Chapter 18: Health Promotion and Communication
White Paper for the Transformation of the Health System in South Africa

1. Background and Introduction

Health promotion and communication activities must be seen within the context of apartheid. Political and economic policies were designed to preserve the power and privilege of a few. This resulted in a health system that was inappropriate, unequal and unsympathetic to the needs of the overwhelming majority of the population. Combined with mass-scale poverty, a lack of proper housing, and low levels of literacy, these policies directly impacted on people’s health status.

The new National Health System aims to promote effective health and communication strategies which would support community action, skills development and the building of healthy social and physical environments. The new health promotion strategies are aimed a creating an environment within which people can make better and informed health choices.

2. Guiding Principles

The strategy for health promotion and communication will be based on four principles:

• The integration of health promotion and communication into the National Health System;
• The alignment of health promotion activities with the Ottawa Charter;
• The establishment of partnerships with all stakeholders, especially communities themselves;
• The provision of information to all people on health policy, new health initiatives, and their health rights and responsibilities.

3. Implementation Strategies

3.1 Integrating Health Promotion and Communication into the National Health System

Structures will be established at the national, provincial and district levels to facilitate the planning, implementation, co-ordination, monitoring and evaluation of health promotion and communication activities. Particular attention will be given to the needs of children, youth, women and other vulnerable groups.

At the national level: A Health Promotion and Communication Directorate will be established. Its main functions are to co-ordinate and support health promotion initiatives. In consultation with the provinces, it will develop criteria for setting national health promotion priorities, including training and capacity building.

At the provincial level: The health promotion team will be responsible for co-ordinating, facilitating and supporting health promotion activities, including monitoring and evaluation.

At the district level: District health promotion activities will be based on the community development model, working in collaboration with RDP and local initiatives.

3.2 Aligning health promotion activities with the Ottawa Charter

Health public policy, such as food labelling and taxation on the sale of tobacco and alcohol will be promoted amongst all South Africans.

Smoke free environments, safe workplaces and safe play areas for children will be created to stimulate healthy behaviour.

Communities will be encouraged to take responsibility for their own health.

Basic health, personal and social educational programmes will be developed in the formal and informal education sectors.

Health services will be reoriented to be more accessible and appropriate to people’s needs.

3.3 Establishing Partnerships with Key Stakeholders

Communities, government departments, the NGO/CBO sector, the business community, the education sector, trade unions and mass media will be mobilised to work in partnership to resolve major health problems.

3.4 Building Capacity to Provide Information on Health-related Matters

Capacity Building and Training: All health personnel will undergo training in health promotion and communication. Short and long courses will be provided at undergraduate and postgraduate levels in suitable institutions, enabling health promoters to work in all areas of the country.

Research: Research capacity to support health promotion and communication will be developed. In this regard, the National Health Information System (NHISSA) will be used to provide baseline information.

Communication: Innovative, culturally acceptable, gender-sensitive and participative communication methods will be used. Special methods will also be developed to reach people with special needs or those who are illiterate.

4. Some Issues Raised

• It is unclear what the specific strategies are to achieve the objectives set out in the chapter.

• For example, how will communities be encouraged to take greater responsibility for their own health? How will health promotion activities dovetail with other health initiatives such as the development of a patient’s/ health rights charter? How will communities be mobilised to become more involved in the resolution of major health problems? What are the time frames envisaged for each of these goals?

• International research indicates that women have a critical role in the promotion of health activities. Are there any plans to increase the role of women in health promotion and communication activities? How will women, especially rural women, be accommodated in a human resource development plan?

• Throughout the chapter no mention is made of the invaluable and selfless contribution of community health workers. What role is envisaged for them? What are the envisaged strategies to draw on the insights, experience and skills of community health workers in the development of research agendas, for instance?

• No mention is made of how health promotion and communication activities would be monitored and evaluated.

For more information, please contact Bea Abrahams by telephone at (021) 6964954, by fax at (021) 6969308 or by e-mail at philaw@wn.apc.org . The PHILA programme is supported by a grant from the Henry J. Kaiser Family Foundation.

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