Health Communication Insights: The Role of Communication in Vietnam's Fight Against Tuberculosis

Published by the Health Communication Partnership (HCP), this 30-page report examines Vietnam's use of health communication as an integral component in its successful efforts to turn back a mounting tuberculosis (TB) epidemic.

The World Health Organization (WHO) set a global target of detecting 70% of infectious cases and curing 85% of those by the year 2005 through the use of Directly Observed Therapy-Short Course (DOTS). According to an evaluation of the National Tuberculosis Control Program (NTP) for the World Bank, Vietnam achieved nationwide DOTS coverage in 1999, and, between 1997 and 2002, detected 82% of the estimated number of new infectious cases for the 6-year period and cured more than 89% percent of cases.

The question that structures this report is: how did the NTP address some of the barriers that have kept other countries from meeting the WHO TB goals? One key factor discussed here was high-level support for and commitment to meeting these goals. (In 1995, TB was designated a national health priority and given the resources and leverage to expand DOTS nationwide). However, the authors claim, it was strategic health communication, integrated into all levels of programme management, that played a central role.

Health communication was designed to change people's misperceptions (the Vietnamese once considered TB incurable and hereditary, which created stigma and discrimination that in turn led to barriers for reaching and treating TB patients) by providing accurate information about the causes of TB, sources of infection, how it is transmitted and what its symptoms are, how it is treated, and what can be done to prevent it. Specifically, the NTP's activities included:

• Advocacy - conducting seminars on TB prevention and control, establishing TB control steering committees at all levels, distributing fact sheets and letters to authorities and local leaders, providing information about TB to National Assembly members, working with journalists and reporters, organising study tours and inviting leaders to international conferences, creating and sustaining relationships with international organisations, holding public meetings in crowded locations, and including topics on TB in school curricula.
• Mass media - using entertainment-education strategies to raise awareness, legitimise the topic of TB, and motivate behaviour change. The NTP took advantage of the fact that, in Vietnam, all television, radio, and print belong to and function under the Government's control. "Since TB control was a government priority, as a result of effective advocacy, the NTP had easy access to mass media."
• Interpersonal communication and counseling - organising training courses on health communication and counseling skills for programme trainers in the provincial centres. The provinces then held training courses on communication skills for health personnel engaged in TB-related activities and village health motivators. The NTP developed and published training materials for workers at all levels.
• Community mobilisation - establishing partnerships with community-based organisations (e.g., the Farmer Association, Women's Union, Youth Union, Red Cross, and the Elder Association) to offer various activities for their members and the community. In the 5 provinces with TB hospitals, provincial TB centres organised a group of fully recovered patients (6-10 people) who received training courses on TB knowledge and communication skills. Once trained, they counseled other patients about TB and their experience in treatment. Provinces mobilised localities through Q&A sessions on TB, publication of reports, and competitions for schoolchildren.

The authors find that these communication strategies had significant impact. The National Institute of Tuberculosis and Lung Diseases conducted a cross-sectional study in 2002 in rural areas to evaluate knowledge, attitudes, and practices (KAP). The survey found high levels of awareness among the public and health care providers about TB symptoms and cure. For example, 80% of respondents knew that TB was a communicable disease and could list the basic symptoms; 100% of respondents knew that when someone has a detected case of TB, he or she should go to a health facility for medical care rather than buying drugs. As expected, the number of TB cases per 100,000 people increased dramatically as the programme expanded; this was a result of the
expansion of DOTS as well as the communication efforts that encouraged people to get tested if they had symptoms of the disease.

The report concludes with an analysis of lessons learned, including:

• Secure political commitment - for increased resources, leverage with donors, access to government-run media, and credibility with the public
• Integrate communication activities into all programme activities at all levels
• Make sure the clinical aspects of the programme are in place and functioning before initiating large-scale public communication activities
• Create partnerships at all levels to expand the reach and visibility of the programme and create a supportive environment for case detection and treatment
• Use a mix of communication channels, each of which should meet a specific need or engage a specific audience
• Make sure messages are clear and consistent - e.g., "TB affects everyone", "TB can be cured", and "Seek care if experiencing symptoms".
• Use public events to reach large numbers of people - organise parades and other communication activities each year on World Tuberculosis Day (March 24)
• Build on the country's or programme's strengths - Vietnam's high literacy rate meant that the NTP was able to rely on the print media and printed materials
• Create a system to monitor, evaluate, and measure progress towards the goal and communicate results to all levels.

Click here for the full evaluation in PDF format.

See also: "Health Communication Insights Summary: The Role of Health Communication in Achieving Global TB Control Goals - Lessons from Peru, Vietnam and Beyond" [PDF].