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National Communication Strategy andAction Plan for
Reduction of NCD High Risk Behaviors in Bangladesh, 2014-2016
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National Communication Strategy andAction Plan for
Reduction of NCD High Risk Behaviors in Bangladesh, 2014-2016
Publisher : Bureau of Helth EducationDirecctorate General of Helth ServicesDhaka, Bangladesh
With support form the World Helth OrganizationDecember 2013
The purpose of this strategy is to provide an account of overarching principles for the prevention and control of NCD. This communication strategy also sets the scope, goals and strategic directions for NCD prevention and control in Bangladesh.
Already, there is consensus amongst the international health authorities that the present NCD situation is an epidemic and must be dealt with like any public health emergency. Health sector of this country will properly upheld the strategy and utilize for the overall health care development of the country.
I am urging every sector in the community to consider, understand and support this communication strategy to reduce NCD high risk behaviors. Working in partnership, we can make Bangladesh a healthier place to live.
I extend my appreciation to WHO for providing support to develop this document
Dr Khondhaker Md Shefyetullah
Message
Director GeneralDirectorate General of Health Services
Government of the People's Republic of Bangladesh
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I am very happy to see that a Communication Strategy to reduce NCD high risk behaviour has been developed by the Ministry of Health & Family Welfare.
The Country is experiencing a double burden of communicable and non-communicable diseases. There is growing evidence that Health Promotion makes an important and positive contribution to the improvement of health by facilitating comprehensive, integrated responses to the broad determinants of health which cut across several programs. The Ministry of Health and Family Welfare therefore fully supports the strengthening and further development of Health Promotion as an important approach to improve health in Bangladesh.
Within the context of on-going reforms being carried out in the health and other sectors, this strategy is a first step in an effort to refocus and intensify health promotion activities in the country.
I would like to extend my gratitude to those who have been involved with the development of this strategy.
Dr Thushara Fernando WHO Representative to Bangladesh
Message
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Table of Contents
List of Acronyms xiPreface xiiiExecutive Summary xv
1. Introduction 12. Risk Factors of NCDs 23. Health Promotion Situation in Bangladesh 44. Strategic Outline 75. Implementation Plan 106. Monitoring and Evaluation 117. Acknowledgement 128. References 13
Annexure 1. Communication Log Frame 142. Responsible Organization for the control and prevention of risk factors of NCDs 29
List of Acronyms
BCC Behavior Change Communication
BHE Bureau of Health Education
DGHS Directorate General of Health Services
GOB Government of Bangladesh
IEC Information, Education and Communication
IEM Information, Education and Motivation
IPC Inter Personal Communication
KAP Knowledge Attitude Practice
MOH&FW Ministry of Health & Family Welfare
MIS Management Information System
NCD Noncommunicable Disease
WHO World Health Organization
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Preface
Globally, we are facing a rising threat imposed by chronic non-communicable diseases or chronic diseases. The World Health Organization estimates that, worldwide, low fruit and vegetable intake and physical inactivity account for 2.7 million and 1.9 million deaths respectively. An individual adopts healthy lifestyle habits early can lessen the risk of contracting non-communicable diseases later.
To avert this from happening, we must work in a coordinated manner and aim to promote healthy eating and physical activity as well as the community participation from all sides and at all levels. For the successful implementation of the strategy there needs to be active involvement, interest and strong support from health staff at all levels, village volunteers, community leaders, NGOs, donor organizations and the media.
It is a great pleasure to introduce the first National Communication Strategy for the Promotion of reducing NCD high risk behaviors- 2014 - 2016. It is a product of collaboration among stakeholders from different sectors of our society.
My heartiest gratitude is to Kazi Rumana Ahmed for relentless endeavors for preparing this strategy and special thanks to Dr M Mostafa Zaman, WHO, for his outstanding contribution and guidance in this regard. I wish to express my sincere thanks the individuals who contributed to this strategy, either by participating in working groups for their sincere effort to complete this important and demanding work.
Md Abdul Waheed AkandaLine DirectorBureau of Health Education Directorate General of Health Services
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Executive Summary
xiii
Background
Globally, noncommunicable diseases (NCDs) are increasingly recognized as a major cause of morbidity and mortality. Health communication is relevant for all aspects of health and well-being, including disease prevention, health promotion and quality of life. Four major killer NCDs are caused by four common risk factors. Concerted effort regarding risk reduction of NCDs will be the vital investment for safeguarding the nation through a well formulated communication strategy.
Objective
To develop effective and sustainable communication for actions at all levels in order to generate awareness for reduction NCD risk behaviors.
Strategies and Communication Activities
Advocate and strengthen this strategy in order to reduce NCD high risk behaviors Guide to design and develop appropriate tools/methods, suitable for target audiences
through effective translation of knowledge and research at a national level Build capacity of all personnel at all levels through training on communication strategies
by the appropriate personnel Achieve excellence in the priority areas of research in community context in order to
the hard-to-reach population imparting on community-based interventions Formulate appropriate policy and legislation through review the existing ones
This communication framework has a set of indicators (process, output and outcome) to combine a range of actions. Continuous monitoring and evaluation throughout the program will be carried out to ensure proper execution of activities.
1. Introduction
In recent years, the worldwide increase of noncommunicable diseases (NCDs) has become a
slow-motion disaster, as most of these diseases develop over time. Unhealthy lifestyles that
fuel these diseases are now spreading with a stunning speed. Disease rates from these
conditions are accelerating globally and across social classes. Furthermore, rapid changes in
diets and lifestyles that have occurred with industrialization, urbanization, economic
development and market globalization have accelerated over the past decade. This is having
a significant impact on the health and nutritional status of populations, particularly in
developing countries and in countries in transition (1). Of the 57 million deaths that occurred
globally in 2008, 36 million - almost two thirds (63%) - were due to NCDs, comprising mainly
cardiovascular diseases, cancers, diabetes and chronic lung diseases (2). NCD's are already of
major importance in developed countries and are rapidly becoming a major public health
threat in the developing world. Nearly 80% of these NCD deaths (29 million) occurred in low-
and middle-income countries. As the impact of NCD increases, and as populations age,
annual NCD deaths are projected to continue to rise worldwide, and the greatest increase is
expected to be seen in low- and middle-income regions by over 20% between 2010-2020 (3).
A large percentage of NCDs are chronic diseases and the underlying cause of this NCD
epidemic is the rise in lifestyle related risk factors resulting from social and economic
changes. Most of this increase will be accounted for by emerging noncommunicable disease
epidemics in developing countries (4). These common risk factors give rise to intermediate
risk factors such as raised blood pressure, raised blood glucose, unhealthy lipid profiles and
obesity. In turn, the intermediate risk factors predispose individuals to the 'fatal four':
cardiovascular diseases (heart disease and stroke), cancer, chronic respiratory disease and
diabetes (5). Tackling the major risk factors are key interventions, but it would be helpful to
also concentrate on environmental factors. (6).
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Communicalbe Diseases (CDs)
CVD
CDs
NCDs
27%
9%
6%
2%8%
10%
38%Cancer
Respiratory Diseases
Diabetes
Other NCDs
Injuries
Source: WHO-NCD Country Profile, 2011
Figure 1: Percentage of deaths caused by NCDs
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Prevalance of NCD risk factors in Bangladeshi population: >25 years
Smoking consumption (26.2%),Smokeless Consumption (31.7%)
Tobacco user (any form) (51.0%)Fruit and vegetables intake (4.3%),
Low Physical activity (27%) andAlcohol consumption (0.9%)
Source: NCD Risk Factor Survey Bangladesh 2010
2. NCD in Bangladesh The country is facing a dual burden of both communicable and noncommunicable diseases. The overall mortality rate in Bangladesh has decreased significantly over the couple of decades. But deaths due to chronic diseases are increasing in an alarming rate. NCDs now impose the largest health burden in Bangladesh. In NCD country profile Bangladesh 2011, more than 50% of NCD deaths are due to Cardiovascular Disease and rest of deaths from Cancer, Respiratory Diseases, Diabetes Mellitus and other NCDs.
There are some common risk factors that underlie non-communicable diseases. Globalization and urbanization are some of the reasons for the promotion of unhealthy lifestyles (e.g. tobacco and alcohol use, unhealthy diets, and physical inactivity) and environmental changes (e.g. indoor and outdoor air pollution). Now global market is open for all because of globalization and urbanization. Unhealthy products (unhealthy energy drinks, palm oil, refine glucose, salty food) are promoted equally to the people and sometimes information gap lays which reflect the negative impact in their health.
Risk Factors of NCDs
The underlying cause of NCD epidemic is the increase in lifestyle related risk factors resulting from social and economic changes. A large percentage of NCDs are preventable through the reduction of four main behavioural risk factors: tobacco use, physical inactivity, unhealthy diet and use of alcohol. Rapidity of epidemiological transition and globalization will escalate these risk factors over the next decades if appropriate public health action is not taken.
Based on current trends, by the year 2020 these diseases are predicted to account for 73% of deaths and 60% of the disease burden in the developing countries (7). There is hardly anyone without a risk factor; 98.7% have at least one risk factor(8). Most of these major risk factors of NCDs in Bangladesh are related to lifestyle.
Unhealthy diet: is a key risk factor although fruit and vegetables are included in people's diet; the amount they consume on an average is far less in terms of required serving. According to NCD risk
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factor survey 2010 of Bangladesh (8) the overall daily per capita consumption of fruit is 1.7 serving and of vegetables 2.3 serving against their minimum daily requirement of 5 servings. Considering the cut off as minimum recommended amount, 95.7% don't consume adequate fruit or vegetables on an average per day.
Salt Intake: A study by the National Heart Foundation of Bangladesh involving 200 subjects reported salt intake of 10-11 g/day. WHO currently recommends less than 5g salt/day/person. Burden of metabolic syndrome as well as different types of cancer in our population is increasing rapidly for use of unhealthy diet.
Tobacco: use is another important risk factor for several NCDs. According to NCD risk factor survey Bangladesh, 2010, smoking consumption is 26.2%. Smokeless tobacco is a problem of the subcontinent. Consumption of smokeless tobacco is 31.7% and women are found to use more smokeless tobacco than men. Overall 51.0% use tobacco products in one or other forms. One third of medical admissions are due to the tobacco related illness such as Ischemic Heart Disease, stroke, Buegrer's disease, Oral Cancer, lung cancer, Laryngeal cancer and COPD (9).
Alcohol: consumption is low in Bangladesh. According to NCD Risk Factor Survey, Bangladesh, 2010, current drinkers are 0.9%. Extra burden of cardiovascular disease can be followed specially among tribal population due to harmful consumption of alcohol.
Physical inactivity: particularly among female and urban residence, is low. Sedentary lifestyle in urban population is a major risk factor. According to NCD survey report 2010 (8), prevalence of low level of physical activity is quite high (27%). Strong evidence shows that unhealthy diet associated with sedentary lifestyle and insufficient physical activity are among the major causal risk factors in chronic NCDs - including type-2 diabetes mellitus, cardiovascular diseases, hypertension, cerebrovascular strokes, and some types of cancer, resulting in disability and premature deaths in developing countries (10).
Major risk factors of today will be the diseases of tomorrow. Therefore identifying risk factors for NCDs is an attempt to predict the future distribution of NCDs in a population and is vital for promoting disease prevention and control programmes (11).
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3. Health Promotion Situation in BangladeshHealth promotion has an established repertoire of proven effective strategies which need to be fully utilized. It is a core function of public health and is effective in reducing the burden of both communicable and noncommunicable diseases including mitigating the social and economic impact of such diseases. Health promotion initiative in Bangladesh is trying to meet the following three goal of Bangkok Charter; identifies actions, commitments and pledges.
Ministry of Health with the collaboration of other ministries and organization (MoH, DGHS, BHE, DGFP, IME unit, BRAC, ICDDRB, Grameen Bank & relevant organizations) are working in all the level of health care of country to reduce NCD risk factors but it is not in that much large scale. This government approach has implanted in existing guidelines and regulatory frameworks relevant to noncommunicable diseases, such as the WHO Framework Convention on Tobacco Control (12), Global Strategy on Diet, Physical Activity and Health (13) and Global strategy to reduce harmful use of alcohol (14).
Non communicable Disease Control (NCDC) programme of DGHS has been implementing NCD prevention model intervention from 2011-2015. Several other pilot initiatives, following the NCD prevention model have also been taken at upazilla level. Some success has been found from these NCD risk intervention in blindness, injury, diabetes, mental illness prevention. However, after completion of program the total outcome can be measured (4). There are innumerable health communication Programmes and activities in Bangladesh implemented by the Bureau of Health Education. Several communication programs complying with all major constituencies of strategic communication were developed and implemented by Bangladesh Center for Communication Program (BCCP). The National FP-MCH IEC Strategy for Bangladesh 1993-2000; National BCC Strategy for NGO Service Delivery Program and Communication Strategy for TB Control (it is one of the common issue for smoking) are a few of the strategies developed and implemented. Several strategic initiatives have been taken in Bangladesh. However, these Programmes and others need to be strengthened, improved and expanded for nationwide impact. The programs could not be successful until or unless the involvement of all relevant ministries, NGOs, donor agencies and community people. The main barrier to implement the successful NCD prevention and intervention program is communication gap. Intrasectoral and intersectoral collaboration, cooperation and consistency are needed between different partners those are working with existing infrastructure and logistics which can stop the devastating effect of NCD. Multisectoral attempts are the key to attend to the wide determinants of noncommunicable diseases. Government leadership and political commitment are absolutely necessary to synchronize the multisectoral response to the NCD load.
Health promotion is carried out through a mixed approach involving mass media, community media, mainstreaming with public and private organizations, social mobilization, enter-educate program, capacity building, monitoring and evaluation. It is coordinated with and complemented by the on-going communication activities of individual public health organizations in Bangladesh. It represents the sum of policies and actions which is securing the conditions for healthy living and sustainable health development at the individual and collective levels (15).
Role of Communication in Health Promotion
Health Promotion represents a comprehensive social and political process; it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate the impact on public and individual health. Communication is essential to inform people about healthy lifestyles
Figare 2 : Supportive Communication Channels
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and risk factors, and motivate them to adopt and maintain healthy behaviors and practices. Health communication attempts to change or reinforce a set of behaviors in a large-scale target audience regarding a specific problem integrated with current social issues. Effective Communication can ensure participation that is essential for promotion of health (16).
Communication activities are multi-tiered focusing on different levels. The main barriers for effective communication are strong stakeholders, limitation and mishandling of law, lack of monitoring, lack of proper documentation of healthy products & research, in-coordination between different agencies, corruption and accountability; example- the proposed bill of increases taxation on tobacco products in national assembly was not possible to pass due to strong stakeholders (bidi & ciggerate industry owners) lobbing, misleading advertising of unhealthy products (energy drink, palm oil, glucose) in the electronic and print media, abuse of social network (promotional activities on junk food, drinks, tobacco).
Integrated team work to minimize the mentioned barriers is needed which can be extended up to the individual; family and community health problem which can foster the adoption of healthful changes in the environment; client-oriented and community- based health and education professionals that can provide the necessary services; and the policymakers who set the policies. All these are pertinent to communicates for NCD prevention.
Supportive Communication Channels
Supportive communication channels can be established under the following headings:
1. Counseling and skill development- working with people either one to one or in groups will help them to develop the knowledge and skills regarding NCDs. Parents, religious leader, school teacher, chairman, member of local government, celebrity and other influential people can play role on the risk factors of NCD. They can describe the harmful effect of unhealthy products and their effect on health. They can encourage on community mobilization and group participation which can work
Figare 3 : Supportive Communication Channels
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together to improve health through programs, such as- community gardens, healthy lifestyle community programs, neighborhood anti-drug initiatives and community economic development programs. Some chapters on 'healthy lifestyle about NCDs risk reduction behavior' can be introduced in the books in secondary and higher secondary levels for making aware of our future generation. Fact sheets, brochures, newspaper and magazine articles, and television programs that may help people become more knowledgeable about NCDs risk reduction behavior. In addition ICT network, m-health & e-health facilities can be used through community clinic and in other places so that the community people get the information easily
2. Social marketing- campaigns that may use traditional IEC tools and techniques, such as advertising campaigns, slogans and logos, to influence attitudes and encourage social changes. Moreover, appropriate BCC materials and enter-educate programs, materials for specific audience, a well-accepted campaign to be developed and disseminated regarding NCDs risk behavior to promote healthy lifestyle. List of healthy foods, harmful effect of tobacco, harmful use of alcohol and necessity of physical activity and others relevant promotional activities to minimize the effect of NCD risk factor can also be introduced through social marketing.
3. Healthy public policy- efforts to influence policies, operating procedures, by-laws, regulations and legislation that have a direct impact on health. For example, banning of smoking in public place by laws helps reduce exposure to second hand smoke. School board cafeteria policies help ensure young people eat more nutritious food, less junk food and not to smoke. However, strict enforcement is required for NCDs risk reduction behavior.
Challenges for Communication
The main challenges for effective communication are powerful industry, poor regulation, lack of media monitoring and poor governance in different levels. Due to these challenging factors, some promotional activities (trans fat, simple sugar, energy drink, add of tobacco products etc) can be seen frequently. These challenges can be neutralized through following effective materials, tools like BCC, IEC materials, policy for skilled manpower, health education program, health infrastructure, ensure strong media monitoring, policy for healthy diet, policy for physical activity and policy for tobacco control in any form and legislative provisions related with health education and communication program will be supportive for this strategy. Presence of powerful industry is a challenge but it can never deter our Health Promotion Research efforts.
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4. Strategic Outline This communication strategy is a well-planned series of actions aimed at achieving certain objectives through the use of communication methods, techniques and approaches.
ObjectiveTo develop effective and sustainable communication for actions at all levels in order to generate awareness for reduction NCD risk behaviors.
Strategies1. Advocate and strengthen this strategy in order to reduce NCD high risk behaviors2. Guide to design and develop appropriate tools/methods, suitable for target audiences through
effective translation of knowledge and research at a national level3. Build capacity of all personnel at all levels through training on communication strategies by the
appropriate personnel 4. Achieve excellence in the priority areas of research in community context in order to the hard-to-
reach population imparting on community-based interventions 5. Formulate appropriate policy and legislation through review the existing ones
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In order to achieve these strategies, the activities are as follows:
Strategy 1: Advocate and strengthen this strategy in order to reduce NCD high risk behaviors
Activities:
Establish a consortium at national and district levels for reduction of NCD risk behavior comprising of members from multi-sectors. The consortium will develop an NCD risk behavior reduction mechanism to support NCD risk behavior reduction Policy.
Develop Health Promotion Foundation to coordinate to implement this strategy Arrange Media coverage on policy dialogue on NCD risk reduction behavior Organize national campaigns for reduction NCD risk behavior Organize individual based advocacy programs to encourage to reduce the NCD risk behavior Sensitize religious leaders, teachers, community opinion leaders, UP chairman and members to
mobilize for reducing NCD risk behaviors Increase knowledge and awareness of media personnel regarding NCD risk behavior
Strategy 2: Guide to design and develop appropriate tools/methods, suitable for target audiences through effective translation of knowledge and research at a national level
Activities:
Formulate IEC and BCC materials for reducing NCD risk behavior Create IT network to disseminate NCD risk reduction messages to population Develop effective tools for health campaign at the community level To invent student friendly materials for school awareness programs Develop media (including the electronic, the latest ICT based technology and WWW) and
audience specific messages for different population groups, settings and issues Develop radio listeners forum of NCD risk behavior reduction in the community Develop promotional materials to disseminate messages on NCD risk behavior Organize formal and informal meetings to disseminate educational information on NCD risk
behavior
Strategy 3: Build capacity of all personnel at all levels through training on communication strategies by the appropriate personnel
Activities:
Individual capacity building
Introduce fellowships, competition and awarding system for institutions and accreditation system.
Training of service providers on NCD risk behavior within the heath sector as well as in other sectors and associated NGOs
Training of master trainers followed by cascade training reaching up to the grass root level Fully utilize the existing personnel for NCD risk reduction. Support professional development and training opportunity for personnel working on health
promotion.
Organizational capacity building
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Build network with existing health care system of Government and develop infrastructure facilities of Health institutions
Train institutes such as medical colleges, nurses' training institutes etc. may exchange expertise, gather updated information and to have uniform course curriculum regarding NCD risk behavior.
Encourage partner organizations to develop a system to facilitate and support NCD risk behavior reduction programme.
Strategy 4: Achieve excellence in the priority areas of research in community context in order to the hard-to-reach population imparting on community-based interventions
Activities:
Provide messages to the community on preventive measures against NCD risk behavior Dissemination of information through social media (face book, twitter etc) Incorporate NCD risk behavior reduction into the existing cultural and social development
programmes. Launch the communication programme in research, monitoring and evaluation
Strategy 5: Formulate appropriate policy and legislation through review the existing onesActivities:
Design the appropriate legislation and regulatory framework to reduce the NCD risk behavior Make partnership and build alliances with government's ministries, local administrations, private
sector, non-governmental development partners, professional associations, media, and international organizations and civil society to formulate a effective legislation
Review the health impact and strengthen the implementation and enforcement of the existing health and other policies, legislations and regulations.
Develop additional policies, legislations regulations and laws to support NCD risk behavior reduction management, prevent health risks, promote health and create supportive environment for health.
Review the law for additional taxation on products that harm health, such as alcohol and tobacco and also on vehicle insurance by the Government
This communication strategy is an interwoven approach with different methods of communication considering programs and sound formative assessment, social norms, services and commodities attributes.
Approaches for communicate
The approaches depend on analysis of the target and predicted groups.
A. Issue Based Approach- which promotes healthy practices on specific issues in the areas of diet and nutrition, physical activity, harmful use of tobacco & alcohol to prevent major common NCD risk factors.
B. Population Based Approach- which seeks to promote healthy populations, such as children, adolescents, women, the elder, workers to prevent major common NCD risk factors.
C. Setting Based Approach- which is associated with promoting healthy settings, like cities, villages, districts, workplaces, markets, schools, hospitals and other places to prevent major common NCD risk factors
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5. Implementation Plan Implementation of a successful Communication Plan depends on concerted efforts by all the responsible person of a program. Government, development partners, implementing NGOs and other key stakeholders should work together to ensure allocation of resources, including quality supplies as per demand generation, in order to contribute in reduction of NCD risk factors. However, coordination and integration of the approaches of all the stakeholders is a must for optimum success.
The Implementation Partners include:
A. Government:
Ministry of Health and Family Welfare (MOHFW), Directorate General of Health Services (DGHS), Bureau of Health Education (BHE) of DGHS, Information, Education and Motivation (IEM) of Directorate General of Family Planning, Ministry of Information (Department of Mass Communication, Bangladesh Television and Bangladesh Betar), Ministry of Education, Ministry of Primary and Mass Education, Ministry of Local Government, Ministry of Social Welfare, Ministry of Youth and Sports, Ministry of Food, Ministry of Agriculture, Ministry of Commerce, Ministry of Finance, Ministry of Women and Children Affairs, Ministry of Law, Ministry of Industry, Ministry of Home, Ministry of Religion, Ministry of Cultural Affairs, NIPSOM (National Institute of Preventive and Social Medicine), NIPORT (National Institute of Population Research and Training) and various other relevant departments.
B. Other Partners
NGOs (National & International), Donor Organization, Private Sector and Community Based Organisations (CBO)
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6. Monitoring and EvaluationThe success of the program will require a systematic approach to monitoring and evaluating the progress of work. A monitoring and evaluation system will be developed to ensure the collection of the monitoring and evaluation data and anticipate how the information will be used for decision-making. The monitoring and evaluation system will specify what data is needed for each indicator, the source of data and the method that will be used to collect it, the frequency of data collection and the responsible person for collecting the data, the types of analyses to be carried out and how the data will be disseminated and used.
Monitoring is the process of establishing checkpoints to make sure the activity is on the right track according to the plan. This needs to establish a system for recording, on a regular basis, useful information for keeping track of the activities and progress being made towards the set objectives. At the end of the planning and implementation process of each program, it is necessary to evaluate the overall impact of the intervention in order to assess the degree of success or failure.
Implementing Stage of Monitoring & Evaluation
Midterm Monitoring (through DGHS, BHE & MoHFW): According to the protocol it will conduct and reconsider the strategies success for revision and improve the process by mid of 2015.
End term Monitoring (Monitoring through DGHS, BHE & MoHFW): According to the protocol it will conduct and measure the success of communication program at the end of third year.
Evaluation: The final evaluation of the program will be evaluated by National Board which will be formed with the help of group of experts
Once all the activities of the communication program have been implemented, it is needed to be seen what have been their practical effects in the field. What change was brought about by the communication strategy being implemented? In this plan, the program will include a baseline survey to establish the initial status of outcome indicators. In addition to the baseline survey, the program will provide for mid-line and end-line evaluations to determine the programs progress towards achieving the overall goal and objectives in light of the baseline survey findings. The baseline, mid-line and final evaluations will be carried out by an independent research firm with the supervision of the research unit. The evaluation process can be held in a monthly, quarterly or annual basis.
The program will also include formative research, using generally recognized and validated testing instruments, to pretest electronic and print materials. The objective of the pretest exercise will be to check whether language, words and messages are attractive, comprehensive, culturally and socially resistance, relevant to the audience, and believable. Qualitative methods will be used to pretest the materials.
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7. Acknowledgements
The Bureau of Health Education on-behalf of the Ministry of Health & Family and Social Welfare Bangladesh wishes to expresses its appreciation for the support rendered by the different players in planning, developing and finalizing this National Strategic Communication Plan to reduce NCD high risk behaviors 2014-2016.
Thanks to Kazi Rumana Ahmed for taking the challenge to prepare this strategy first ever in Bangladesh. The support, suggestions, comments, and guidance, as applicable, provided by the following persons are duly appreciated and acknowledged:
Professor M A Faiz, Former DGHSDr. A K M Jafur Ullah, DGHSProfessor Dr Abul Kalam Azad, DGHSProfessor Hajera Mahtab, BIRDEMProfessor Mahmudur Rahman, IEDCR Dr. M Mostafa Zamman, WHO, BangladeshDr. Md Nazmul Karim, WHO, BangladeshDr. Mahfuzur Rahman Bhuiyan, WHO, Bangladesh
Reviewers of the document:
Professor Khurshida Khanom, BIHSProfessor Tofail Ahmed, BIRDEMDr. Jahanara Begum, NIPSOMMr. Mohammad Shahjahan, BCCPDr. Suvajee Good, WHO/SEAROProfessor Sohel Reza Choudhury, NHFH & RIDr. Habibullah Talukdar, NICRH
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8. References
1. Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation, WHO technical report series 916; Geneva 2003.
2. Alwan A, Maclean DR, Riley LM, d'Espaignet ET, Mathers CD, Stevens GA, et al. Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. Lancet. 2010 Nov 27;376:1861-8.
3. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization; 2011.
4. Strategic plan for surveillance and prevention of non-communicable diseases in Bangladesh 2011-2015. World Health Organization; 2011 [Available at: http://www.searo.who.int/ bangladesh/publications/strategic_plan_ncd/en/]
5. The public health impact of noncommunicable diseases in the western pacific. World Health Organization. Available at http://www.wpro.who.int/NR/WHO_NCD_RAP_02.pdf.
6. High-level Meeting of the United Nations General Assembly on Non-communicable Diseases, Geneva: World Health Organization; November, 2010.
7. World Health Organization, WHO NCD Surveillance Strategy. Available at http://www.who.int/ncd_surveillance/strategy/en/print.html>.accessed on 22 Oct 2010
8. Bangladesh NCD Risk Factor Survey 2010. World Health Organization; 2010 [Available at: http://www.searo.who.int/bangladesh/publications/ncd_risk_factor_2010/en/]
9. Zaman MM, Perucic AM, Rahman K(eds). Impact of tobacco-related illnesses in Bangladesh. SEARO, New Delhi, World Health Organization, 2007. [Available at: http://www.intranet.searo.who.int/ LinkFiles/Tobacco_Free_Initiative_Health_Cost_bangladesh.pdf]
10. Global strategy on diet, physical activity and health. WHA55.23. Geneva: World Health Organization; 2002
11. Magnus P, Beaglehole R. The real contribution of the major risk factors to the coronary epidemics: time to end the 'only-50%' myth. Arch Intern Med 2001; 161:257-60
12. Global Report on preventing chronic diseases: a vital investment. Geneva: World Health Organization; 2005.
13. Prevention and Control of Noncommunicable diseases: Fifty-first session of the WHO Regional Committee for the Western Pacific; 2000 Sep 18-22; Manila, 2000.
14. Global strategy to reduce the harmful use of alcohol. WHA63.13. Geneva: World Health Organization; 2010
15. Guide to Health Promotion and Disease Prevention Family Health Teams, Advancing Primary Health Care Jan 16, 2006. Available at http://www.health.gov.on.ca/en/pro/programs/fht/docs/ fht_health_promotion2.pdf.
16. Rimal RN, Lapinski MK. Why health communication is important in public health. Bulletin of the World Health Organization 2009; 87:247-a.
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Annexure 1Communication Log Frame
SL No Strategy ActivityYear
1Year
2Year
3Responsible
PartnersTarget
audiences Process
indicatorsOutput
indicators Outcomeindicators
Advocate and strengthen this strategy in order to reduce NCD high risk behaviors
Establish a consortium at national and district levels for reduction of NCD risk behavior comprising of members from multi-sectors. The consortium will develop an NCD risk behavior reduction mechanism to support NCD risk behavior reduction Policy. Develop Health
Promotion Foundation to coordinate to implement this strategy Arrange Media
coverage on policy dialogue on NCD risk reduction behavior Organize national
campaigns for reduction NCD risk behavior Organize individual
based advocacy programs to encourage to reduce the NCD risk behavior Sensitize religious
leaders, teachers, community opinion leaders, UP chairman and members to mobilize for reducing NCD risk behaviors
Multi-sectoral Policymakers, Development
partners Members of the
Parliament High Officials such
as Secretary, Additional Secretary etc from relevant ministries Multi-sectoral
Service Providers at national, divisional, district, upazilla and field levels NGO Affairs
Bureau Programme
Planners
National GoB officials Mid and senior
level representatives of private sector stakeholders including NGOs and private practitioner Media personnel
at national and local level Development
partners (bilateral and UN agencies), professional bodies and research institutions
Advocacy meeting Sensitization
meeting with partner organizations Workshops in
districts with stakeholders and implementing partners Orientation
sessions Monthly
Coordination Meetings Disseminating key
messages through mass media
Information package consisting of
- file folder, - brochure, Press stories/
newspaper articles Projector
presentation SMS for mobile
phone Dissemination
of bulletin and information
This strategy will strengthen the advocacy system and will ensure the involvement of policy makers in NCD risk behavior reduction program
1
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Guide to design and develop appropriate tools/methods, suitable for target audiences through effective translation of knowledge and research at a national level
Formulate IEC and BCC materials for reducing NCD risk behavior Create IT network to
disseminate NCD risk reduction messages to population Develop effective tools
for health campaign at the community level To invent student
friendly materials for school awareness programs Develop media
(including the electronic, the latest ICT based technology and WWW) and audience specific messages for different population groups, settings and issues Develop radio listeners
forum of NCD risk behavior reduction in the community Develop promotional
materials to disseminate messages on NCD risk behavior Organize formal and
informal meetings to disseminate educational information on NCD risk behavior
Increase knowledge and awareness of media personnel regarding NCD risk behavior
Ministries of Health and Family Welfare, Education, Women and Children Affairs, Religious Affairs, Social Welfare, Information Print media
personnel of the national and local dailies Electronic media
personnel from TV and radio, including national and private channels Journalists both at
the national and local levels Program Planers NGOs Partners Other Professional
Bodies & Institute
Community Health Workers (CHW), community volunteers, HA, FWA, HI, & NGO field workers Community
influential (UP Chairman, female members, Imams, teachers), Community Clinic Village
practitioner Nurses
New print materials to promote consistent messages about NCDs risk behavior: leaflets, poster, banner, stickers, T shirts & Umbrella Advocacy package
including - DVD, Song, Banner, Poster, Leaflets, Stickers, T-shirt Web portals Radio spots with
NCDs risk behavior theme song Interviews Text messages to
key stakeholders Color newspaper
advertisement and key messages about NCDs risk behavior reduction TV Talk shows
featuring policymakers Arrange for media
coverage on 'Policy Dialogue" and 'Roundtable'
No of TV spots broadcasted Radio spots
every day on all local and national radio stations No of all health
chiefs, village volunteers and village chiefs to deliver messages No of
documentary, short films developed No of Press
conferences conducted No of materials
produced No of products
distributed, for example T-shirts for village volunteers and health staff No of distribute
advocacy package and demonstrate use of materials at village level
New and effective materials will be developed, suitable for target audiences
2
22
Build capacity of all personnel at all levels through training on communication strategies by the appropriate personnel
Individual capacity building Introduce fellowships,
competition and awarding system for institutions and accreditation system. Training of service
providers on NCD risk behavior within the heath sector as well as in other sectors and associated NGOs Training of master
trainers followed by cascade training reaching up to the grass root level Fully utilize the
existing personnel for NCD risk reduction. Support professional
development and training opportunity for personnel working on health promotion.
GoB and NGOs Partners Other Professional
Bodies & Institute
National GoB officials Mid and senior
level representatives of private sector stakeholders including NGOs and private practitioner Media personnel
at national and local level Development
partners (bilateral and UN agencies), professional bodies and research institutions §Community Health Workers (CHW), community volunteers, HA, FWA, HI, & NGO field workers
Arrange media coverage of observation of National and International Days Develop TV spot
No of VCD/ DVD and cassette tapes copied for all health facilities that have TV/ video and cassette tape player No of products
distributed No of materials
produced No of events held
Training conducted by skilled trainer Advocacy
workshop held Orientation held A comprehensive
curriculum developed Training for health
staff Village volunteer
training using updated curriculum and
tools Training for
Institutional staff Advocacy
workshop held with private clinic providers, village doctor and other service providers Ongoing online
mentoring
No of Training conducted No of Advocacy
workshop No of
Orientation No of
comprehensive curriculum No of Village
volunteer training No of Training
for Institutional staff
This strategy will build capacity of all personnel at all levels
3
23
Achieve excellence in the priority areas of research in community context in order to the hard-to-reach population imparting on community-based interventions
Organizational capacity building Build network with
existing health care system of Government and develop infrastructure facilities of Health institutions Train institutes such
as medical colleges, nurses' training institutes etc. may exchange expertise, gather updated information and to have uniform course curriculum regarding NCD risk behavior. Encourage partner
organizations to develop a system to facilitate and support NCD risk behavior reduction programme.
Provide messages to the community on preventive measures against NCD risk behavior Dissemination of
information through social media (face book, twitter etc) Incorporate NCD risk
behavior reduction into the existing cultural and social development programmes.
Research and development Division of the program Other Professional
Bodies & Institute
Community influential (UP Chairman, female members, Imams, teachers), Community Clinic Village
practitioner Nurses
Women, Men, Children, Youth, Student (School, college, madrasa, university), Senior Citizen
Problem identification Protocol design Questionnaire
development & data collection Data analysis, data
interpretation & dissemination of result One on one
counseling (IPC) & home visits Focus group
discussion
No of problem identify No of protocol
design No of
questionnaire development No of
arrangement for the data collection
Proportions of Individuals aware of major NCD risks. Proportion of
Individuals' conscious about their eating habits and physical activity.
4
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24
Formulate appropriate policy and legislation through review the existing ones
Design the appropriate legislation and regulatory framework to reduce the NCD risk behavior Make partnership and
build alliances with government's ministries, local administrations, private sector, non-governmental development partners, professional associations, media, and international organizations and civil society to formulate a effective legislation Review the health impact
and strengthen the implementation and enforcement of the existing health and other policies, legislations and regulations. Develop additional
policies, legislations regulations and laws to support NCD risk behavior reduction management, prevent health risks, promote health and create supportive environment for health. Review the law for
additional taxation on products that harm health, such as alcohol and tobacco and also on vehicle insurance by the Government
GoB and parliament members
All level of personnel
Advocacy meeting Sensitization
meeting with partner organizations Workshops in
districts with stakeholders and implementing partners Orientation
sessions Bill formation for
the ministry Bill approval from
the ministry Draft Bill
documentation for the civil society Bill review &
approve by the parliament Review &
amendment the existing law & regulation
No of advocacy meeting No of
sensitization meeting No of
workshop for the bill No of file
processed for the bill No of
correction produce for the bill No of opinion
from the expertise No of
comments from the reviewers & civil society No of
amendment and pass the bill in parliament
New Laws and regulation will be established Amendment
the existing law
5
Launch the communication programme in research, monitoring and evaluation
Courtyard meetings with target groups to provide correct information
Proportions of individuals aware of tobacco and alcohol harms.
26
Annexure 2Responsible Organization for the control and prevention of risk factors of NCDs
Risk Factor Ministry
Tobacco
Unhealthy Diet
Harmful use of Alcohol
Physical activity
Ministry of Education
Ministry of Primary and Mass Education
Ministry of Local Government
Ministry of Information
Ministry of Health & Family Welfare
Ministry of Youth and Sports
Ministry of Agriculture
Ministry of Food
Ministry of Commerce
Ministry of Finance
Ministry of Women and Children Affairs
Ministry of Law
Ministry of Industry
Ministry of Religion
Ministry of Science & Technology
Ministry of Home
Note: Various other relevant departments, organizations and other partners will be included for reducing the NCD risk behaviors.
Accumulation of NCD high risk factors through life course
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