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Zambia HL Manual Dec 2012 Lfs.Pdf Ministry of Health (MoH), Zambia and Lusaka District Health Management Team (LDHMT), Zambia Ndeke House P. O. Box 30205, Lusaka, Zambia Training and Research Support Centre (TARSC), Zimbabwe Box CY2720, Causeway, Harare, Zimbabwe Authors and citation: Loewenson R, Kaim B, (TARSC) Simamuna K, Zulu Lishandu I, Mbwili Muleya C, Chizema E, (MoH Zambia). (2012) Health literacy manual for people centred health systems: Zambia TARSC, Harare With grateful thanks to peer reviewers: Dr Catherine Mukuka (Health Consultant), George Sikazwe and Rose Masilani (MoH); to Lusaka District Health Team health literacy facilitators and community members for the pilot in Lusaka and Chibombo districts and to Cordaid Netherlands for financial support. All rights reserved. Redistribution of the material presented in this work is encouraged by the publisher, provided that the original text is not altered, that the original source is properly and fully acknowledged and that the objective of the redistribution is not commercial gain. Please contact the publisher if you wish to reproduce, redistribute or transmit, in any form or by any means, this work or any portion thereof. Photographs and graphics are covered by copyright held by the sources listed below each and permission must be sought from the copyright holder for use. ISBN: 978-0-7974-5237-4. Design and layout: M Bedingfield and Blue Apple Design Artwork: M Ndhlovu Photography: As accredited below photos Printed by: Ideas Studio Published by: Training and Research Support Centre © TARSC 2012 Foreword It is with pleasure and pride that the Ministry of Health presents the Zambia Health Literacy manual, developed with Lusaka District Health Office, Training and Research Support Centre (TARSC) in Zimbabwe and the Regional Network for Equity in Health in East and Southern Africa (EQUINET). Health literacy refers to a process of reflecting on experience, informing and empowering people to understand and act on health information to advance their health and improve their health systems. It builds knowledge and capacity to act within a framework of Participatory Reflection and Action (PRA) that strengthens community level diagnosis, action and engagement with health systems. The manual is an outcome of work we have been implementing to support and strengthen community roles in health and communication between health workers and communities. In light of the positive outcomes from pilot work done in the pilot areas of Lusaka District, the MoH in Zambia has decided to institutionalize the Health Literacy (HL) programme and scale it up to other health districts in the country. Health literacy will contribute to a movement to transform our society into a community of health literate men, women and children who will be the fertile soil upon which the seeds of healthcare will thrive. As Government we consider community involvement key in the development of our country and essential in addressing the health inequities in the health service delivery system. We are particularly concerned with improving the status of our women through empowering them with reproductive health knowledge. As MoH we will ensure that the scale up of health literacy is included in the annual health plan. The MoH is also cognizant of the fact that improving community health outcomes requires support from many sectors. We appeal to all who have a role in health to contribute to this pioneering initiative. We wish to thank the personnel at TARSC and the consultant and personnel at Lusaka District Health Office for their role in writing content for the manual, the peer reviewers of this first edition and all those who have contributed to it. We thank also CORDAID Netherlands through TARSC and EQUINET for their support of the work. Hon Minister of Health Dr Joseph Kasonde Lusaka, Zambia, November 2012 TABLE OF CONTENTS SECTION 1: Promoting Health MODULE 1: INTRODUCTION TO HEALTH LITERACY 1 1.1 About this manual and our understanding of health literacy ............................. 1 1.2 How we understand health . 4 1.3 Using participatory approaches ....................................................6 1.4 The characteristics and roles of facilitators ...........................................8 1.5 A guide to the manual ...........................................................11 1.6 Working with the manual ........................................................12 MODULE 2: THE HEALTH OF COMMUNITIES 17 2.1 What do we mean by health? .....................................................17 2.2 What are the most important health issues in our community? ..........................18 2.3 What causes disease? ............................................................25 2.4 What can we do about these causes? ..............................................27 2.5 Rising health problems: alcohol and substance abuse...................................28 2.6 Our right to health .............................................................31 MODULE 3: HEALTHY NUTRITION 37 3.1 Food sovereignty in communities . 37 3.2 Healthy diets ..................................................................42 3.3 What happens when people do not get adequate healthy food?..........................46 3.4 Nutrition needs of special groups ..................................................49 MODULE 4: HEALTHY ENVIRONMENTS 55 4.1 Safe water, sanitation and housing .................................................55 4.2 Safe work environments .........................................................58 4.3 Diseases spread through unsafe water, poor sanitation ................................63 4.4 Diseases spread through overcrowded or unsafe housing ..............................69 MODULE 5: HEALTHY LIFE CYCLES 73 5.1 What do we mean by healthy life cycles? ............................................73 5.2 Protecting newborn babies .......................................................75 5.3 Health in the first year of life......................................................77 5.4 Protecting children’s health .......................................................81 5.5 Adolescent health – great opportunity and new risks . .87 5.6 Early adulthood – and the challenges of AIDS ........................................93 5.7 The challenges of adulthood and ageing ............................................102 SECTION 2: Strengthening People-Centered Health Systems MODULE 6: UNDERSTANDING HEALTH SYSTEMS 105 6.1 What do we mean by a people-centred health system? ..............................105 6.2 Primary health care ............................................................109 6.3 Health systems reflect society and respond to social groups ...........................111 6.4 The way health systems are financed affects communities .............................116 6.5 Relationships with health workers ................................................120 MODULE 7: COMMUNITY ROLES IN PEOPLE-CENTRED HEALTH SYSTEMS 127 7.1 What roles do communities play in health systems? . 127 7.2 How do health service personnel listen to people’s views?.............................130 7.3 Who else can communities engage in health issues? . 134 7.4 Civil-society alliances in health systems .............................................137 SECTION 3: Organizing for health MODULE 8: ORGANIZING FOR HEALTH IN ZAMBIA 141 8.1 Organizing for health ...........................................................142 8.2 Acting on health ...............................................................145 8.3 Taking local action .............................................................150 8.4 Mobilizing for health ............................................................154 APPENDICES REFERENCES AND RESOURCES 159 ABBREVIATIONS 161 GLOSSARY 163 Please refer to the glossary if there are words you don’t understand in the manual. If you cant find them in the glossary you can also ask your health literacy facilitator for further information. TABLE OF ACTIVITIES SECTION 1: Promoting health MODULE 1: INTRODUCTION TO HEALTH LITERACY 1 • What are our experiences in using participatory methods? (Group discussion) . .7 • What are the characteristics and roles of a Health Literacy (HL) facilitator? (Brainstorming with a picture; true/false statements) ...................................8 MODULE 2: THE HEALTH OF COMMUNITIES 17 • How do people understand health? (Picture codes – drawing our own pictures ............17 • How can I describe my community with a map? (Social mapping) ........................20 • How can I find out more about my community? (Transect walk).........................21 • What are the priority health issues or needs? (Ranking and scoring)......................22 • What are the top ten diseases in our area? How do they compare with community priorities? (Semi-structured interview and analysis) ............................................24 • What causes our health problems? (“But why?”)......................................26 • What can we do about our priority health issues? (Group work and stakeholder analysis) ...28 • Alcohol and drug abuse in our community (Letter to agony aunt) ........................29 MODULE 3: HEALTHY NUTRITION 37 • Strengthening food sovereignty in communities (Story with many gaps; role play) ...........39 • How healthy are the foods we eat? (Three-pile sorting cards) ...........................42 • What happens to people when they do not have enough food? (Life history and Mwanza Mpundu’s well-being map) ........................................................46
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