1. Development of Pictorial Materials to Support Health Education (Case Study: ORT, Baluchestan)

2. ORT: The Case for Consensus In any health programme, it is important that all agencies active in the area agree to support a common intervention – or consumers will become confused as to which ‘method’ to follow. In this case study, all Government, UN, INGO and local NGOs were presented with the problem and agreed to support the same system of home solution (ORT).

3. Define the Technical Problem IMR/CMR unacceptably high Diarrhoeal mortality major contributor What rôle malnutrition/micronutrients ? What rôle measles ? Who/what will be the target audience ? How will we reach that audience ? What reach radio, TV, newspapers ?

4. Define the Audience Population to be reached Gender, age, occupation, etc Literacy rate (thus discard all text) Culture and especially taboos Problem area (diarr. mortality) and whether there are special health characteristics to be noted

5. Define the Essential Messages Technical content to be by MoH Women must identify diarr. + dehydration They must realise the urgency They should be able to prepare ORT They should continue breastfeeding; & Should give a healthy diet on recovery

6. Define the medium to be used Pictures on a poster was selected Should they be colour or B & W ? Line drawing or artistic or photos ? If writing required, how detailed ? What technical terms should be used ? Should this have application beyond Baluchestan; and if so, where ?

7. Drawing the First Pictures For a flyer or a poster ? How many pictures for the whole mess age Content of each picture ? Message of each picture ? Relationship between successive pictures The office test

8. The Field Test Identify a typical consumer group Meet them, explain what you are doing Ask individuals what they see in the pix Record their comments Ask a focus group the same Record their comments Return to office, write trip report

9. Office Discussions re Field Test Estimate comprehension rates What was not understood ? Why ? Was the meaning clear ? Is a complete re-draft required ? Can the pictures be improved ? How ? Can the pictures be simplified ?

10. Modifying Pictures (and text) Based on field test + discussions, re- draft the pictures (and text) Avoid identifying a single group/tribe If text is used, ensure terms are those used by the consumers Check that the modified pictures (and text) reflect exactly what was intended originally unless there is good reason why not

11. Breastfeeding Picture Continuation of breastfeeding during diarrhoea is essential Breastfeeding pictures can cause offence if badly presented Field test must be handled with great care; but If done well, young mothers confident to breastfeed when most needed

12. The Breastfeeding Picture

13. Comprehension Rates If the picture is 100% understood, keep; If less than 100%, try to raise comprehension rate; What to do if repeated redrafting and field testing cannot improve the rate ? Does field test allow for a stand-alone poster, or must there be training as well?

14. What Training is Required ? Poster could not stand-alone. So, what ? Who to train mothers; and where ? How many trainers; who to train them ? What support materials for trainers ? Remember to field test the trainers materials as well......

15. Trainers’ Flipchart Instructions for FHWs on back of flipchart

16. The Print Run: How Many ? Do not overestimate the need Clinics need posters; and schools as well Standardise in adjacent areas as well To conform with policy, mention ORS Keep the ‘masters’ for reprints Ensure that all posters for use in Pakistan carry the MoH logo for credibility

17. Feedback for Future Materials All records MUST be kept available Any feedback must be kept on file Trainers should be encouraged to provide comments (also to be filed) Try to use common themes (same logos, same artist, etc) Use common themes on radio & TV if they are used later

18. Important Lessons Focus material on real health problems Define audience with care Have simple, focussed message(s) Develop material with consumers Field test materials; keep records Aim for hi compr. rates; common themes Print only what you can use; keep masters Keep feedback for future use

19. The Final Poster