Health Education: Impications for The Achievement of
The Health-related Millennium Development Goals
OSUALA, E.O. B.Sc, MPH
Department of Nursing Science, Nnamdi Azikiwe University
ABSTRACT
The focus of a public health intervention is to prevent
rather than cure. Health education is said to be the
process of passing information to individuals or groups
with the purpose of helping them adopt positive
change in attitudes and behaviour in health-related
matters. Health education is geared towards change in
behaviour that persists over time. It has to be
practised andrepeatedlyreinforcedthrough learning.
Health, which can be explained as a state of complete
physical, mental and social well-being of an individual,
group or community, can be attained if the eight-
millennium development goals (MDGs) are achieved.
Health education, helps to maintain, promote, prevent
and restore the various components of man, and
therefore contributes immensely to the achievement
of the health-related millennium development goals,
even though it could be applied partly in the
achievement of some others .This paper outlines the
various principles, steps and methods of health
education and explores the implications of health
education in the achievement of the health-related
MDGs. I t is therefore believed that this paper would
sensitize nurses in general, community health nurses,
and health educators in particular, on their roles in the
achievement of the health-related millennium
development goals, through the adoption of health
education asan indispensable tool.
Key words: Ignorance, Health education. Health
Educator, Millennium Development Goals (MDGs).
WEST AFRICAN JOURNAL OF NURSING
INTRODUCTION
The process of educating the community or people on
prevailing health problems and the method of putting
these health problems under control is considered by
many as the most important role of community health
nurses. The indispensable roles of educating, mobilizing
and motivating the community in achieving a therapeutic
milieu, cannot be over emphasized. Indeed health
education is considered by many, as the first and most
important component of public health. This is most true
of a developing country like ours where ignorance and
superstition prevail'.
For people to know the value of good health, how to
achieve it and what to do individually and collectively
towards achieving good health, health education must
be given and the process must among other things,
include activities that foster community participation. For
individual or community participation to be achieved,
adequate information need to be given to people for
them to recognize their health problems and the
relevance of using the available health services and
facilities, in solving them. The people need to be
adequately motivated for them to assume active interest,
lead and participate in the provision of such services that
would protect and promote their health and that of
others. Some of the developing countries show certain
common features, for example, limited central
organization of services, scattered populations, living in
small self-contained units, low level of economic
development, limited educational facilities, and
inadequate control of common agents of diseases. Some
of these communities are still held tightly in the vicious
cycle of ignorance, poverty and disease.^ Health
53
 Health Education: Implications for the Achievement of the Health-Related Millennium Development Goals - Osuala, E. 0.

education therefore serves as the cheapest and easiest sanitation, improved agriculture, security, education,
tool to dismantle this vicious cycle. Through health road maintenance et cetera. Even though there is no
education, the misconceptions based on ignorance can fixed standard pattern for a health education
be clarified, and awareness created on how to reduce programme, there are yet some basic principles, which
poverty and disease and thereby avert problems that serve as a guide. Such principles include:
affect health. • Interest and Motivation
• Comprehension and Communication
GENERAL PRINCSPLES OF HEALTH EDUCATION • Moving from simple to Complex matters
Proper health education cannot be attained without the • Participation/ exercise
application of some basic principles derived from the • Reinforcement/Repetition
theories of learning as postulated by Pavlov, Skinner and • Leaders involvement
Thorndike.^ • Integration
Health education is not just simply telling people what • Evaluation and Correction of the health education
will make the world a better place to stay in or what will programme.
make the people live in paradise on earth. No, it goes These principles should be used in line with the steps in
beyond that to include empowering people to health education. Certain steps need to be adopted
understand who they are, where they come from, and whenever health education is to be delivered, either to
what they and their community can be."* Health individuals, groups or communities.
education may involve an individual, group or community The steps are as follows:
and is influenced by many factors such as attitudes, ,1. Collection ' of InfoirmatöorD arad Facts:
beliefs, tradition and level of education, as well as wants Assessment of target audience is done. The health
and needs of both the giver of the health education care provider should review available information on
package and the receiver. IncSövidaial sdlucatiors, cultural and social characteristics, health status, and
involves the health education given to individuals and health seeking behaviour of a community. A good
families whereas gmiap edycaftioire entails the health health education package is based on facts and
education given to a ffoirmall group (planned) or information on peoples values, beliefs, behaviours,
informal groisp (unplanned or impromptus). Example interests, and needs, as they relate to health.
of formal group is Widows Associ ation, school children; Observation, interviewing, use of records or
¡etc. It can take place in schools, institutions or Service documents etc may be employed in the data
Delivery Points (SDPs), while a group of women in a gathering.
market place is an example of an informal group. 2, ©etermêraîmg the IPirewalliiiig Practices and
CommMmiDt^ educattoorD^ on the other hand involves EderaîsfViing ttè IProBsllems; Health information
health education given to a community. A community is a needs of the audience should be ascertained. The
group of people who share common interests and have the
provider then analyzes the audience information
feeling that they belong together.' Community education is
needs. Information gathered is used also as baseline
adopted when a problem affects many or all the people in a
of level of knowledge. This includes understanding of
coiTimunity and when the co-operation of everyone is
the facts involved in a problem. In a community
required to solve the problem. The package of health
where women are ostracized for one reason or the
education, for the community usually focuses
other, one has to understand the facts surrounding
on needs that affect all, such as water shortage, proper

54 Vol. 22 No. 1 May, 2011

 Health Education: Implications for the Achievement of thé Health-Related Millennium Development Goals - Osuala, E.O.

such practice before developing a health education displays, flip charts, flannel graphs, photographs,
package for intervention. tapes, films, role play, to mention but a few.
3. Deciding on Priorities, Objectives, and Actions: Preparation of a health education package is a
The decisions, on which actions to take first or last in crucial stage in health education delivery.
achieving an objective would among other things, 6. Implementation: This involves conducting the
depend on the resources available. Problems of the talk, that is, implementing the health education
society are usually multifaceted and diverse and package. One should remember to use appropriate
therefore need to be prioritized according to the IEC materials, considering age, sex and level of
needs of the people in question. education among others and incorporate
4. Identifying and Obtaining Resources: Planning interpersonal skills when conducting the talks, as this
and preparing for the health education package encourages participation and ensures friendly and
requires identification and procurement of the informal atmosphere. Provider should use open-
required resources. At this stage appropriate place ended questions and encourage the audience to ask
for the talk is identified, as well as timing for the questions. The seven Cs of effective communication -
talk; the objectives and content of the health talk are should be applied for the message to go down well.
prepared and resources, brought together. They indude:
5. Selecting Appropriate Methods for carrying 1- C - Command attention
out the Action: it is not just enough to decide on 2- C - Cater to the head and heart
what will be done. It is also important to identify 3. C - Clarify the message
who will do what, when and how it will be done, 4. C - Communicate a benefit
depending on the resources available. Use of 5. C - Create trust
appropriate method or technology is important for 6. C - Convey a consistent message
carrying out actions that require the involvement of 7. C - Call for action
communities. Appropriate technology means that 7. Evaluation of the Effectives of the Talk: Lastly
besides being scientifically sound, the method used the effectiveness of the talk should- be evaluated.
should be relevant for the topic of health education, This should be based on the objectives set. Key
easily applicable and acceptable to both users and points are highlighted and key issues demonstrated.
the target group. The method or technology adopted The audience is encouraged to respond to questions
should be easily understood and applied by both the used for evaluation. Results of health education may
health educator and the community members. be positive or negative.
The health education package should be one that
can easily be adapted and developed further, if need Barriers to effective communication in health
be. The method of health education to be used education
depends on the objective/goal to be achieved, the Even when these steps are adopted, the manner in
target group and circumstances under which the which the health education is conveyed may produce a
health education exercise is to be carried out. The negative result because of certain barriers. For this
skill and competence of the educator is also reason, the nurse or health educator must guard against
considered in choosing a method. Media of barriers to effective communication of health education
communication when ever any of these methods is package. The barriers to effective communication in the
adopted should include mass media, posters.

WEST AFRICAN JOURNAL OF NURSING

55
 Health Education: Implications for the Achievement of the Health-Related Millennium Development Goals - Osuala, E.O.
delivery of health education package include the
following:
® Language bamer. The health provider must have
a good command of the language used by the
receiver; otherwise she would not be understood.
English is used for literate audience and mother
tongue for illiterate groups such as the rural
community. Use of technical terminologies could also
pose a barrier and so should be avoided.
•-,. Negative Atiityde otF Provôdeir: If the provider is
lazy and nonchalant, much will not be achieved. She
has to motivate the audience by being active,
working tirelessly and enthusiastically. Timeliness is
important. Non adherence to scheduled
appointments could be frustrating and discouraging.
• Poor Kuowlleiage of Sybject-matter'by Semce
ProvDdler: If the provider is not an expert In the
area, the message may be scanty or delivered
haphazardly. Communication is a two-way action.
What you give is what you receive back, thus the
adage garbage In, garbage out. One can only give
what he has. In-depth knowledge of the subject
matter is essential for proper comprehension and
likely implementation by the client.
• Finance: Lack or inadequate funding may hinder
the health educator from using the appropriate tools
for effective communication. For instance only a
hand bill may be employed when an Audio Visual Aid
would have been a better option to drive the
message home.
o Timing: If the timing is not conducive, the
attendance if any will be poor. For instance. If a
health programme is to take place on a market or
festive day/time, it becomes futile in a rural
community because of wrong timing. The people will
be engaged and will not turn out for the programme.
The provider is always in a hurry to deliver the
message if the timing of the programme is short,
and this may lead to loss of some part of the
message. Timing therefore, is a very important
56
element in the planning of a health education
programme.
o Physical] Esivironment: The physical environment
is important. Noise affects communication. If a
health education programme is going on in a rowdy
or noisy environment, most of the information may
be lost. Privacy can influence health education
programme in certain circumstances. For example,
privacy will encourage clients with HIV/AIDS to
attend counseling sessions. Comfort is important. If
one is not comfortable during the session he/she
may walk out nonchalantly before the end of the
session.
o Reliigöoys Coûstraints: The provider should put
into consideration, the religion/denomination of the
people. Religion puts a lot of constraints on
communication. Some people are barred from
listening to certain information based on their
religious beliefs. For instance the Roman Catholics
would always disregard any information outside
natural family planning, just as a Jehovah Witness
would not want to hear of any benefit of blood
transfusion.
« Cultural Beliefs and Values: People prefer paying
attention to information that does not conflict with
their values and cultural beliefs. Some believe in
listening to the ideals of the Babalawo than the
orthodox medicine. The cultural beliefs and values of
the people must therefore be taken into
consideration for effective health education outcome.
Hugging for instance may mean different things in
many cultures.
® To overcome the above mentioned barriers, use of
simple, clear, culturally acceptable language the
audience understands should be adopted. Technical
terminologies should be avoided where possible and
such terms explained in simplest term the
audience/individual would understand. Judgmental
behaviours should be avoided. All forms of prejudice
should be avoided. One should see and take the
Vol. 22 No. 1 May, 2011
 Health Education: Implications for the Achievement of the Health-Related Millennium Development Goals - Osualá, E.O.
individual/audience thé way they are. Clients/groups
should always be attended to at all times. One
should not turn down an opportunity
communicate by the phrase l a m busy now, come
another time, as there may not be another time.
The receiver may feel let down. Information being
provided must always be credible and relevant. The
environment for interaction must be conducive in
terms of comfortability, quiet, weather-friendly and
spacious. The atmosphere must be free from
pollutions.
HEALTH EDUCATION: IMPLICATION
MILLENIUM DEVELOPMENT GOALS.
The Millennium Development Goals (MDGs) were derived
from the United Nations Millennium
endorsed, December 2000 by 149 Heads of States and
adopted by 189 member nations as the millennium
declaration^'^. The eight millennium development
goals are a global agenda to bring about improvement
in the well being of people worldwide by the year 2015.
Alongside with the goals are eighteen targets aimed at
reducing poverty, hunger, illiteracy,
discrimination against women and environmental
degradation. Indicators were also mapped out for
monitoring of the process and outcome of set goals. The
Millennium Development Goals (MDGs) include the
following:
• Eradicate extreme poverty and hunger
• Achieve universal primary education
• Promote gender equality and empower women
• Reduce child mortality
• Improve maternal health
• Combat HIV/AIDs, Malaria and other diseases
• Ensure environmental sustainability
• Develop a global partnership for development.
In this paper, emphasis will be on the three health-
related goals- 4*, 5* and 6^.
In primary prevention, factors known to cause diseases
are removed so that diseases will not occur. Health
WEST AFRICAN JOURNAL OF NURSING
promotion measures as good food, sanitation, clean
environment, healthy lifestyle, etc and specific protection
to measures such as immunization, supplementation With
specific nutrients etc, can for many be accessed if they
have the necessary information /knowledge. It is a
painful irony that in parts of some developing countries,
it is not uncommon for people to fall sick or die of
diseases that can easily be prevented and treated. Many
people in developing countries do not benefit fully from
modern knowledge and technology that could have
protected and restored their health. Even though some
communities have access to simple but efficient
FOR remedies, many fail to make use of the appropriate
services even when provided. Individuals and
communities do not keep healthy often because of lack
Declaration, of essential knowledge on how to recognize dangerous
signs in the individuals and hazardous situations in the
environment coupled with knowledge of how to mobilize
resources to solve their health problems. One may then
ask why many individuals are not doing the simple things
that would keep them in good health? The answer is
simple. IGNORANCE,, along with its siblings -
disease, misconceptions, superstition, spiritual poverty etc lead
to actual poverty and disease.
For the number 4 millennium development goal, reduce
child mortality ; a target is set, to reduce by two-thirds,
between 1990 and 2015 the under-five mortality rate.
The indicators or parameters for the evaluation of this
goal include under-five mortality rate, infant mortality
rate, and proportion of 0-1 year old children imrriunized
against measles. Worldwide 73% of the 10.6 million
yearly deaths in children Under- 5 years are as follows:
pneumonia (19%), diarrhea (18%), malaria
(8%),neonatal pneumonia/sepsis (10%).One
million (61%) of these deaths are due to the presence of
under nutrition.^ A study conducted in Monrovia reveals
that the incident rate of diarrhea is highest among
children ages l-2years( 54%).' Coming to Nigeria, child
mortality rate is 80-110 per a thousand.^" A study
conducted by Ibeziako et al, at the Childrens Emergency
57
 Health Education: Implications for the Achievement of the Health-Related Millennium Development Goals - Osuala, E.O.
Room of the university of Nigeria Teaching Hospital
Enugu, reveals that the commonest causes of admission
were febrile convulsions (21.5%),severe malaria with
anaemic heart failure (18.4%),acute lower respiratory
tract infections (ALRTI) in 16.1%,diarrhoeal diseases
(12.3%), complications of sickle cell anaemia ( 7.6%),
acute asthma (5.2%) and neonatal
(4.8%).Leading causes of mortality beyond the neonatal
period were severe malaria with severe anaemia in
30.0%, ALRTI in 19.3% and severe dehydration with
shock in 10.9%.The majority of deaths 73.5% in children
under five years of age occurred in those aged two years
and below with a peak in the age group, 7-12
months".Another study by Tagbo et al, showed that out
of 101 children with respiratory symptoms of less than
28 days duration, 52 had radiological pneumonia; 42
(80%), of them were less than three years old including
22 (42%) less than one year^^. In developing countries
over 50% of deaths in infants and young children are
associated with diarrhoea^ Malaria,
pneumonia and diarrhoeas could be prevented through
health education on the importance and use of ITNs, and
environmental sanitation; adequate nutrition; proper
clothing and ventilation; as well as proper hygiene,
respectively.
The number of children that die under five years of age
is an important index of child health. It is a sensitive
measure of the effectiveness of health services, as well
as the socio-economic progress of a country. Most of the
causes of morbidity and mortality in children under five
years are preventable. When one goes through causes of
such deaths as malaria, diarrhoea, anaemia, or even
measles which can be prevented through simple
vaccination, it becomes apparent that most of the deaths
could be averted through health education of parents,
especially mothers. Ignorance and cultural beliefs have
made mothers to continue the use of cow dung in the
treatment of the babys cord. There is the misconception
that it makes the cord to fall in 2 days. This practice will
be discontinued if mother knows that the baby is
58
exposed to risk of neonatal tetanus and possible death
through this practice. If our mothers are convinced on
the benefits of all immunizations and nutritional
supplements as Vitamin A, all the immunizable diseases
would be under control by this date, but what do we
have today, outbreak of measles, poliomyelitis,
conditions insurgence of Guinea worm and tuberculosis, etc in
various communities, where parents have refused the
services due to ignorance. Cases of respiratory tract
infections were reported in the study, the morbidity and
mortality rate arising from this end can easily be taken
care of by health education and environmental
sanitation. Malaria is claiming lives of children under-five
years. This is because of unhealthy environment, bushy
areas, stagnant water in gutters, especially in our urban
slums and non use of the insecticide treated mosquito
nets. All these morbidities can be prevented through
appropriate and aggressive health education campaign
to ensure a change of behaviour/lifestyle amongst our
anaemia, people. Such health education should be on Exclusive
Breast Feeding, adequate weaning diet using cheap but
nourishing available foods, marriage counseling to
prevent sickle cell disease and MTCT of HIV and
preventive measures against malaria, the 6-killer
diseases, diarrhoea, febrile convulsion etc. If every
mother, during Antenatal Care is informed about the
relevance, effectiveness and procedure for tepid
sponging the common practice of using palm kernel oil
to treat febrile convulsions will stop .If alerted that the
oil prevents the heat to be let off and the one in the
nose and mouth could be inhaled and cause inhalation
pneumonia which kills the baby thereafter, she will desist
from such practice. Health education will also provide
mothers with knowledge of signs and symptoms of minor
childhood ailments, simple treatment, and seeking
prompt-quick intervention would reduce child morbidity
and mortality rate. This is just few examples of situations
where health education will help to reduce child
mortality, putting every other factor in place.
Vol. 22 No. 1 May, 2011
 Health Education: implications for the Achievement of the Health-Related Millennium Development Goals - Osuala, E. 0.
The number 5 goal is to improve Maternal Health: It is
hoped that to achieve this goal, the maternal mortality
ratio will have to be reduced by two third. In Nigeria,
maternal mortality ratio will have to be reduced by two
third. In Nigeria, maternal mortality ratio is estimated to
be about 800 per 100,000 live births. Globally 585, 000
women die every year from pregnancy related causes^^
It may interest us to know that the causes of such
maternal deaths especially hemorrhage; obstructed
labour, infections etc are traced to ignorance, cultural
beliefs, superstitions about causes of diseases and lack
of access roads to mention but a few. In some religious
sects women depend on the husband on the decisions
about labour and delivery. Many women cannot convey
themselves to hospital when in labour or pay their bills if
the need arises. This trend can be perfectly reverted
through a health education intervention. Women can be
talked into forming co -operative groups and acquiring
skills that will enable them to generate their own
income. The maternal health need to be improved
through proper antenatal and postnatal care. If the
pregnant woman considers herself first in matters of the
quality of nutrients she takes from the family menu,
problems like anaemia, which may lead to congestive
cardiac failure or post partum hemorrhage or even intra
uterine death, will be prevented. In most cultures in
Nigeria, the husband gets the lion share of the family
menu and when food is insufficient in the family, the
woman tends to take the least share. Some pregnant
women refuse taking some food stuffs during this period
either due to ignorance, old womens tale, taboos, or
beliefs. Some do not take snail that contains calcium for
strong bones and teeth of both mother and fetus. The
reason for this refusal is based on the belief that snail
makes the baby to salivate excessively. Some look down
on certain foods like mushroom that
micronutrients (zinc) for bioavailability of other nutrients.
Another group refuses to take the grass cutter (bush
meat) even when thats the only source of protein,
because they believe it causes prolonged labour. Health
WEST AFRICAN JOURNAL OF NURSING
education will go a long way in changing such attitudes,
beliefs, and habits, thus improving maternal health. Early
marriage, which causes low birth weight in babies,
rectovaginal and vescicovaginal fistulae in the mother,
should be discouraged through health education in order
to improve maternal health. Awareness on the causes,
mode of transmission, signs and symptoms, and possible
complications of the minor ailments would improve their
health seeking behaviours, towards prevention and
maintenance of good health.
The number 6 goal is to combat HIV/AIDS, malaria and
other diseases: It will be easier to combat HIV/AIDS,
malaria and other communicable diseases if people have
adequate knowledge of causes, hazards, and preventive
measures of these diseases. Some people believe that
HIV/AIDS is caused by ones enemy through native
poison. Their belief gets a stronger backing, as orthodox
medicine has no cure yet, for the HIV/AIDS. Health
Education will reduce if not eliminate these. Elimination
of malaria through ITNs, IPT (Intermittent Prophylaxis
Treatment) for pregnant women, etc and prevention of
HIV/AIDS through the creation of awareness on mode of
transmission, screening and HIV counseling, may be
achieved through health education. This, it does by
providing knowledge, changing misconceptions,
modulating practice.
Conclusion
The paper discussed the importance of health education
in the actualization of the 3 health-related (4'^ 5*, and
6*) millennium development goals. Health education has
been defined as the process of passing information to
individuals, or groups for the purpose of positive change
in altitude and behaviour in health-related maters. The
principles, steps, and methods of health education were
provide brought into focus. Some opportunities for health
education were discussed in relation to these MDGS.
Many diseases and situations are preventable through
simple, health education using methods and packages
that are easily understood and acceptable by the target
59
 Health Education: Implications for the Achievement of the Health-Related Millennium Development Goals - Osuala, E.O.

audience. The focus of a public health intervention is to Ibadan, Nigeria: College press and publishers limited .2006.47 -
48.
prevent rather than treat a disease, through surveillance
5. Muthu, V.K.A .Short Book| of Public Health. New Delhi: Jaypee
of cases and the promotion of healthy behaviour. Brother Medicinal Publishers Ltd.2005.
Healthy behaviours are achieved through health 6. Millennium Development Goals.Retrieved on June 23, 2008 from

education. For health education to produce the desired http://www.unmillenniumobro1ect.ora/htm/dev.aoals.shtm.

fruit, effective communication is an imperative.
Health education, which is geared towards maintaining,
promoting health, preventing illness/diseases and
restoration of health, is therefore the bedrock for the
achievement of the 3 health-related millennium
development goals. Every health care provider should
therefore be involved in health education. This might just
be the cheapest and easiest way towards achieving the
health-related millennium goals.
REFERENCES
1. Obionu.CN.i ¡Primary Health Care for Developing Countries.
Nigeria: Delta Publications Ltd. 2001.
2. Lucas, A.O. & Gilles, H.M. Short Textbook of Public Health
Medicine for the Tropics. London: Arnold Hodder Headline Group.
2003.
3. Lancaster, J. Community Health Nursing; Process and Practice for
Promoting Health. NewYork: Mosby.1992.
4. Bragg, M.E: An empowerment approach to community health
education.1997,in Akinsola, H.A. A-Z of community health in
Medical, Nursing and Health Education Practice. 2"" edition.
7. Website development: UN' Web Services Section, Department of
Public Information. United Nations. © 2005.
8. Diarrhoea Cases Today. April 11, 2008. Retrieved December
15,2008.
9. Sankoh, M.D. Factors contributing to the incidence of diarrhea in
children between the ages of 1-5 years. West African Journal of
Nursing 2003; 14 (2) :71-85
10. National Curriculum on Réproductive Health for Nurses/Midwives
Nigeria:FMOH. April, 2004.
11. Ibeziako,S.N. Ibekwe, R. G.Pattern and Outcome of Admissions in
the Childrens Emergency Room of the University of Nigeria
Teaching Hospital Enugu. Nigerian Journal of Paediatrics 2002;
29:103.
12. Tagbo,A.C. Ude, A. C. Ibe,B.C. Predictive Value of Respiratory
Rate Threshholds in Pneumonia among Preschool Children in
Enugu, Nigeria. Nigerian Journal of Paediatrics 2002; 29:108.
13. Health Indicators. Lagos, Nigeria: FMOH. April, 2004.
14. Joslin, D. & Harrison, R. |Self reported Physical Health among
Older Surrogate Parents to Children Orphaned and Affected by
HIV, Disease AIDS Care 2002; 14: 619-64
15. Allender, J.A. Community Health Nursing; Promoting and
Protecting the Public Health. London: Lippincott Williams &
Willkins.1995.

Pain is a gift humanity without pain, would

know neither fear nor pity.
Without fear, there could be no humility and
every man would be a monster.
The recognition of pain and fear in others gives
rise in us to pity, and in
our pity is our humanity, our redemption".
Dean Koontz, Velocity.

60 Vol. 22 No. 1 May, 2011

Copyright of West African Journal of Nursing is the property of West African College of Nursing and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.