Health communication has achieved a distinguished identity in the discourse of Media and Development since health care is a vital indicator of development. ‘Health is both a public and merit good and Health care being so basic to the well-being and productivity of society, access to it needs to be universal’[i]. The international agencies actively working on healthcare, hygiene and sanitation emphasize the importance of effective health communication strategies to achieve their objectives. Health communication is intended to bridge the knowledge gap in the healthcare practices and to promote positive action to make the people healthy. ‘Communication that is engaging and empowering, and provides individuals and populations with evidence-based options for positive action is critical to enhancing health literacy in society, thereby enabling its movement towards better public health outcomes’. [ii]
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In India, since independence there are significant efforts to sensitize people on the health issues. In these endeavours, the public service broadcasting (All India Radio and Doordarshan) has contributed commendably, as paying special attention to health and family welfare is one of the established objectives of Prasarbharati. At the same time, our country has pitiable records in the health care index in terms of international standards. In this context, this study critically explores the role of the Public Service Broadcasting in India within the historical and functional perspectives of Health Communication.
Role of PSB in the Development Discourse
Generally, the market driven media scenario is highly reluctant to take the development issues seriously. P Sainath (2007) says, “The fundamental characteristic of our media is the growing disconnect between mass media and mass reality.” That is why India’s majority of the population doesn’t make news. The mass media which are funded and controlled by advertisers would only remain loyal to them. As Chomsky and Herman (1994) puts it in their propaganda model, the media effectively serves elite interests in terms of selection and distribution of topics, framing of issues, disparity in emphasizing, and the filtering of information.
We can’t forget that the beginning of Television in India was literally in the name of development. When television was introduced in the country in 1959, it started as an experiment in social communication for which small teleclubs were organized in Delhi and provided with community television sets. Educational television began in 1961 to support middle and higher secondary school education.[iii]
In this context, the Public service broadcasting must aim at enhancing new social environment, reaching out people enriching their lives and seeking communication that provides the warmth of human contact. Public service broadcasting is aiming at the improvement of respect for social, political, cultural and traditional values (Pati: 2004).
A strong PSB can play an important role in today’s competitive and complex broadcasting market. In a world of many channels, it is found that a PSB is at its most effective when it only broadcasts a distinctive schedule, but also exerts a pressure on its commercial competitors to do the same. While government regulation of commercial braodcasters can achieve some of these aims, the PSB model is the preferable approach, it combines creative and market pressures on broadcasters to achieve society’s aims for its broadcasting market. (Sahay: 2006)
Health Communication – Policy Frameworks in India
The National Health Policy (NHP) – 1983 re-emphasized Informing, Educating and Communicating (IEC) as the core communication strategy. NHP 2002 reiterated the importance of IEC. The document commented, ‘A substantial component of primary health care consists of initiatives for disseminating to the citizenry, public health- related information’. The National Population Policy (NPP) – 2000 urged to utilize radio and television as the most powerful media for disseminating relevant socio-demographic messages. The document says ‘Government could explore the feasibility of appropriate regulations, and even legislation, if necessary, to mandate the broadcast of social messages during prime time’.
Campaigns for Family Planning
In the case of Health communication, the threat of the ever bulging population was the first issue that was addressed by the media experts. In fact, India was the first country in the world to announce an official Family Planning Programme. During the inter plan period of 1966-1969, Family Planning department carved out a unit in the form of Mass Education and Media Unit in 1966. Simultaneously, the media units of Information and Broadcasting Ministry were strengthened for Family Planning communication. The scheme started with the concept of a small family and the raging slogan was, Hum do Hamare do (‘we two and our two’) and vigorously telecasted through DD and AIR.[iv]
Satellite Instructional Television Experiment (SITE)
SITE is a social development initiative in India and one of the most extensive educational and social research project ever conducted in mass mediated communication. The effectiveness of TV as a medium for educating the masses in rural areas was emphasized by this experiment. With the help of NASA, UNDP, ITU and UNESCO, the Indian Space Research Organization (ISRO) launched SITE on August 01, 1975. Development oriented programs like agricultural modernization through hybrid seeds, better farming methods and management, family planning, public health, social and educational improvement of women and children, better learning and teaching methods were transmitted through the satellite to community TV sets in 2,400 villages in 20 districts spread across the six Indian states of Andhra Pradesh, Bihar, Karnataka, Madhya Pradesh, Orissa and Rajasthan. The experiment ended on July 31, 1976.
Doordarshan – Development Communication Division (DCD)
Definitely Doordarshan can be the vital player in the Health Communication arena of our nation as its present coverage is 79.1 per cent of the geographical area and 91.4 per cent population of the country. Further in the bouquet of Doordarshan DTH service (DD Direct Plus) there are 36 TV channels and 20 Radio channels and it is a free to air service.[v]
Doordarshan set up in 2001 a Development Communication Division (DCD) to discharge its social responsibility of highlighting development-oriented issues and to cater to the communication needs of government departments and public sector undertakings. Until 2001, small amounts received from government departments were used to commission private producers on behalf of the clients. Development Communication Division revived in-house production of all such campaigns using available manpower and resources.
Health Communication: The Indian Stories
With the emergence of colour Television, communication experts, media professionals and practitioners started exploring this attractive medium inspired by the Mexican experiment and broadcasted the teleserial Hum log (‘we people’) from 1985-85 addressing issues like gender inequality, health, alcoholism and family planning. [vi]
In India, two examples of successful health communication that had considerable impact are Polio and HIV. In either case, a host of agencies worked together to develop a multi-pronged strategy led by communication professionals. This helped in creating multiple strategies that were used to engage diverse audiences. Polio messaging for example was built on simple idea — two drops that could save your child’s life. This message was everywhere — from print, TV and radio.
In polio eradication, India has implemented proven strategies and developed innovative approaches to reach and immunize children in hard-to-reach areas. Communication strategies have contributed to such progress on several levels by: mobilizing social networks and leaders, creating political will, increasing knowledge and changing attitudes, ensuring individual and community-level demand, overcoming gender barriers and resistance to vaccination, and, above all, reaching out to the poorest and the most marginalized[vii].
HIV was perhaps India’s most complex disease communication exercise. The HIV program managers within the government understood the importance of prevention and sought help from external agencies creating what was perhaps the most elaborate and effective health communication campaign in recent history. An important aspect of this campaign was it consciously focused on being entertaining and connecting with the audience[viii]. The multimedia campaigns by relaying on TV and Radio and the coverage of such issues by PSB make the health communication prospects further brighter.
Since May 30, 2002, the Kalyani series has focused on malaria, tuberculosis, iodine deficiency, blindness, leprosy, cancer, HIV/AIDS, reproductive and child health issues, tobacco related and water borne diseases and food safety and telecasted on Thursdays and Mondays at 6:30 p.m. to 7:00 p.m. and repeated on Fridays and Tuesdays. Kalyani targets almost half the population of India, in the nine most populous States with the poorest health indicators. Kalyani is telecast by the nine capital Doordarshan Kendras – Bhopal, Bhubaneshwar, Dehradun, Guwahati, Jaipur, Lucknow, Patna, Raipur, Ranchi and 12 sub regional kendras[ix]. The programme is produced in partnership with the Ministry of Health, Ministry of Family Welfare and the National AIDS Control Organization (NACO).
As a result of the programme, Kalyani Clubs have sprung up in various parts of the country to spread the message of good health. The concept of Kalyani clubs with membership of local people of the village who watch the programme avidly and strategize on how to implement the health messages was a crucial part of the communications strategy. At present, there are more than 3063 Kalyani Clubs across the country with more than 78965 members till August 2010. Club members organise dance programmes and plays on various health issues. The performances provide information to patients, providers and the community in an entertaining way. These performances are telecast on Doordarshan as a part of the Kalyani episode, spreading awareness amongst a larger audience.[x]
This programme has made a significant impact on the target audience as is evident from the reported attitudinal change and social activism. Children, and women, who are among the members of “Doordarshan Kalyani Clubs”, are taking the television messages further through inter-personal communication and social activism. The Kalyani campaign bagged the prestigious “Gates Malaria Award” of the Commonwealth Broadcasting Association in 2004 and is also the only media programme to be in WHO’s top 15 innovations list.[xi]
This publicity campaign of Ministry of Health & Family Welfare continues to be on the top of the chart with an investment of Rs. 190 crores and is telecast from 30 Kendras in 20 languages and 3 dialects. It is telecast with the title “Swasth Bharat/Healthy India/Arogya Bharatam”.
The campaign is the initiative of Ministry of Drinking Water and Sanitation, Govt. of India which is telecast on DD National with an investment of Rs. 45 crores in the financial year 2012-13.[xii]
All India Radio
Having higher reach in terms of population and the geographical area, All India Radio had been the forerunner in the process of implementing Health Communication strategy being adopted by the government. AIR one of the as the largest radio network in the world is the only mass medium which is accessible to both rural and urban audiences in plenty. Radio also provides series of special audiences programmes on variety of subjects including health management even in the age of television revolution. At the same time, the time, duration, coverage and quality of health education programmes are not appreciated by the people in large number.
The Critique of Health Communication Initiatives in India
Health Communication from the functional perspective explores four key factors – an analysis of the health related issues, devising strategies to communicate them with the people, implementation and evaluation. A critical appraisal of this approach reveals that, there are some losses due to the process of group decision making and implementation.But many of the health related media campaigns in India lack the cohesion of all these components.[xiii]
There are also certain accidental slips occurred in the health communication scenario in India – First, the communicators could rarely view engaging the most vulnerable creatively and contextually on health issues as a priority and secondly the overly medicalized approaches to health care. These healthcare communication activities are supervised not by communication professionals but by doctors who understand and know less of health communication. Moreover, health messaging is viewed as a soft aspect of public health programming. ‘Real’ doctors are reluctant to do health communications.
A Critical analysis of Comprehensive communication strategy for RNTCP suggest that the main television channels does not reach the poorest and expensive to produce and most disadvantaged groups though they reach to communities on a large scale. The local television channels reach to communities through their dialects but it is limited.
The government controlled media has been more or less toeing a centralized form of communication. AIR (All India Radio) during its initial days formulated its communication policies in Delhi and got it translated to the various languages for dissemination. The irony was that it never even looked at the regional variations of the problems. To cite an example, every year, the government observes the first week of August as “Breast Feeding week” to emphasise on the importance of Breast Feeding for the new born as well as the lactating mother. The government media goes overboard with the campaign. Whereas, in India the people of the Northeastern part needs no campaign as all mothers breast feed their babies instinctively. Hence spending so much of valuable transmission time on such campaigns for these areas could never elicit any result[xiv].
Coming to the rural population of India, a widely prevalent but deeply flawed belief is that the poor and the vulnerable population do not care about their health and well-being. The prime objective of health communication is to expose this myth. In fact the vulnerable populations absorb health information well, if it is relevant, localized, integrates well with current cultural and social situations and is entertaining.
[i] Article 25, Universal Declaration of Human Rights – 1948, The United Nations
[ii] Health Communication: (Knowledge to Action – Public Health Foundation of India, 2011-12
[iii] Rommani Sen Shitak, TELEVISION AND DEVELOPMENT COMMUNICATIONIN INDIA: A CRITICAL APPRAISAL, Commentary – Global Media Journal – Indian Edition/ISSN 2249-5835 Winter Issue / December 2011Vol. 2/No.2.
[iv] Suresh K., Evidence based communication for health promotion, Indian Journal of Public Health. Oct-Dec, 2011
[vi] Bulletin of the World Health Organization, 2009
[vii] Rafael Obregón, Ketan Chitnis, Chris Morry, Warren Feek, Jeffrey Bates, Michael Galway & Ellyn Ogden, Achieving polio eradication: A review of health communication evidence and lessons learned in India and Pakistan, http://www.who.int
[viii] Chapal Mehra, Why Health Communication is Important, The Hindu, 3 January 2013
[ix] Kalyani News Letter, Vol.IV, July 2006
[x] A Health Communication Strategy for RNTCP, Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India & DANTB, 2008
[xiv] Dr B P Mahesh Chandra Guru, Sapna M S&Madhura VeenaM L, Health Education In India.
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