5
Working with the Health Sector
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| Officials, opinion leaders, ordinary people, industry owners and workers, and bureaucrats -- everybody has personal and professional interests that can cause problems if they are not discussed.
The health worker who distributes iodine pills to people with goiter might say, "I'm going to lost my job," unless you explain that instead of distributing pills, the job is now to encourage people to use iodized salt. It is exactly this kind of seemingly small misunderstanding that can block programs.
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Even some ministry of health officials, who are presumably backing the IDD program, may not be thoroughly briefed on the brain damage caused by IDD. The health sector is complex, a maze of departments and subsections. Published decisions and recommendations often do not penetrate the bureaucracy and keep coming up for endless debate. For example, such tired issues as "controlling goiter," iodized oil during pregnancy, and the appropriate level of iodization at the factory level have all been resolved, and yet time and effort can be wasted rehashing them.
Meanwhile, clinic doctors may be thinking, "I went to medical school, and they didn’t teach me that," so they may give patients wrong information or none at all. For these reasons, we need convincing data, repeated by different, reliable sources. Bureaucrats working for the government, as well as technocrats working privately, all have to be sold on the importance of salt iodization. Writing a couple of memos may not be enough. Information material has to prove the seriousness of IDD and the importance of iodized salt. Workshops may have to set aside time for the information to sink in.
Curriculum review
At the same time, we should work to change the curriculum of medical schools producing doctors who think: "IDD is not serious. It's only goiter."
Medical experts may have to tackle curriculum and textbook reform, surveying the teaching materials all the way up to the medical school and updating them so that educational institutions don’t keep churning out health workers and doctors who follow an old line of thinking about goiter and IDD.
Many developing countries have already visited this problem of neglected curriculums and textbook reform in the context of primary health care. As with IDD, universities kept producing doctors who never fully understood the new concept and were therefore unwilling to support it.
In education of the health sector professionals, there at least has to be a concerted effort to address those people who have day-to-day contact with mothers and cooks because they are dispensing information all the time and that information must be correct.
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Box 8 - Reaching the Household through Health Workers (Pakistan) In 1996, Pakistan revised its communication strategy to redouble its efforts to involve doctors and health professionals at all levels, to clarify that iodized salt is a preventive measure, not a cure, and to explain what iodized salt prevents. A study found that people were receiving and remembering mass media messages, but not using the salt because of high price and availability problems, coupled with rumors linking iodized salt with family planning and adverse health effects. Consumers said that if these rumors were strongly refuted by credible sources, they would be willing to start using the product. Up to this point, the IDD health information campaign had centered on doctors, asking them to promote iodized salt and dispel consumer concerns about its safety. The campaign was also intended to keep doctors from circulating negative information about iodized salt based on outdated knowledge and inadequate understanding. A prescription pad was designed with the iodized salt logo, slogan and four key messages about use of iodized salt. The inside and back covers included detailed information on the latest research findings on IDD and the need for USI. Medical representatives of a large pharmaceutical firm delivered the pads directly to 25,000 doctors across the country and briefly discussed the issue with them. District Health Officers were involved in seminars and medical associations of private practitioners participated in advocacy events aiming to provide the latest information on IDD and on the country program for its elimination. As a result of the 1996 assessment, the campaign put a greater emphasis on working through medical associations, networking with NGOs, and training health workers, including social workers, sanitation promoters and Lady Health Workers as well as school teachers and active NGO field staff. PSI (1996) |
| Professional associations
Just like bureaucrats and technocrats, non-government groups, especially professional associations, often take positions that may contradict what is being done to combat IDD. For example, in some countries, it has been very difficult to persuade pediatricians that iodized salt is a good thing. In other settings, there might be an association of primary care doctors who are not up to date on IDD and who may refuse to support iodized salt and may feel threatened by new information or policies they have not yet embraced. This situation is comparable to that of doctors who once strenuously opposed the training of midwives as birth attendants or pediatricians who only belatedly endorsed breastfeeding. |
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Communication Tool Kit 5 contains key messages for doctors published in a medical association journal.
