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This publication presents the activities and lessons learned from a project which sought to halve malnutrition among preschool children, raise primary school enrollment, reduce dropout and repetition rates, improve psycho-social and cognitive development, and increase the number of mothers practicing appropriate childcare. A strategic communication programme was designed to help mothers and other caregivers adopt new behaviours needed to achieve project outcomes. It helped the project team identify necessary changes in behaviour, knowledge or attitude for all target audiences; frame project-related issues relevant to different stakeholders, such as parliamentarians, mothers, community leaders, educators, and local government administrators; craft persuasive messages according to their needs, concerns and perceptions; and use the most appropriate communication channels. The communication strategy included a: national advocacy effort aimed at parliamentarians, health and education ministry officials, district and community leaders; multi-media campaign that emphasized three behaviour change interventions; training programme for health workers and pre-school teachers on their role; and monitoring and evaluation component to ensure that materials were disseminated via cost-effective channels of communication and that messages reached target audiences. Lessons learned emphasize the value of developing a comprehensive communication strategy during project design.

Drawing on the accounts from the World banks ‘Voices of the Poor’ this booklet looks at the intimate link between health and poverty and the need for health to be central to attempts at poverty reduction. Three key lessons are: [1] People view and value their health in a holistic sense, as a balance of physical, psychological and community well-being, consistent with the WHO view of health as ‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. [2] People overwhelmingly link disease and ill-health to poverty, while poverty is also seen in terms of instability, worry, shame, sickness, humiliation and powerless-ness. [3] Health is valued not only in its own right, but because it is crucial to economic survival. Other lessons include: the fact that ‘poor people’ are not homogenous and in particular women and men, and the young and old, experience poverty and ill-health quite differently. Gender differences include the fact that men access and are seen as more entitled to formal health care, while women more often draw on traditional and alternative health services or defer their own treatment. Attitudes of health staff often appalling. Humiliating treatment by health personnel who treat people as ‘worse than dogs’ was a common experience and barrier to getting treatment. Access to health facilities, rarely built in poor areas, and often too costly to access are a problem. WHO concludes that "there can be no real progress on poverty reduction, or improvement in health outcomes, unless economic and social inequities are tackled"