Healthcare, more than needles and nurses
The critical role of Demand Creation in public health campaigns
As everyone in the public health ecosystem in South Africa struggles to absorb the shocking news of the sudden withdrawal of all US-funded aid except for the delivery of critical services, TB HIV Care's Michelle Carey explains the crucial role of Demand Creation in the efficient and effective delivery of critical healthcare services.
Demand Creation is about more than just telling people that healthcare services are available, it's about making sure they want to use them. Without fostering the desire and motivation to seek care, these health services, no matter how well-funded or accessible, are likely to remain under-utilised and ineffective. Thus, Demand Creation is not just a last-minute addition to a health campaign, it's an essential component that should be integrated from the very beginning.
What is Demand Creation?
Demand Creation refers to strategic efforts designed to increase the uptake of healthcare services among specific target populations. It's about addressing barriers that prevent people from seeking care, whether those barriers are cultural, logistical, or based on misinformation and stigma.
Ultimately, Demand Creation focuses on building awareness, reducing barriers, and motivating people to take action and to engage with the services that can improve their health.
Key objectives of Demand Creation include:
Raising awareness: Informing target populations about the healthcare services available to them, explaining their importance and making them aware of the benefits.
Reducing barriers: Addressing the stigma, misconceptions and logistical obstacles that prevent people from seeking care, whether they are related to social determinants of health or individual concerns.
Driving action: Turning awareness into tangible steps, such as visiting a healthcare facility, attending counselling sessions, or participating in prevention programmes.
Building trust: Cultivating long-term engagement by fostering trust between health providers and vulnerable communities, as trust is foundational to sustaining health behaviours.
Who should Demand Creation target?
Demand Creation is not one-size-fits-all. It must be tailored to meet the unique needs and concerns of the populations that interventions are aimed at. This often includes vulnerable and marginalised groups, such as:
People who inject drugs: With challenges like stigma and criminalisation, Demand Creation for this group must focus on harm reduction and creating safe spaces for care.
Adolescent girls and young women: Education about sexual health, HIV prevention, and post-violence care are key to empowering this demographic.
Sex workers: Ensuring health services are accessible, non-judgmental and targeted to the needs of sex workers is crucial for engagement.
Incarcerated individuals: People in correctional facilities face unique health challenges, including high rates of HIV and TB. Targeted Demand Creation can help address their specific needs.
People with HIV/TB: Demand Creation here is about dispelling stigma, highlighting the benefits of early diagnosis and ensuring consistent treatment.
For these populations, a deep understanding of their unique concerns is essential. Demand Creation must speak to these communities in ways that resonate with their experiences and challenges.
Delight at arrival of healthcare vending machines
Effective tools and channels for messaging
When it comes to spreading the word, the tools and channels used can be just as important as the message itself. Given the resource constraints often present in public health campaigns, creative and cost-effective approaches are essential.
Radio and television: Especially in rural and remote areas, these traditional media platforms remain powerful tools for spreading awareness.
Social media: Platforms like Facebook, Instagram, and WhatsApp are invaluable for reaching younger populations, although tracking behaviour change from these channels can be difficult.
Community engagement: Partnering with local organisations, faith leaders and community influencers can help spread messages in a way that is relevant and culturally sensitive.
Promotional materials: Posters, leaflets, and other materials can raise awareness, but they must be used strategically to inspire action rather than just awareness.
Campaign duration and sustainability
Demand Creation is not a quick fix; it requires sustained effort over time. Public health campaigns must recognise that lasting behaviour change takes time. The duration of a campaign should allow for ongoing engagement, feedback collection, and adjustments to ensure its effectiveness. Additionally, sustainable Demand Creation efforts should involve community-led initiatives that continue after the campaign has officially ended.
Addressing the budget gap
A glaring issue in many public health campaigns is the imbalance between the budget allocated for service delivery and the budget for Demand Creation. Even when health services are well funded, Demand Creation often receives only a fraction of the investment required. As a result, services may be under-utilised, even in the face of ample resources. To put it simply, building a healthcare infrastructure without building demand for that infrastructure is like building a dam without pipes connecting it to the community.
In particular, populations like people who inject drugs often face significant underfunding in Demand Creation efforts, despite their vulnerability and the risks they face. If we are serious about public health, we must ensure that Demand Creation receives the attention and funding it deserves.
Strengthening community engagement and building trust
Ultimately, Demand Creation is not just a matter of marketing; it is about building trust and credibility within communities. Engaging communities early on, through surveys, advisory groups and peer-led discussions, ensures that campaigns are addressing real concerns. When individuals from vulnerable groups are involved in creating and shaping health campaigns, the message resonates more deeply and effectively.
Peer educators, especially those from within the targeted communities, can be instrumental in breaking down stigma and providing culturally relevant information. Similarly, partnerships with trusted local figures, such as faith leaders, can build trust and ensure the message is received in a way that feels natural, rather than imposed.
Shifting the focus: Recognition over material incentives
In many campaigns material incentives, such as promotional items, are used to encourage participation. However, a more effective approach involves creating social capital through recognition. Rather than offering material rewards, communities can be motivated by acknowledgment of their positive actions, such as regular clinic attendance or educating others. This recognition can be a powerful motivator, particularly in tight-knit communities.
Addressing holistic needs
Finally, it’s crucial that public health campaigns take a holistic approach to care. Successful Demand Creation does not simply focus on healthcare, it also considers the broader context of individuals' lives. For example, integrating mental health counselling or vocational training into HIV and TB prevention efforts can make health services more appealing and help to increase engagement.
By addressing not just the medical needs of individuals, but also their social, psychological and economic needs, health services become more than just a place to seek treatment, they become an essential part of an individual’s overall well-being.
Conclusion
Demand Creation is the often-overlooked linchpin of effective public health campaigns. It’s not enough to just build healthcare services; people must be motivated to use them. By prioritising Demand Creation, addressing community-specific needs and building trust through sustained engagement, public health campaigns can ensure that millions of people not only have access to healthcare but also feel empowered to take advantage of it.
In the end, it’s about making healthcare something people desire and see as essential, because that’s when true impact is made. It is also the best way to make sure that every cent spent really has an impact.
Michelle Carey is Demand Creation Manager at TB HIV Care
This is a great article about real solutions and supporting communities. It's an overlooked aspect of healthcare systems - so much more than just providing the resources.