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.
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 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.
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.
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
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;
Science Reporter, Researcher, Trainer Uganda, EastAfrica;
Freelance
journalist based at The EastAfrican newspaper.
E-mail address: nakkazie@yahoo.com, estanakkazi@gmail.com
E-mail address: nakkazie@yahoo.com, estanakkazi@gmail.com
Doris Kwesiga
Researcher,
Child Health and Development Centre (CHDC),
Makerere University
E-mail address: dknnkwesiga@gmail.com;
dkwesiga@chdc.mak.ac.ug
Hannington
Muyenje
Project Manager,
BBC World Service Trust,
Kampala, Uganda
E-mail address: hannington.muyenje@bbcwst.net
Susan Ajambo
Researcher,
Child Health and Development Centre (CHDC),
Makerere University
E-mail address: susanajambo@yahoo.com
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