Opportunities and challenges for health communication in health disparities settings

What are some of the recent milestones and challenges in global health equity? Rafael: As part of its emphasis on equity, UNICEF has been working with regional and country offices to increase focus on the most marginalized and disadvantaged populations, and to ensure that those who are typically left out of the reach of social services or programmatic interventions are brought into the picture, and benefit from them. For instance, the global initiative A Promise Renewed, which focuses on accelerating the achievement of the Millennium Development Goals (MDG), has mobilized stakeholders towards efforts in this direction, and a number of countries have made additional progress towards achieving the MDG, particularly goal four (reduce child mortality) and five (improve maternal health). Polio eradication efforts, especially the recent success in India, are an example of how the international development community has made significant progress in improving the lives of children by bringing in the equity focus. However, we continue to face challenges surrounding most of the basic indicators that reflect the well-being of children in many parts of the world. Along with other vulnerable populations, children placed within some of the various dimensions of poverty and discrimination are more likely to be affected by disease or by various disparities and conditions. The challenge, then, is to ensure that our programs reach out to these children, and those that belong to marginalized groups. Benjamin: Some of the places where we are really struggling to realize equity are where people are affected by insecurity and violence, and where we are trying to get basic access to the population. This is the case in the Central African Republic, federally administered tribal areas of Pakistan, some parts of Afghanistan, Syria, and northern Nigeria—some of the areas where the last reservoirs of circulating wild poliovirus are. How have communication strategies helped achieve these successes, or how can they be used to address these challenges in health disparities settings? Can you provide some specific examples? Rafael: Communication, specifically Communication for Development (C4D), is a key component in UNICEF’s work across the whole development spectrum from the introduction of new vaccines, to polio eradication efforts, maternal and newborn health, child health and well-being, basic hygiene, and prevention of mother to child transmission of HIV. It provides UNICEF the opportunity to advocate with different stakeholders and partners, mobilize communities, and implement strategies that address social and behavioral determinants, and promote healthy practices and behaviors. Benjamin: As an example of innovative programming, we have been using mobile theaters in Mozambique to communicate with communities about the importance of immunization, and also to listen to the communities and record their voices. Through an iterative process of listening and communicating, we have refined the delivery of immunization services in Zambezia, a region of Mozambique with high population density and very low access to communication channels, including radio. We have packaged the immunization services with other essential health services that the communities are asking for, such as water, sanitation, nutrition, and antibiotics. Rafael: Another interesting development has taken place in Niger, West Africa, where we have been working over the last six years to implement an essential family practices package. This is a community-based, action research approach, involving several components—community meetings, household visits, community radios, advocacy with religious leaders—and focuses on the promotion of eight life-saving practices, including having children sleep under insecticide-treated mosquito nets, hand washing, and exclusive breast feeding. Through a systematic approach, we ensure that families begin