PRB Discuss Online: Are the News Media Holding Governments Accountable on Promises to Improve Public Health?

(September 2010) Perhaps the greatest satisfaction for a journalist is to see one’s reporting produce positive change. Journalists are the link between policymakers and the public, and their role as watchdog is to monitor the actions of government and hold those in charge accountable. To do this, they need information, and they need to be able to communicate it with context and background to both policymakers and the public. How well are journalists monitoring the actions, or inaction, of their government institutions (particularly those in developing countries) responsible for public health? What obstacles do journalists face in this pursuit? Are news organizations making an adequate commitment to coverage of public health? If health issues are being pushed aside by political news, what can health journalists do to raise the profile of their stories?

During a PRB Discuss Online, PRB’s media specialists Deborah Mesce and Victoria Ebin, and Nairobi-based journalist Florence Machio, answered participants’ questions about the news media’s role in holding governments accountable. This Discuss Online session was sponsored by the BRIDGE project, a cooperative agreement between USAID’s Global Health Bureau and PRB.

Sept. 15, 2010 1 PM EST

Transcript of Questions and Answers

Sissoko Foussénou: What Strategy could be used to developp materials which simplify basic concept on Public Health ?
Victoria Ebin: Keep in mind who your audience is. If you want to reach a general public, keep your writing simple, jargon-free and of course, it must be 100% reliable and up-to-date. Complicated data should be expressed in terms that your audience can understand and also pass on to others.

Geoffrey Onditi in Nairobi.: How do you hold the government accountable in countries where freedom is expression rare?
Florence Machio: Thanks Geoffrey. I want to believe that in countries where they have achieved freedom of expression especially in Kenya it’s because someone (usually a journalist) chose to be persistent. It’s this persistence and sometimes stepping on government’s toes that has resulted in freedom of expression. I know one can always tell a good story without landing themselves in jail. Remember the story of women sharing beds and others lying on the floor at Kenyatta National Hospital (Kenya’s largest referral hospital) and how the minister then and even parliament woke up and discussed the issue which would have otherwise beeen ignored? Investigative pieces that are factual will always win the day and might create the space for freedom of expression.

ssebiryo F Exaviosu: Comment: In a situation where Media freedom has not been realized substantially, I wonder whether the new-media as you have termed it has done anything big! Take a case of my country Uganda, thought the media give spotlight on disarray in public health system management; government press censoring and intimidation do much to conceal more misfortune in public accountability…
Deborah Mesce: You are right that the Ugandan media has highlighted problems in the country’s public health system, and in fact it has brought results. One example is a series of stories that ran in one of the newspapers about the dismal state of referral hospitals. According to people close to the government, the series prompted officials to seek a loan from the World Bank. And in June, the World bank announced a loan for $130 million to improve health infrastructure in the country. I think it’s also the media’s job to follow up and monitor how this money is used.

Geoffrey Onditi in Nairobi.: Some media people lack facilitation or the capability to cover health stories lets say in slum and rural areas. How can journalists who do not have that ability be motivated to highlight health problems?
Florence Machio: I hope I understand correctly that by facilitation, you mean the resources to get to areas that are less reported about e.g., rural areas. If that is the case…yes it is challenging and speaking as a journalist, many times I felt like giving up because of that, but when I started pitching good stories and identifying editors in the newsroom who could back me up, I eventually did get the resources to go out. Most editors will back a good idea and facilitate you to do it. Everyone likes a good scope! What kept me going and helped me stay motivated was the fact that there was a story that was yet to be told and I had a duty to tell it.

zofeen t. ebrahim: I am from Pakistan and I don’t see journalists covering this very important aspect, although I have seen a few doctors writing articles in newspapers highlighting it. What I see in the media is sensational news, never an academic and a fruitful discussion on the above issue. There will be stories and television packages on the alleged negligence of doctors or use of expired drugs. There will be a story or two of a multi-million rupee-health facility rotting away and then no follow-up after that in a few months if any action was taken by the government to the news. The problem is that journalists are not interested in doing investigative stories. It takes too long, there are many dead-ends, people in the know are not willing to talk and those in the government usually make journalists go round and round in circles. Most of the time they tell writers they(journalists)need to take permission before they can talk on record or show public records. Given such a complex way of getting information, the journalist is bound to find another easier story to do or tackle an issue which is “sexier”. In the meantime, the private sector flourishes! Can you suggest a way to tackle this not so easy subject?
Deborah Mesce: You make good points, but at least the media is covering some health news. Investigative stories can be time-consuming, which can mean expensive for media companies that look for the quick fix. One problem common to many countries seems to be lack of follow-up on stories. I’m sure part of this is that government officials don’t want to talk, but they are going to continue to spin reporters in circles as long as they are able to, and that could be until the media dig in their heels.

Aumio Srizan: What is the role of the media? What do they show us? What we want to know? Or what we need to know? Or what the media wants us to know?
Deborah Mesce: These are age-old questions. I think there is not just one role for the media. But one of the things I think they should do is provide the information that their readers/listeners need to know. Then the question becomes: who decides what we need to know? This is a discussion that will take more than an hour to resolve, if ever.

Orton Kiishweko: In LDCs like Tanzania where HIV response budget is 96 percent donor dependent,the top killer malaria is largely donor dependent,-does nt it make it tricky for a journalist to hold accountable the government when donors walk out of the equation?who do I hold accountable?is it my government or the donor countries?
Deborah Mesce: I think journalists should hold their governments accountable for the amount they contribute to health sector spending, and in the 2001 Abuja Declaration, African governments agreed to strive for 15 percent of their national budgets being devoted to health. The other question, though, is whether the money being spent on health—whether from the country’s resources or donors—is used effectively and efficiently. The government will tell you one thing, but the media should see for themselves if what the government says is true. The answer is usually not black-and-white, so these are not easy stories to do. But I think that if the media should try to do them.
Florence Machio: Thank you for your question Orton. Who do you hold accountable?..your government. I believe donors come in to try and supplement what governments are doing and it is not necessarily their prerogative.If we take the example of health or just family planning most governments in Africa have yet to commit to the Abuja declaration of putting aside 15% of their GDP towards health care. That shows lack of political will.These same governments have enough to pay their Members of parliament and equip their armies yet find it difficult to commit to healthcare even with the smallest of percentages.I hope that answers your question.

Susan Anyangu-Amu: Media ownership is an issue in Kenya where media is driven by making profits…advertisements take centrestage…politics and gossip are the lure of the day for profits to be made….how then does a journalist focusing on health ensure that public health story makes it to the front page. Are we not fighting a loosing battle here, especially so when it comes to reproductive health…because then here we are dealing with double discrimination…it is a health story and a health story most probably about women. Women rarely make it to the news. How can a journalist who is so low in the decision-making ladder push for a health story to appear?
Florence Machio: When I was in journalism school they taught me that any story can get to the front page, one just needs to look at what is going on at the time so that you can link it to the health story you are working on. Health can be linked to economics, politics,development…in short try to always link your story to what is current.

Issa Almasarweh: Journalists are human and can like others be partial? For example, are there incidences where journalists’ views about the impact of huge industries on the environment and public health were influenced by pressure or incentives from these industries?
Deborah Mesce: No doubt there are lots of examples of where a journalist takes a stand on an issue based on things other than journalistic objectivity—part of which is explained by the underlying political stances that newspapers and media houses may take. You might want to talk with some local journalists to get examples of industry dominating media. Many countries have government-controlled media, which runs the risk of not being sufficiently critical or holding the government accountable for improving health—or any other area for which government has responsibility. We don’t want to confuse journalism with public relations, whose function is to present news and information from their client’s perspective. Our goal in working with the media is to build journalists’ capacity to understand the health and population issues so that they can report objectively and raise the visibility of key health issues.

Geoff Dabelko: Is it the news media’s role to hold governments accountable? Or do they provide the information that allows the public, or donors, or multilaterals to hold governments accountable? Semantic difference perhaps but I think you might get very different answers from journalists on what their proper roles are. It also suggests the answer depends in part on the level of freedom for the press in a given country.
Deborah Mesce: The function of the media is to inform the public, and doing so in a way that empowers the public or sectors of the public can enable them to hold government accountable. At the same time, the media’s job is more than just reporting on the facts. It’s the media that have the means to investigate, for example. You’re right that the level of press freedom will determine the ability of the media, the public, donors, multilaterals, etc., to hold governments accountable. But without an informed media, they can’t begin to inform the public accurately.

Sanjay Mishra: Media in most of the situations favors the ruling government and rest attentions pays to gossips and interesting news that too exaggerated news, thus public health like dull issues no more attracts to media. If we look this in developing context, Indian media . . . have very very limited space, especially if the concern is unpolitical. No clear cut analysis of the government policies on the issues of public health. . . . [Using] contraceptive and abortion pills without consulting medical practitioners are on rise in most parts of the country, but media especially TV channels are openly advising to take abortion pills in 36 hours of having sex. So how can media put pressure on the government as well as media/entertainment channels to prevent such things . . . .?
Deborah Mesce: Just to set the record straight, I think you are talking about emergency contraception, not abortion pills, because it is emergency contraception that is taken within days of unprotected sex to prevent pregnancy. The distinction is important. As to your question, in many countries the news media operate differently from the entertainment media, but in any media, reporting on reproductive health and emergency contraception must be done accurately.

Farzana Shahnaz Majid: The present govt has taken the initiative to establish community clinics in all upazila level. But media is not really taking proper role to improve the public health situation through strong policy advocay,criticism and suggession. Recenly The Anthrax outbreak in the northern portion in Bangladesh has become an alarming public health issue. To me it is really dissapointed to see that that the media in this area is such relactant and not taking any strong initiatives to make people aware and sensitize.
Deborah Mesce: It would be unfortunate if the news media were not reporting on the anthrax threat. The media’s role is to inform, but not necessarily to advocate. I think the media should be able to hold the government accountable for its actions or inactions, but not take an advocacy stance on specific approaches (unless it’s done in an editorial or commentary.)
Victoria Ebin: One way to improve local coverage of such public health issues is for the district health officers and local NGOs to develop ties with local media. But they shouldn’t wait for a crisis to take this step. Part of their on-going communication strategies should include developing and maintaining contacts with local journalists. Government and NGO communication staff need a list of local journalists who cover health and should send them regular updates. They can also conduct training workshops for journalists on health topics and organize press conferences, especially when there is an urgent health emergency.

Nnenna Ike: I am Nnenna Ike from Nigeria. Nigerian journalists are facing multiple challenges to effectively carrying out their roles as independent monitors and evaluators of government promises in all aspects of the economy. They include the apparent lack of capacity to adequately investigate on health issues before reporting (as against just reporting events) and the love for financial gain (from non-performing government officials). Who is to blame for these two things? Please let us remember that it is not all practicing journalists that studied journalism and professional journalism courses are expensive to undertake. Also, quite a number of journalists go without salaries for some months. If they are not performing their roles properly, who takes the slack for their ineptitude?
Victoria Ebin: Unfortunately, it’s the public that suffers when journalists cannot adequately perform their jobs. They miss out on their right to accurate information. You’ve noted some of the major obstacles to the media’s capacity to hold the government responsible for its promises to improve public health. The journalists “lack of capacity to adequately investigate health issues” has multiple causes. Lack of time, resources, and also lack of communication with health experts (which is not necessarily the fault of the journalists). Health experts often distrust the media and refuse to talk with them, making it impossible for journalists to obtain accurate information. A key factor in improving health reporting is better communication between the media and the health sector. Both sides need to work on developing this relationship because they each have valid complaints against the other. Journalists accuse health experts of wanting to use them as their publicity agents and health organizations accuse the media of practicing “envelopement” journalism (referring to cash-filled envelopes). Among the steps necessary to improving media ethics is adequately paying journalists for their work.

Aumio Srizan: The constructive criticism of the government policies on public health by the news media is somehow missing or not prominent. Are the journalists properly reporting to the issues that are major public health concerns? The lack of follow up reports raised this question in my mind.
Deborah Mesce: Lack of follow-up is definitely a problem, but so is understanding the issues. Some journalists don’t necessarily see their job as following up on a story. But I think they need to realize that most stories are dynamic, always changing. They need to ask, for example, what progress has been made on a project they earlier reported on or whether there are better, more effective ways of addressing a problem. They can look for successful projects and ask why they’re not being replicated in other areas. Just reporting on these projects can go some of the distance because policymakers also get their news from the news media and they may not necessarily be aware of such projects. Many a doctor has told me that they get as much news about HIV and AIDS from the newspaper as from their medical circles.
Victoria Ebin: Reporting on governments’ public health policies often requires time and resources that are not available to all journalists. They also need the support of their media organizations and that, too, can be in short supply. But despite these obstacles, journalists in many countries are producing stories that call on their governments to improve public health policies, and the implementation of already-existing policies. In Senegal, a journalist’s story about a lack of contraceptives led to an investigation of the national supply pharmacy. In another example, a Malawian journalist reported on a government official’s misuse of AIDS funds. Tanzanian journalists’ reporting on contraceptive shortages contributed to a government decision to increase the budget line for family planning. These are just a few examples, but do show that that journalists in developing countries are struggling to carry out investigative reporting that leads to improved public health.
Jamie Rosen: How can civil society organizations help journalists hold governments accountable for public health laws and commitments?
Deborah Mesce: Good question. They can start by working with the media to make sure journalists understand the public health laws and commitments. When we work with journalists we rely on health experts, many from civil society organizations, to explain different aspects of reproductive health and how laws affect the way programs are implemented and ultimately how services are or are not rendered to the public. There needs to be two-way communication between journalists and CSOs. CSOs need to keep journalists apprised of situations that they may not know about. The flip side is that journalists need to recognize the expertise of CSOs but ask the right questions and report appropriately on what they find.

Meskerem Bekele, Ethiopia: Hi, How are you? I think we are not poor in policy. As we know our country also has health policy. The Constitution (the supreme law of the land) and the Family Law strongly committed for public health. But when we come to implementation there is a gap. This gap couldn’t come only because of government but even because of public. When we come to journalists, we can’t make our responsibility effectively. For example, FGM is one of our harmful traditional practices and strictly forbidden by law. But last week when I was in one meeting, one of the laws professional told us she tried to look after if there is any recorded document, which talks about persons who were accused because of FGM but she couldn’t found in any police offices of Addis Ababa. Can we say there is no any Female Genital Mutilation? I don’t think. There is a gap between the government and… so, I think the government media and the journalists have the big responsibility for public health.
Victoria Ebin: While the practice of FGM shows signs of decreasing in Ethiopia, there’s still a long way to go to eliminate it. Is it possible for journalists to track progress of the ministries responsible for the National Plan to stop FGM? Journalists could also contact the many NGOs working in this area and follow their activities in the field.

Dr Bharat: Why are media exposing only the loopholes of Govt Health Services? The media must reflect Govts’ sincere efforts for resolving crisis, even watching human rights and the democratic arena.
Deborah Mesce: I would argue that it’s not the media’s job to report on the government’s sincerity but rather on what it has done, is attempting to do or has not done. If government has produced positive results, then those should be reported, but the opposite is also true. As journalists say, when a dog bites a man, it’s not news. It is news when man bites the dog. So, reporting on a government’s good will is not necessarily news, but reporting on what it has accomplished or not is.

Jones Lewis Arthur: Sections of the media is already ‘in bed’ with the governent of Ghana. My question is ‘how do we hold such media accountable in order to ensure that they act as watchdogs to censor government policies and ensure accountability?’
Victoria Ebin: In flagrant cases of a journalist’s violations of ethics, the media regulatory commissions can intervene, but it sounds like you’re referring to the more usual types of collusion between the media and the government. Ghana has laws that protect the state-owned media from government control, but journalists can take advantage of their position for their own gain. One way to lessen corruption is to make sure that the media organizations pay their journalists adequately. Can you count on the indepedent media that are not owned by politicians? In many countries, people turn to these print and broadcast media for more balanced reporting.