The communication Imperative

Chapter 2The Communication Imperative: Relationships in Education on HIV and TB

In health education, messages are developed so that they can be beacons of communication. It is because there is a breakdown of communication, or there are factors that strangulate communication, that giving the right message to the right person in the right way for the right results is important and has been the subject of many models of education on health in kenya, from Magnet Theatre to Peer Education. Organisations and consultants have used such frameworks as BCC (and now I am told ACSM) as the currency.

In this chapter, we are going to deal with the issue of relationships of key players in health education. It is easy to identify the following communication key players: the policy makers, the health workers, the patients, the care providers and the community. The communication barriers that exist between these groups are huge and have a cultural as well as historical bearing – depending on which community and the level of awareness and exposure they have on both TB and HIV. There are 10 generic relationships (grouped into six) to be addressed in message development for interventions in health education( see Figure 1 below)



Figure 1: The Relationships Matrix in Health Education. © kawive 08
(Though the framework was developed in 2008, the relationship notes were re-written in 2011.)

(a) Relationship 1: Policy makers and Health workers
This relationship constitutes a desired common planning, education and sensitization. The developers of policy must widely consult with health worker to harvest challenges and narratives from the actual implementation process. The challenges that health workers face must be addressed in policy and in designing of implementation initiatives.

(b) Relationship 2 and 3: Health workers and Patients
The patient, procedurally, (by design or default) discloses his or her status to the health worker. The expertise of the health worker endears him/her to the patient. Ideally, there is no other way.


The health worker must therefore have the requisite social skills to gain the confidence of the patient. This is important so that the patient is prepared to “share” his/her health situation. At the point of first exposure, the patient needs understanding and support from the health worker. That the health worker will know the results (or the condition) of the patient before the patient does not help matters. The health worker therefore must be prepared to “walk the journey” of health with the patient by providing both health care and health information. Of critical importance is confidentiality: if the health worker betrays this, the patient will most likely die of stress rather than of HIV or TB related illnesses.

(c) Relationship 4and 5: Patients and care providers

Both HIV and TB have elaborate care and support mechanisms that have been stipulated over time. Invariably, a relative or another person close to the patient will be required to provide this care and support. This person will of necessity have to get all relevant information on the illness and of the expected care and support. This is a second disclosure. It is important to understand that such a person is “affected” by the same disease and needs a lot more guidance on what to do or say to the patient during the course of the illness. How to protect the care giver form infection is critical information that should be given.

(d) Relationship 6 and 7: Care providers and the community

The community, consisting of contact persons, needs to be enlightened on two things: one, the cause, symptoms, spread, prevention and cure/treatment for both TB and HIV and AIDS. This is important to curtail the gossipy abandon of village wisecracks who know it all. Secondly, since both the patient and the care givers live in the community, it is important that the community knows what is expected of them. Where communities understand all that there is to know about HIV and TB, they will be most supportive of efforts aimed at cure, treatment, care and support. Where they do not understand, the community can easily isolate and demonise patients and care providers. Community members do understand that “they could be the ones” in the place of the patient. This is not blackmailing, it is reality.

(e) Relationship 8 and 9: the community and health workers

Health workers have a responsibility to take advantage of all opportunities (open days at the hospital, public meetings, opportunistic gatherings, community outreach sessions etc) to discuss with communities on various aspects of both HIV and TB. This is because health workers fall in the trusted category because of their expertise. The community on the other hand will provide the health workers and other intervention seekers with appropriate idiom, channel and forms that are effective in their context. Indeed most community members are willing to volunteer to take part in and shape interventions The health worker therefore give education on health and the community gives them education on communication.

(f) Relationship 10: patients and the Community

Though in the diagrammatic representation above the community has been located as an entity, it is important to note form the onset that all the other entities are part of the community – either of interests or of people. The patient is a member of the community and shares this space with the health care givers, other patients, the health workers and the policy makers. Yet the patient has a special role as a behaviour change agent, a motivator for sustaining of behaviour and as a pedestal of courage (where he/she discloses status) and of fortitude.

In developing and deploying messages, these relationships should be at the fore. They are the social dynamic of interventions and where they are not well handled, it is possible that the education initiative will achieve little if any results.

© kawive, wambua
Musings on Communication in Health. (Unpublished) Nairobi, 2008