Roy Head Photo: Joseph Rowntree Charitable Trust.
Roy Head - Developing medical campaigns to save lives
Rosemary Hartill describes the vision of Roy Head to help save lives by empowering governments and media in developing countries with the skills to communicate with their citizens.
Roy Head is crackling with energy. But he is also just a shade nervous. He’s currently launching a new £7m multi-message health information campaign which he hopes will provide a model for saving 2.2 million lives in ten countries over the next decade. In its scale, depth and level of scientific testing, this campaign in Burkina Faso in West Africa is unlike anything ever attempted before in this field.
Roy is no stranger to demanding health information campaigns. Between 1997 and 2005 he set up the Health Division of the BBC World Service Trust, personally raised £15 million and ran many of the world’s largest and most successful media campaigns. The BBC’s leprosy campaign alone led to 12,000 people being treated in Nepal and 200,000 being treated in India. Yet major health successes received virtually no media coverage.
By 2005, he felt time was running out. Roy reckoned that the desperate need for quality information could no longer be met by projects that focused on single diseases or on the one month a year when UNICEF was having a big blitz.
Instead of international staff flying in on expensive contracts in short bursts, he wanted to set up a consultancy, Development Media International, that would train local people to run the campaigns. He left the BBC and shortly afterwards heard that the Joseph Rowntree Charitable Trust (JRCT) was looking for ‘visionaries’ to fund. The timing was perfect.
He was soon planning and running, with local people, campaigns on tuberculosis (TB) in Brazil and mother and child health care in Orissa, India.
What he hadn’t quite reckoned on was how vulnerable local projects were to political, logistical and financial problems. Asked by the UK’s department for international development to examine Mozambique’s HIV/AIDS campaigns, for example, he found serious flaws. Far too much stress was being put on TV, even though only twenty per cent had access to it and it broadcast only in Portuguese. By contrast, very little advertising was being done on radio, which reached seventy-five per cent of the population in nineteen languages. But despite his advice, ‘Did anything change? Not much. You don’t achieve change just by writing on a piece of paper.’
But new evidence was coming in that gave an exciting glimpse of what could be done. In 2003, the Department for International Development (DFID) had given the BBC a £3.3 million grant to conduct an AIDS campaign in Cambodia. Roy had persuaded DFID to add maternal and child health messages to the campaign, like the importance of attending ante-natal check-ups, using iron supplements, using midwives and breastfeeding alone for six months. In 2006, the published results proved beyond doubt that progress could be made against multiple health indicators for no more than the cost of the single AIDS campaign.
At this point, Roy’s vision went through a significant change. He decided that the way ahead was multi-message, not single issue, campaigns. His long-term goal is the creation of departments within ministries of health in developing countries, run by ten or fifteen local people trained to really know how to commission a programme, monitor it, evaluate it, and keep on rolling it from year to year for the next twenty, thirty, maybe forty years.
In July 2007, he approached the Wellcome Trust for funding. Wellcome doesn’t fund health promotion. But it does want scientific evidence of what saves lives more cheaply. They liked his presentation, but didn’t think it was really science.
Every year about eight million children die worldwide. They asked him: ‘How many lives is your project going to save?’ He didn’t know.
The child survival series published in 2003 by the medical research journal The Lancet showed that one third of those eight million could be saved by simple actions in the home – like keeping babies warm after birth, giving food and water to children with diarrhoea, breast feeding and having bed nets as a protection against malaria-carrying mosquitoes. Another third could be saved by basic medical interventions, like treatment for malaria and TB and using antibiotics for pneumonia.
Roy spent the next nine months bolting this research together with everything he knew about the results of health care media campaigns.
‘That kick from Wellcome,’ he says, ‘changed my life. We became an organisation that’s pulling media and science together, forcing these two almost incompatible fields together. And that’s almost become an identity now, so I’m very grateful for that push.’
He worked closely with Simon Cousens, professor of Epidemiology and Medical Statistics at the London School of Hygiene and Tropical Medicine, and with Anne Mills, one of the world’s leading health economists.
‘It was such a privilege to work with top-grade academics,’ he says. ‘They don’t tell you how complicated everything is. They just think about it, and then propose a way forward.’
This, he says, was some of the most exciting, thrilling and stimulating work of his life. ‘It involved getting everything together that I’d learned over fifteen years. There were times when I thought: ‘This is what I was born to do.’
The Wellcome Trust had told him that anything less than a five per cent reduction in the deaths of under-fives couldn’t be funded. Roy’s results showed somewhere between a fourteen per cent and a twenty per cent reduction.
The Trust was also looking for an economic cost ‘per life-year saved’. The cheapest intervention previously found was immunisation at around $8 per life-year saved in Africa, or $16 in Asia. Roy’s interventions came in between $1 and $9.
He developed a proposal for a major twelve-message campaign to test the scientific evidence. The country chosen, the French-speaking Burkina Faso, has one of the highest rates of child mortality in the world.
After nearly two further years of gruelling examinations of this funding application, Wellcome finally agreed to fund the project. But only half of it.
That was tough good news: ‘I’d hoped this was the end of this Mickey-Mouse approach of Roy working out of his back bedroom.’
In the summer of 2009, he and his Asian fiancée, a management consultant, married. Now he faced the possibility of years more exhausting fundraising from their home in Tufnell Park, London.
Roy estimated that the true cost of the application so far had already been about £300,000. Without the JRCT money, he says he would have gone bankrupt: ‘It was not remotely sustainable without their money.’
‘There have been low points, when I thought “Maybe I’m not going to get there, maybe I should get a proper job”. But it would be a real b… if I walked away after not only having the JRCT money, but also their very loving nature and strong emotional support.’
He buckled down yet again, and submitted about another hundred applications to trusts. The Steinway piano in the modern uncluttered living room, Mozart, Beethoven, meditation and yoga helped him relax.
The applications yielded rejection after rejection. Finally, Planet Wheeler Foundation, the trust fund of the founders of the Lonely Planet guides, came up with a further £3.5million. It was only forty-eight hours before Roy’s time as a JRCT visionary came to an end.
There was great celebration at JRCT that day. This was part of an email Roy sent to JRCT the following week: ‘When I got the news (last Thursday) about the grant, I was quite emotional, and at first it was about finally making it across the finish line after so many years… But as the day went on, I became aware of something else. That in the next few years, we will know as an absolute certainty, that there are people alive who otherwise wouldn’t be. Ordinary people, people having their first day at school, their first job… I hadn’t quite hoped we’d dare to get this far.’
