By Fredrick Echeku and Shehrbano Jamil for ReLAB-HS
Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) is building leadership and scalable, evidence-based approaches to integrate rehabilitation and assistive technology (AT) into health systems. However, new services cannot reach their full potential without demand from communities. So, how do we make sure people in the community know what rehabilitation and AT services are, and where to find them?
ReLAB-HS is addressing this challenge through Social and Behavior Change Communication (SBCC) strategies in Uganda and Pakistan. ReLAB-HS has worked with national and sub-national experts, including government stakeholders, to design comprehensive SBCC materials. Collaborators used the Human-Centered Design (HCD) process to ensure messaging reflects local health priorities and aligns with new rehabilitation and AT strategic plans, fostering a strong sense of local ownership. Co-design workshops, informed by HCD, emphasized using a mix of “channels” and materials to ensure persuasive messages reach as many people as possible.
Ugandan collaborators critically assessing SBCC materials in pre-testing. Photo courtesy of Fredrick Echeku for ReLAB-HS
New multimedia materials, such as posters, flip charts, radio spots, and simple handbooks, have been launched alongside other ReLAB-HS-supported activities. The materials intentionally target different stakeholders at different health system levels to comprehensively address gaps in the supply of and demand for rehabilitation and AT services. In short:
For consumers – Radio and TV spots, along with visual posters and information sheets, address the knowledge gap, “What is rehabilitation, and who can benefit from it?” These materials account for the diversity of consumer needs to ensure available services are represented.
Excerpt from Uganda radio spot script. Image courtesy of ReLAB-HS
For health workers – Decision-making support consistent with World Health Organization (WHO) frameworks and training, such as “on-hand” information like decision-support and referral pathway flip charts, helps health care workers deliver quality services. In Pakistan, Lady Health Workers (LHWs), the country’s cadre of community health workers, have been provided simple visual and text-based resources to engage community members and shift perceptions about rehabilitation.
For health leaders – Equipping health leaders with clear talking points and basic, consistent messaging about rehabilitation and AT “demystifies” what these services entail. Policy briefs on reimbursement for assistive products and AT regulation are just two examples of evidence-based, practical messaging for health leaders.
In Uganda, where there is an effective national clearinghouse for health messaging, ReLAB-HS has benefitted from knowledge exchange with other health fields, learning from good practice in the health areas of HIV, malaria, and others that have been transformed by the power of health communication. But as one rehabilitation collaborator put it:
“Rehabilitation is new, we are not at the same level of community awareness like Malaria and HIV where the community sees a mosquito or needle on a logo, and everybody knows what you are talking about.”
Targeted messaging for various audiences across the health system levels and the community at large requires creative thinking and cultural relevance. In Pakistan, ReLAB-HS collaborated with diverse stakeholders at the national and provincial levels to design culturally appropriate posters in local languages to share with communities. Key contributors included governing and regulatory bodies, such as the Ministry of National Health Services, Regulations, and Coordination and the provincial health departments of Khyber Pakhtunkhwa and Sindh, health care provider groups that specialize in rehabilitation and AT services, rehabilitation research and training institutions, and user advocacy groups.
A culturally relevant poster translated into local languages for communities in Pakistan. Image courtesy of ReLAB-HS
What have we learned so far?
ReLAB-HS offers the unique opportunity to compare diverse contexts, such as those in Uganda and Pakistan, which can reveal both good practice and implementation barriers. For example, Pakistan’s decentralized health system has required a more targeted, localized approach to deploying an SBCC strategy, rather than a national rollout. To support this, ReLAB-HS developed tailored SBCC materials on rehabilitation and AT for community-based organizations, which, in turn, disseminated this information within their communities. This approach reflects the cultural distinctions within Pakistan, including how people relate to health care overall, and to rehabilitation and AT specifically.
To understand the combined effects of its system-wide interventions—policy reform, workforce capacity strengthening, and locally adapted service delivery models—ReLAB-HS measures a range of outcomes. These include the quality of services and integration with local systems, the quantity of referrals made, and rehabilitation and AT services provided at the primary care level. None of these outcomes are possible without improving community awareness and support for rehabilitation and AT.