4. In which ways is the initiative creative and innovative?
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The objective is to allow all people, regardless of their geographical location, level of education, literacy, gender, age, or acute poverty to access relevant information about their health and treatment. The fundamental obstacle was finding a way to educate people with low levels of literacy – finding appropriate and effective ways to leave information behind that was economical and sustainable.
The Speaking Book was created 7 years ago. Quotes were obtained from around the world, and suppliers sourced. The first book was on Teen suicide with De Beers and S A Government and researched in a school with low literacy. This was to ascertain to what extent the books compared with trainers on site. They are colourful and interactive and Speaking Books can be seen, read, heard, and understood regardless of reading ability. Soundtracks can be played in any order, so the Book can be listened to repeatedly until the message is absorbed. They’re also battery operated. The technology consists of a hardbound laminated book equipped with a sound box (IC recorded chip, circuit board, speaker, batteries) that produces the recorded spoken text identical to the printed words.
The first Speaking Book, on Teen Suicide Prevention, was developed in partnership with the South African Directorate of Mental Health. SADAG’s teen suicide prevention programme, run in schools, showed the need for an interactive, safe tool to get the message to children and teens that depression exists and suicide can be prevented. This book was such a success that more topics were created and the concept was applied to rural home-based care workers to use with their patients and communities.
The content and illustrations of each individual Speaking Book series are copyrighted and most are in the public domain. SADAG works with other NGO’s, government departments, pharmaceuticals, and communities to develop the content for the Books. The Speaking Book has been recorded in a variety of languages and have been supplied to a number of African and non-African countries.
The Books are distributed during training and education workshops in communities with local stakeholders, clinics, home-based caregivers, and schools. They’re delivered free of charge and communities are trained to use them. The Speaking Book literally talks to the ‘reader’ in his own language, and answers questions that may not be able to be answered - or asked - elsewhere. Many patients who use the Speaking Books feel like their doctor is always with them, answering their questions, and reinforcing healthy treatment compliance. The Book is a powerful aid for health personnel, NGO staff and government workers and a training tool for community workers and volunteers.
The traditional model of patient education has become outdated, boring, and selective in its target. The world is changing. Illiteracy and poverty are on the increase, and the healthcare industry can ill afford sophisticated but misguided training techniques. Poverty and burden of disease correlate directly with low levels of literacy. Life expectancy is lowest where people cannot read. Appropriate healthcare communication has indeed become critical to the health of all people, and the need has arisen for a new form of communication and instruction that can instill knowledge in all people, literate or not. The Speaking Book offers – and delivers – an innovative, interactive, and influential alternative to patient awareness and learning.
5. Who were the stakeholders involved in the implementation?
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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Initially the Speaking Book was developed in partnership with the South African Directorate of Mental Health with a book on Teen Suicide Prevention. The book was co-funded by the Department and privately and a local South African copywriter and illustrator were used. The Speaking Books works with all interested parties and stakeholders – from government to other NGOs, pharmaceutical companies to business. The Books are also endorsed by various national and international organisations like the WMA, SAMA, The Steve Biko Centre for Bioethics, Johns Hopkins, Rotary International, USAID, and Pepfar. The Speaking Book works because the people involved are dedicated to patient education. Whether it’s the copywriters, researchers, illustrators or the company funding the book, each Speaking Book is created with passion and inspiration. Without volunteers, community caregivers and community stakeholders on the ground in the communities, we would not be able to distribute the books or train people how to use them as an education tool. The Speaking Books are accountable to the government of South Africa, NGOs, clients and patients to ensure that the messages are clear and understandable, and the Books are effective. The Speaking Book has over 52 titles created in over 28 languages. Each is its own success story – from the time volunteered by local celebrities, to the support of the media, to the impact on each community the book touches, every Speaking Book has positively changed the lives of individuals and communities.
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6. How was the strategy implemented and what resources were mobilized?
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The Books were initially funded in conjunction with SADAG and each time with a new donor. De Beers funded the teen suicide book at R460,000. To date we have been able to maintain the cost at around R500,000 for a complete project. We have also been able to develop longer sound tracks, at a slightly higher cost from R95.00 per book, and up to R125.00 per book, for dual language dual track Speaking Books allowing clients to provide multiple languages in one book.
Speaking Book orders are only undertaken when a donor has been found, or as is often the case, a donor approaching us. As an NGO we were not able to spend our own internal funding . Human Resources costs were no extra to the NGO as the Founder and the CEO took additional fund raising for the sales of the books and sourcing of donors.
Other external cost have all been negotiated at great discounts, ie the artists whose names are promoted in the cover of the book , and follow specific briefs from client. Celebrities at nominal costs as the publicity gained is beneficial to them. Print and layout staff who work with the charity on our other work and do this work at a discount. Shipping is a cost which must also be taken into consideration. Typically Speaking Book orders are delivered to one venue in South Africa or other countries, unless client has other needs which can then increase the cost.
There has been a diversity of clients with unique needs who require specific briefs, like the Swaziland government in a landlocked country. Most clients have specific needs for unique donors logos and graphics and very clear copy. One of our biggest problems is making sure the copy is appropriate in terms of words used that are comprehensive and understandable to the users. Frequently this copy is tested in a rural community prior to printing . Very often the language is too mature and needs altering with the client.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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Following the launch of the first Speaking Book in 2005 “Suicide Shouldn’t Be a Secret” to educate South African rural teens on suicide prevention, acceptance and demand for the books has increased dramatically to over 52 titles, in 28 different languages and distributed internationally throughout Africa, China, India, Pakistan, Haiti, USA and South America and funded by all the major pharmaceutical companies, major NGO's and many Governments.
Being able to adapt and be suitable for adults and children alike.
Introducing stigmatising topics such as sexual behaviour, substance abuse, HIV and AIDS, and safe use of medicine in a non threatening or embarrassing environment.
Being used as a teaching tool that can also be left behind for distribution and further discussion amongst the community who can play the messages over and over again as necessary
Numerous International Awards for Sustainable Innovation by UN, UNESCO, Pepfar, Saatchi, Pan African Health, Commonwealth Association, etc
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8. What were the most successful outputs and why was the initiative effective?
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The research indicated its success in a variety of topics. We looked at participants in communities, hospitals, clinical drug trials, and Schools. The initial one was North of Kimberley for children, comparing trainers in the schools on suicide prevention with free standing books. Results showed, a very positive improvement using the speaking books.
Clinical drug trials is a key topic to ensure patients fully understand the Informed consent process. Initially it was tested through Wits University with non Educated teams of cleaners and lay staff. Then it was compared to research with over 90 in Uganda University and Hospital for comprehension and Knowledge of Clinical trials. Prof Roberson showed that participants who had instruction in the Speaking Books had a statistically significantly larger increase in knowledge assessment score.
One of the areas in Africa using Speaking books is Home Based Care workers, tested in the Free State Province. 210 participants participants were requested of which 63% participated. 92% indicated that the book was easy to understand and they shared their book and over 6000 members of the community were exposed to it by the care workers. Ie 38 people per book.
Unicef book on Maternal Child Health completed a major study and showed they were an extremely useful guide in the hands of health care workers to listen to books at home in Amharic. Each health care worker met with 30 groups of women approx 6 per group. Conclusions indicated that women all understood the messages. They believed content to be very accurate and truthful. Comparatively readers did not have the same level of confidence in the health workers. This research was accepted and printed by world medical journal.
A very emotive book Comparing for your Child Headed Household was tested with 23 Home Based Care Workers so that we could return and assess their comments. 99% reported that the books were easy to understand and 96% indicated they had learnt new facts. Of key importance the HBCW indicated that Home Based Caregivers should have their own book in their home.
Communities that have been exposed to the Speaking Book are more aware that help and support exists, are more likely to access that help, and talk more openly and freely about previously ‘taboo’ subjects. There is other research available that has equally positive responses.
In a study in the Limpopo Province, 88% of home-based caregivers reported the Book made it easier to talk to patients about depression (an average of 35 people were shown each Book). The Speaking Books are accountable to the government of South Africa, NGOs, clients and patients to ensure that the messages are clear and understandable, and the Books are effective.. From abused and vulnerable children, to HIV positive patients, from pregnant women to pensioners needing to access government grant, the Speaking Book is touching and impacting the lives of all communities and people. 5000 copies of a Speaking Book are likely to impact 30,000 to 100,000 people. Communities that have been exposed to the Speaking Book are more aware that help and support exists, are more likely to access that help, and talk more openly and freely about previously ‘taboo’ subjects. They’re empowered to be responsible for their wellbeing. The Speaking Book has demonstrated success in communities, and organisations, and contributed to a better understanding of health care issues. The Speaking Book educates and empowers low literacy communities. The Book is a powerful aid for health personnel, NGO staff and government workers and a training tool for community workers and volunteers.
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9. What were the main obstacles encountered and how were they overcome?
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Once the batteries die, the book may be thrown away even though the trainers and health care workers are trained in advance to explain how to replace them. The use of solar power has been investigated and can be made available, however at a significantly higher cost.
Profit margins are minimal to ensure we can offer books at the lowest unit cost. This means that we do not have significant funds to market the Speaking Books internationally or support a sales staff, so we rely on referrals and, awards and press reports on the impact and cost effectiveness of our books.
Similarly as much as we would like to exhibit at more international conferences on health care and public health, the cost is prohibitive and we look to invitations as guest speaker and allowed to display Speaking Books for free.
The only suppliers for the Speaking Book sound boxes are in China where we are required to meet their minimum order quantities, so we cannot do small quantity orders.
Speaking Books are perceived as items of value that empowers the holder as being more knowledgeable on the particular topic. As such they are often reluctant to give up or pass on the book, even though Speaking Books are always provided free of charge to the community. There has been limited reported cases of attempts to sell some sample books for personal gain. These are quickly halted.
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