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Wednesday, February 27, 2013

FROM PAPER TO MIKE- RESEARCH ON UGANDA MEDIA


Executive Summary

This study was premised on the assumption that the media is an important stakeholder in health systems research. The media can potentially influence public attitudes through its role of sensitization and publicity and is the public’s most significant source of information. In Uganda there is currently wide media coverage of health issues in newspapers and on the radios. Despite this growing interest by the media to cover health few systematic studies have been conducted in Uganda on media coverage of the health system in general and of health systems research in particular. Those conducted have focused almost exclusively on the print media and on coverage of specific diseases such as TB, HIV/AIDS, and Malaria. Of the studies reviewed none focused specifically on how the media could influence policy and civil society engagement with health through it’s reporting on health systems research findings. While the few studies conducted expressed concerns regarding the depth of the information and its sources, none paid particular attention to the reporters behind the stories in terms of their background training and orientation or the journey through which articles/programs on health go through in order to get into the press or onto radio. Furthermore, hardly any documentation exists on the mechanisms through which health issues are prioritized by the media.

This study explored media coverage of health systems in general and of health systems research in particular by the Ugandan media.  More specifically the study:
1.     Analyzed health system issues and research covered by the print and radio in Uganda
2.     Determined the extent to which media articles and radio programs were informed by health systems research 
3.     Analyzed the mechanisms through which newspaper articles and radio programs were prioritized
4.     Established the backgrounds of the reporters, producers and program hosts that covered health stories and programs
5.     Recommends ways and means through which media coverage of health systems and health systems research can be strengthened

A mixed approach that combined both qualitative and quantitative data collection methods was adopted for this study. Two main data collection methods were used: content analysis and in-depth interviews. A content analysis was conducted of newspaper articles and radio programs that focus on health system issues. Four newspapers and four radio stations were included in the study. The four newspapers were New Vision, Monitor, Bukedde and the Weekly Observer. A total of 101 newspapers were reviewed during the period. The four radio stations included in the study namely Radio Simba, NBS, Radio West and MEGA FM covered the four regions of the country. A total number of 72 radio programs were reviewed. In-depth interviews were conducted with 19 journalists and 3 researchers.

Findings

The study found that while there was wide coverage by the media of health system issues in general there was very little coverage of health systems research. None of the articles published during March 2010 were based on health systems research in Uganda and the few that were informed by health systems research, most of it was conducted elsewhere other than Uganda.

The majority of health system articles were on disease prevention and health promotion; these were also the better researched articles. Those on the formal health services were more of critics of what was happening in the formal health services in the country and the majority were not informed by health systems research.

Other elements of the health systems such as use of medication, home care for the sick, actions of traditional healers and other health enhancing interventions did not receive much coverage by the media.

There was evidence that a lot of community members were interviewed for different health articles, and their voices filtered through most of the articles but in most cases they were interviewed for their opinions rather than as key informants.

Among the main sources of information for the health system articles were the internet, policy makers and policy documents, politicians and others. Conspicuously missing were health systems researchers and research reports on health systems in Uganda.

The coverage of health systems on the radio was largely determined by the sponsors of the health programs, in the print media the coverage was determined by the editors of the papers. This raises question as to how possible it is in these circumstances to get a more even distribution of articles and programs that cover the entire health system. Radio programs aired during March were skewed towards disease prevention and even then the diseases were mainly HIV/AIDS and malaria.     

The majority of journalists interviewed did not have specialized training in health reporting and given the conditions under which they were employed there was no motivation for them to specialize.

The relationship between health researchers and journalists was strained by the mistrust that existed between the two and this undermined the interaction between the two and the flow of information.

The research noted that there were several ongoing efforts on either side to try and address the trained relationship as well as efforts to strengthen media coverage of health research

Recommendations  
Both the media and the health researchers need to work on their attitudes towards each other. The media in the past has portrayed researchers as exploitative and as using people as guinea pigs. Health researchers on their part have had a dismissive attitude towards the media. Both these attitudes need to be addressed if their working relationship is to be strengthened

Makerere University and other media training Universities in Uganda need to have tailored modules in health communication. The modules that currently exist are not within the country and are at graduate level. So there is need to develop modules in this area.

The media seem to lack staff that has the interest to cover health research. For example they have staffs that frequently cover issues relating to the environment.  There is need therefore to build a pool of media people interested in health research and to build capacity and interest among health researchers in communicating their research to the public.   

Health researchers need to recognize the media as an important stakeholder in the research enterprise and therefore to budget for their engagement in the research process and to organize more face to face interactions between the journalists and health researchers.

Health researchers also need to understand research dissemination as going beyond the publication of their findings in scientific journals and presenting papers at conferences, to include the informing of the public of these findings and ensuring their utilization. 

More needs to be done in terms of building relationships with the media and in building researchers’ capacities in engaging with the media. Health researchers need to engage editors, program producers and journalists in order to persuade them to devote more time to health programs and space in newspapers for discussions of research issues. For example in the west, they have weekly columns on health research, the media devote, time, space and resources for discussion of health research.

Researchers are busy and in most cases they do not have the time to devote to writing up their research in a way that it can be easily communicated to the public. To do this they would need compensation for their time.

Those that fund research devote a lot of funds to the research process but in most cases do not include any funds for communicating the research findings to the public. If this was done it would improve the links between the media and researchers as well as media reporting of health research. If those that fund research made it a condition that any research that they fund, should include a budget line for the researchers’ engagement with the media during the research and on completion of the research, researchers would go the extra mile to engage with the media and the media personnel would also engage with the health research because there would be some facilitation for their engagement with the researchers. Those that fund research therefore can influence how researchers view public engagement through the media and also the involvement of the media during the research design, implementation and dissemination. 

The Journey to Publication and Production

This research explored the journey of the health articles to publication. According to the journalists interviewed 3/11 reported that they were assigned stories by their editors, the rest generated their own story ideas from their daily experiences and from attending events such as conferences and workshops on health issues and celebrations of days like World Water Day or World TB Day. The journalists reported that they normally gave priority to health issues that affected the majority of the readers and those making news headlines at the time. One responded that they normally paid attention to what other papers were reporting and picked health ideas from those.

According to the journalists when they found a tip or story idea, they submitted it to their editor at their weekly editorial meetings. Together with the rest of the reporters, such story ideas were discussed and enriched with the input of the other team members. The editor then decided whether the story idea should be pursued further, modified or rejected. None of the print media has a health features’ editor dedicated to reporting on health exclusively. Once the story idea was accepted, the reporter then proceeded to carry out research on it and submit it once again to the editor. The editor could decide to alter the story by emphasizing an angle different from that in the original story. In some cases, due to limited space, editors summarized the stories and only published what they deem to be the salient features of the story. The editors also chose the section where to publish the health story.

With regard to the electronic media the majority of the health programs were sponsored by NGOs and the sponsors determined the topic for discussion and the content to be broadcast. For health programs that were broadcast on radio and not sponsored, the presenters have the responsibility to identify health experts who they invite to the studios to discuss different health issues. While this gave them leeway to determine the topics which they considered to be priority to the listeners, it also had its own challenges. For example one of the presenters explained that while some health professionals willingly came into the studios for the programs when invited others expected a transport refund at the very minimal and this was not budgeted for by the station. An interview with the Director of Uganda Radio Network revealed that they now have an arrangement where they come up with health issues which are well researched by the team at URN and a report is produced. Once the report is ready it is disseminated to partner radio stations to broadcast. This reduces on the need for the different radio stations to source out their own health stories. 

Challenges Faced in Getting Health Stories into the Media
Challenges faced in getting health stories into the media were explored from the perspective of the journalists and from that of the researchers. According to the journalists interviewed it is difficult to specialize in health reporting for several reasons; one is that if you are a freelance journalist you are paid according to the number of articles accepted for publication. So the more articles one can get published the better, Attempting to specialize in these kinds of circumstances would not be very wise.

Journalist reported that they often experienced problems in accessing information especially in government institutions that they needed to include in their articles. They highlighted statistical information as a case in point. Furthermore they argued that very few of them can break down the medical language and health issues into articles that are reader friendly for the public so in the end they opt to writing articles on events which are simpler to write. Journalists also reported that sometimes, due to other competing stories, the health stories submitted for publication ended up being summarized by the editor and their original story is distorted. In other cases, due to pressure to publish other competing stories, articles on health are either dropped or placed on non-prime pages that do not command much readership. They also reported that some media houses make unrealistic demand on the journalists and they end up having insufficient time to research and enrich their stories. Other journalists reported that lack of necessary training on reporting health was a hindrance to their reporting on health.
A Knight International Journalism Fellow who has been very instrumental in training journalists in health reporting observed that journalists faced several challenges. The emphasis on marketing and sales by the management of the media houses influenced coverage of health in the media. He also noted that journalists are paid very little for their stories so they tend to lay more emphasis on the quantity of stories other than on the quality. He observed that:

Journalists love events and workshops because stories from there are simpler to report, compared to the time it takes to get to know a researcher before writing a story about their research.

He also observed that health research is difficult because it is slow, individual studies may not add up to a big story and there is need to get the basic facts right. This is time consuming especially if one factors in the time it takes to read a scientific research report and understand it. He noted that as always there is mistrust between scientists and the media and that this poor relationships between researchers and journalists exists because of misinterpretations and misrepresentation. Since most health researchers’ use scientific jargon when writing up their research this tends to repels journalists from reporting on research issues.

An interview with a senior health researcher shed some light from the researcher’s perspective as to what the challenges were from a researcher’s perspective. He noted that researchers do not go the extra mile to disseminate their research findings beyond the scientific community through conferences, scientific journals and books. This had to do with their attitudes towards the media. He noted that some researchers think that people will not understand their work. Secondly he noted that

As researchers we do not use the media enough and in some cases we brush it off i.e. we do not have the time to deal with the media and this to some extent is due to the lack of realization and recognition of the media as a key stakeholder in the research enterprise. If we did we would be inviting them more to participate in research discussions

He also noted that researchers do not budget for activities that make use of media coverage in research. If they did they would be working more closely with the media in disseminating their research findings. Other barriers were historical. He cited cases where the media coverage of health research was unfavorable and as a result researchers have become more protective about their work, scientific language was also perceived as barrier in that if health research is to be communicated effectively to the public simpler language has to be used. This required time and commitment on the part of researchers in order for them to simplify their work in order for it to be communicated to the public.

Efforts for Strengthening Media Coverage of Health Research

Other ongoing initiatives to strengthen media coverage of health research in particular include efforts by the College of Health Sciences to set up a communication unit. A Communication Strategy has already been developed. The School of Public Health has already launched its own communication strategy and is involved in the training of journalists in health reporting. The idea is to promote ways in which the College can relate with the media and the public in general to ensure information flow to the media and the public At a recent workshop, the Deputy Principal of the College of Health Sciences lauded the increased training of journalists in health issues that has reduced the antagonism between the health professionals and health reporters, thus increasing media coverage in health sector as well as accuracy in health reporting.
 
An attempt has been made by the College of Health Sciences through the Uganda Health Communication Alliance to identify and work with journalists and reporters interested in health matters to help support research communication, most of those identified in the past were more interested in reporting on health in general than on health research.

Other efforts reported were a project known as Sustaining Use of Research Evidence in Africa (SURE) whose objective is to promote the use of research in policy making. The project is training health researchers and policy makers on how to present research evidence in a way that is attractive to policy makers and how to communicate effectively.  Another effort is the Regional East African Community Health (REACH) which is designed to link health researchers with policy-makers and other vital research-users the media being one of them. This initiative trains researchers, policy makers and members from the media in the East African Region in an attempt to bridge the realms of health research, policy and practice. Welcome Trust awarded a grant to the Makerere University College of Health Sciences in 2008 to engage the public in health research. As part of this grant researchers are trained on how to work with the media and the media is also trained on how to work with researchers. 

CONCLUSIONS
The study found that while there was wide coverage by the media of health system issues in general there was very little coverage of health systems research. None of the articles published during March 2010 were based on health systems research in Uganda and the few that were informed by health systems research, most of it was conducted elsewhere other than Uganda.

The majority of health system articles were on disease prevention and health promotion; these were also the better-researched articles. Those on the formal health services were more of critics of what was happening in the formal health services in the country and the majority were not informed by health systems research.

Other elements of the health systems such as use of medication, home care for the sick, actions of traditional healers and other health enhancing interventions did not receive much coverage by the media.

There was evidence that a lot of community members were interviewed for different health articles, and their voices filtered through most of the articles but in most cases they were interviewed for their opinions rather than as key informants.

Among the main sources of information for the health system articles were the Internet, policy makers and policy documents, politicians and others. Conspicuously missing were health systems researchers and research reports on health systems in Uganda.

The coverage of health systems on the radio was largely determined by the sponsors of the health programs, in the print media the coverage was determined by the editors of the papers. This raises question as to how possible it is in these circumstances to get a more even distribution of articles and programs that cover the entire health system. Radio programs aired during March were skewed towards disease prevention and even then the diseases were mainly HIV/AIDS and malaria.     

The majority of journalists interviewed did not have specialized training in health reporting and given the conditions under which they were employed there was no motivation for them to specialize.

The relationship between health researchers and journalists was strained by the mistrust that existed between the two and this undermined the interaction between the two and the flow of information.

The research noted that there were several ongoing efforts on either side to try and address the strained relationship as well as efforts to strengthen media coverage of health research

RECOMMENDATIONS
Both the media and the health researchers need to work on their attitudes towards each other. The media in the past has portrayed researchers as exploitative and as using people as guinea pigs. Health researchers on their part have had a dismissive attitude towards the media. Both these attitudes need to be addressed if their working relationship is to be strengthened

Makerere University and other media training Universities in Uganda need to have tailored modules in health communication. The modules that currently exist are not within the country and are at graduate level. So there is need to develop modules in this area.

The media seem to lack staff that has the interest to cover health research. For example they have staff that frequently cover issues relating to the environment.  There is need therefore to build a pool of media people interested in health research and to build capacity and interest among health researchers in communicating their research to the public.   

Health researchers need to recognize the media as an important stakeholder in the research enterprise and therefore to budget for their engagement in the research process and to organize more face to face interactions between the journalists and health researchers.

Health researchers also need to understand research dissemination as going beyond the publication of their findings in scientific journals and presenting papers at conferences, to include the informing of the public of these findings and ensuring their utilization. 

More needs to be done in terms of building relationships with the media and in building researchers’ capacities in engaging with the media. Health researchers need to engage editors, program producers and journalists in order to persuade them to devote more time to health programs and space in newspapers for discussions of research issues. For example in the west, they have weekly columns on health research, the media devote, time, space and resources for discussion of health research.

Researchers are busy and in most cases they do not have the time to devote to writing up their research in a way that it can be easily communicated to the public. To do this they would need compensation for their time.

Those that fund research devote a lot of funds to the research process but in most cases do not include any funds for communicating the research findings to the public. If this was done it would improve the links between the media and researchers as well as media reporting of health research. If those that fund research made it a condition that any research that they fund, should include a budget line for the researchers’ engagement with the media during the research and on completion of the research, researchers would go the extra mile to engage with the media and the media personnel would also engage with the health research because there would be some facilitation for their engagement with the researchers. Those that fund research therefore can influence how researchers view public engagement through the media and also the involvement of the media during the research design, implementation and dissemination.

Investigators:
Anne Ruhweza Katahoire (Principal investigator)
Associate Professor and Director,
Child Health and Development Centre (CHDC),
Makerere University
E-mail address: akatahoire@chdc.mak.ac.ug;
Telephone number: +256-414-541684/530325

Esther Nakkazi,
Science Reporter, Researcher, Trainer Uganda, EastAfrica;
Freelance journalist based at The EastAfrican newspaper.
E-mail address: nakkazie@yahoo.com, estanakkazi@gmail.com

Doris Kwesiga
Researcher,
Child Health and Development Centre (CHDC),
Makerere University

Hannington Muyenje
Project Manager,
BBC World Service Trust,
Kampala, Uganda

Susan Ajambo
Researcher,
Child Health and Development Centre (CHDC),
Makerere University
E-mail address: susanajambo@yahoo.com

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