spacing contributes
only and are shown out of context. The choice to healthy families
126
Reproductive Health of Young
Further Readings
People:
n How young people can protect them- “A Tool Box for Building Health Communica-
selves through safe sex tion Capacity”, Healthcom, Academy for Edu-
cational Development, Washington, DC, 1995.
n Delay and patience is a positive value
and that there are other ways to have Debus M. Methodological Review: A Hand-
fun book for Excellence in Focus Group Research,
n Young people need to take responsibility Washington, DC, Academy for Educational
for their own health Development, 1988.
n High-risk behaviours may result in long “Developing Health and Family Planning Print
term, unwanted consequences Materials for Low-Literate Audiences: A
Guide”, Program for Appropriate Technology
in Health, Seattle, PATH, 1989.
Links to Providing Services,
Support and Follow-up “Developing Health Promotion and Education
Initiatives in Reproductive Health: A Frame-
For IEC of any kind to be effective it must be work for Action Planning”, WHO, RHR,
linked with the availability of support and re- Geneva, 1998.
sources so target audiences can act in the
manner which is being recommended. It is “Facts for Life”, UNESCO/UNICEF/WHO.
therefore essential that the content of any IEC
“Guide to Planning Health Promotion for AIDS
programme accurately reflect the nature and
Prevention and Control”, WHO AIDS Series 5,
quality of the services provided. Logistical sup-
Geneva, WHO, 1989.
port must be adequate to ensure the neces-
sary supplies (material and human) are con- “Refugee Reproductive Health Needs Assess-
sistently available and adequate training ment Field Tools”, RHR Consortium, 1997.
should be provided to health workers to sup-
port inter-personal communication and com- “Tools for Project Evaluation: A Guide for
munity follow-up. People must be able to act Evaluating AIDS Prevention Interventions”,
on the advice contained in the IEC messages Family Health International , AIDSTECH/Fam-
and materials. ily Health International, Durham, NC, 1992.