Media Coverage of Health in Uganda, July 2015-June 2017
Media Coverage of Health in Uganda, July 2015-June 2017
Media Coverage of Health in Uganda, July 2015-June 2017
Published by
African Centre for Media Excellence
Plot 124 Nanjala Road, Bunga
P. O Box 11283 Kampala, Uganda
Telephone: +256393202351
Email: [email protected]
Website: www.acme-ug.org
Facebook: ACME.UG
Twitter: @ACME_Uganda
ACKNOWLEDGEMENTS
This report is published with support from the United States
Mission in Uganda, which funded the African Centre for Media
Excellence’s project on Reporting Health and HIV/AIDS in Uganda
for two years. We are grateful for the support.
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RESEARCH ON MEDIA COVERAGE OF HEALTH IN UGANDA
JULY 2015 – JUNE 2017
CONTENTS
Executive Summary vii
CHAPTER I: INTRODUCTION 1
Background to the Study 1
Context of the Print Media Environment in Uganda 1
Context of Health and Public Affairs Coverage in Uganda 4
Research Questions 6
iv
12. Context 49
13. Story Frame 54
14. Newsmaker 56
15. Location of Story 60
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EXECUTIVE SUMMARY
This report contains findings from research on newspaper
coverage of health in Uganda between July 2015 and June 2017
conducted by African Centre for Media Excellence (ACME) in the
last half of 2018. The study sought to provide systematic evidence
to support informed analysis and debate about health coverage
in Uganda. Five major Ugandan print publications were reviewed
under this study. They are:
1. Daily Monitor
2. New Vision
3. The Observer
4. The Independent
5. Bukedde
The research is one of the key outputs of ACME’s project,
“Entrenching Knowledge-Based Health Journalism in Uganda,”
which was funded by the United States Mission in Uganda
between 2016 and 2018.
The data that informs the key findings of this research is from
ACME’s on-going bigger research project on press coverage of
public affairs in Uganda, which has focused on 12 key issues.
These are:
1. Agriculture
2. Business and Economy
3. Defence and Security
4. Education
5. Energy and Extractives
6. Environment and Natural Resources
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7. Foreign Affairs
8. Health
9. Justice, Law and Order
10. Land, Housing & Settlements
11. People and Power
12. Public Works and Infrastructure
A summary of the findings about media coverage of health in
Uganda between July 2015 and June 2017 are as follows:
viii
their capacity as ordinary persons and CSO representatives,
while male sources were mostly experts.
Health topics covered: Stories about diseases were the
most covered compared to those on institutional or sector
management; drugs and equipment & supplies. A breakdown
of disease coverage shows that Non-Communicable Diseases
were the most covered. The top three diseases covered
included HIV, cancer and malaria.
Context: Majority of health stories had “adequate context”
(56.4%).
Story Frame: A total of 46.2% stories were packaged using
the service delivery frame, followed by those on livelihoods
and human development (39.2%).
Location of stories: Although a majority of health stories
originated from parts of the country (57%) other than
the capital, Kampala took a disproportionate share of the
coverage.
The research findings offer a mixed picture. There appears to
be significant progress in areas such as provision of context,
multiplicity of sources, and a healthy focus on non-communicable
diseases -- which are a major global health challenge. However,
the predominance of the hard news storytelling format with
the accompanying lack of depth, enterprise and investigation,
limited diversity in sourcing, and over reliance on officialdom, still
undermine the contribution of media coverage toward improving
the health sector.
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x
CHAPTER I
INTRODUCTION
Background to the Study
This study sought to examine how the media covered health in
Uganda and to shed light on reporting health as a public affairs
issue. Specifically, the study provides evidence on the quantity,
quality and nature of health reporting, as well as trends and
patterns in press coverage from July 2015 to June 2017.
For the purpose of this study, health has been defined to include
issues, occurrences, and developments concerning, affecting, or
originating from activities, laws, regulations, policies, authorities,
as well as state and non-state actors and institutions involved
in the development, management and use of all forms of health
facilities, systems and services such as public and private
hospitals and health centres for the general physical and mental
wellbeing of the population.
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industry. Freedom House’s Freedom in the World report for 2018,
for instance, notes that Uganda’s status improved from “not free”
to partly free” “due to the resilience of the media sector and the
willingness of journalists, bloggers, and citizens to voice their
opinions”.
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1 ACME (2016), Monitoring Media Coverage of the 2016 Elections: Final Report
4
attention to this nexus. A 2015 USAID report2, for instance, found
that the “emergence of “market-driven” or “market-oriented”
journalism and stiff competition were driving the media in Uganda
toward a trend of “news” that they believe audiences prefer.
The same study found that stories about health did not get as
much prominent coverage in our media, except in situations of
“outbreaks of deadly infections, or of mysterious diseases, and
during special health days”3.
Cooper et al (2016)5 also note that health reporting still does not
represent the changing burden of disease. The prevalence of non-
communicable diseases (NCDs), they argue, therefore requires a
change in mindset and approach to reporting so that audiences
are in tune with present-day health challenges and issues.
2 USAID (2015), Where are the human rights in human interest stories?
Analysing the coverage of health issues in the Ugandan mass media from a
human rights perspective.
3 Ibid
4 ACME (2017) Press Coverage of Public Affairs in Uganda: Research Report
(Round 1, Round 2, Round 3, Round 4).
5 Cooper, et al (2016) Does health-related content in a major Ugandan
newspaper reflect the changing burden of disease in East Africa?
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Research Questions
The study explores the following questions:
6
CHAPTER II
METHODOLOGY
This chapter presents the scope of study, the sample and
sampling methods, methods and tools of data collection.
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1. Content analysis
Content analysis of data detailed an all-round picture of the
nature of health coverage by the print media as assessed using
various dimensions of journalistic quality and quantity. Stories
were coded and analysed for the extent to which they reflected
various pre-determined features of coverage that were apparent
in nature, to more latent characteristics of reporting. They were
analysed using the following research variables:
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3. Front-page coverage of health vs. other public affairs issues
4. Reporting format
5. Story trigger
6. Number of sources
7. Occupation of sources
8. Gender of sources
9. Occupation of sources by gender
10. Institution that is the focus of the story
11. Health topics covered
12. Context
13. Story frame
14. Newsmaker
15. Location of story
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CHAPTER III
RESEARCH FINDINGS
1. Volume of Health Stories
a) Health vs. Other Public Affairs Issues
The media published 59,966 public affairs stories during the study
period — July 2015 and June 2017. Of the total, health stories were
4,445. This placed health in fourth position (percentage of 7.4%).
10
followed the story of the day as it happened (instead of setting
the agenda) and stopped doing so when electioneering ended,
as seen in a dip in health story volume. This episodic coverage
of news deprives the audience of in-depth reporting. It’s not
surprising that the conventional reporting format is dominant
as shown this and our public affairs studies.
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Table 3: Volume of health stories by publication
Publication July 2015 -June 2016 July 2016 - June 2017 Overall
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3. Front Page Coverage of Health vs. Other
Public Affairs Issues
The front page (also known as the cover) is the “face” of a
newspaper and, as such, stories that are deemed absolutely
important (based on editorial parameters of different publications)
make it to the page. Front-page placement of a story is a measure
of prominence but only so many stories can make it there.
For this study, only 9.8% of health stories appeared on the front
page/cover; making it the fourth least prominent public affairs
issue out of the 12.
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A breakdown by publication shows that New Vision (41.9%) and
Daily Monitor (39.2%) had the most health stories featured on
their front pages. Bukedde (3.5%) had the least number of health
stories featured on its front page. The Observer (7.1%) and The
Independent (8.3%) didn’t do any better either.
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4. Reporting Format
The study analysed health stories on use of three reporting
formats; conventional hard news, enterprise, and investigative
reporting.
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usually proactive by initiating coverage rather than waiting for
events to happen.
Our findings show that 81.1% of health stories were reported using
the conventional hard news approach. This is also a dominant
trend of coverage for public affairs issues generally, according
to our research on press coverage of public affairs in Uganda.
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Table 7: Reporting format by publication
Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2
Conventional 100 88.5 77.9 77.9 74.3 91 33.3 45.5 81.3 66.7
Enterprise & 0.0 8.2 20.9 22.1 4.3 7.5 66.7 54.5 18.8 33.3
interpretive
Investigative 0.0 3.3 1.2 0.0 21.4 1.5 0.0 0.0 0.0 0.0
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body supplied anti-cancer drugs to Uganda Cancer Institute (UCI)
at inflated prices.
It also indicated that the NMS has kept the UCI budget at Shs7
billion and that it also supplies poor quality medicines to the
cancer institute.
“No such loss was occasioned because the cost of the said item
was the actual cost for the USFDA-approved medicines,” he
added.
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Mr Kamabare added that the wrangles between NMS and UCI had
been ironed out under the auspices of the Office of the Prime
Minister and the Health minister.
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EXAMPLE OF AN ENTERPRISE STORY
Headline: Hepatitis: Ignored killer
Publication: The Independent
Date: 5 August 2016
Website: https://www.independent.co.ug/hepatitis-ignored-
killer/
“Many hospitals have vaccines only. If you need drugs, you are
told to go to the referral hospitals where most times you are
given ARVs (Anti-Retroviral Drugs),” says Kenneth Kabagambe
who is infected.
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While 1.4 million Ugandans live with HIV, about 3.5 million
are infected with hepatitis and 30% (more than a million) are
chronically ill and require treatment.
The 2005 HIV sero survey which included screening for hepatitis B
showed the disease to be more prevalent in the Karamoja region
with 23.9%, Northern Uganda (20.7%), West Nile (18.5%), and
Western Region (10.0%); and the lowest infection rates were in
Central Region (6%) and South-Western (3.8%).
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The second is given a month after the initial one and then the
final one after six months.
Statistics from WHO indicate 240 million people suffer from the
disease and an estimated 780,000 succumb every year. Most
of these deaths are registered in developing countries where
awareness is still lacking. Some people only get to know a thing
about the disease when they test positive for it. Many do not show
any symptoms until when they are diagnosed with liver cancer
which is the most advanced stage of the disease. At this point,
it is too late for them.
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5. Story Trigger
This refers to what sparked off or motivated the coverage.
28
dominance of conventional reporting format which often result
from events. Further, a look at the story triggers also suggests a
dominance of “officialdom”. For instance, stories that originate
from the government and arms of the government (central
government activity, local government activity, parliament and
judicial activity) are 20.8%.
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6. Number of Sources
Sources are voices in a story. For this study, focus was on human
sources – people who comment on stories either in their official
capacities or as victims, interested parties to events, perpetrators,
etc. Sources, whether human or documentary, help enrich stories
through diversity of views and depth of issues raised.
30
A further breakdown of sourcing by publication shows that New
Vision had more stories with five or more sources, while 27.3%
stories by The Independent had no source.
Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2
No source 1.8 0.0 0.0 2.6 2.9 0.0 0.0 27.3 12.5 0.0
1 source 45.6 54.1 26.7 23.4 11.4 3.0 25.0 45.5 43.8 26.7
2 sources 29.8 26.2 36.0 33.8 30.0 7.5 8.3 27.3 6.3 13.3
3 sources 10.5 3.3 23.3 20.8 21.4 26.9 25.0 0.0 12.5 33.3
4 sources 5.3 1.6 7.0 14.3 17.1 20.9 8.3 0.0 6.3 13.3
5 or more 7.0 14.8 7.0 5.2 17.1 41.8 33.3 0.0 18.8 13.3
sources
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The virus was first isolated in Uganda in April 1947, from a rhesus
macaque monkey. The monkey had been placed in a cage in the
Zika forest located near Entebbe by scientists of the Yellow Fever
Research Institute, now the Uganda Virus Research Institute
(UVRI). Human infections were later reported in African countries
such as the Central African Republic, and parts of Asia.
32
Additionally, the Ae. aegypti mosquito found in many parts of
Uganda, which bites during the day, does not prefer to bite
humans, but animals. Owing to this, there is reduced risk of
transmission.
The ministry says UVRI has testing facilities for the Zika virus
and that the public should remain calm as no cases have been
recorded.
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7. Occupation of Sources
In what capacity do sources in health story speak? Are they
ordinary persons, experts, or lawmakers? This variable helps
explain which category of sources dominates health news
coverage and what that means for news consumers.
From Table 10, government officials from all branches and organs
(i.e., representatives of central, local government, minister, MP,
law enforcement, military, president, judicial official and vice
president), make up 42.5% of all sources in terms of occupation.
This is against voices of people whose occupations fall under
“private sector” (20.3%) - excluding experts (since this can be
either government or private experts), “other”, anonymous/
unknown sources and ordinary persons quoted in their individual
capacity.
34
Table 10: Occupation of sources
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8. Gender of Sources
Data shows that male sources were the most quoted in health
stories at 66.9% compared to 33.1% female. A look at the overall
coverage of public affairs issues during the study period, shows
that less than 25% female sources were cited in stories, with many
quoted as victims or witnesses to events.
Key respondents noted that men still control and occupy most
leadership and work positions (including in the media) and make
key decisions, which explains the slanted nature of sourcing
against women. However, many acknowledged that more female
journalists report the health beat; that women have more health
seeking behaviour and are key caretakers in health situations.
36
Figure 7: Gender of sources
Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2
Male 50.3 61.4 44.7 57.8 49.2 64.7 21.2 20.0 46.2 64.0
Female 49.7 38.6 55.3 42.2 50.8 35.3 78.8 80.0 53.8 36.0
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Table 12: Occupation of sources by gender
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For this period of study, the central government was the focus
of most health stories (33.6%). When divided into central
government organs and private sector, our findings from
coverage of public affairs issues show that the former (including
central government, local government, state-owned enterprises,
parliament & judiciary – a total of 62.5%), dominate coverage
over private sector/business/organisations (32.3%). The central
government and private sector grouping both exclude the
category “other” (5.2%).
While one may explain the lion share by government on its policy
control and resource allocation role, it’s noteworthy that even with
decentralisation the private sector still lags far behind in health
coverage. However, because most health stories are reported
conventionally with a focus on disease outbreaks (as we’ll see
in the variable on health topics covered), central government’s
dominance could also be tagged to ‘official’ communications
that Ministry of Health representatives give in cases of outbreak,
shortage of medical supplies, etc.
40
Table 13: Institution that is the focus of the story
(i) Diseases
(ii) Institutional or sector management of health
(iii) Drugs
(iv) Equipment and supplies.
From the analysis, stories about diseases were the most covered
(41.1%), while those on equipment and supplies (8.9%) were the
least covered.
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Further disaggregation of findings reveals the top three covered
diseases by the media were HIV/AIDS (28.7%), cancers (15.9%)
and malaria (8.2%).
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EXAMPLE OF A TYPICAL STORY ABOUT DISEASES
Headline: A child’s story recovery from cancer
Publication: Daily Monitor
Date: 20 October 2016
Website: N/A
His uncle carries him into the reception room and sits him down
on the sofa, where he had earlier placed large sheets of black
polythene.
At first contact, Vincent Otita, 10, is shy just like any other child
when near strangers.
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Double jeopardy
Since Otita’s mother was also sick at the time, his uncle, 16-year-
old William Lochoro, then in Senior Two at Pokot Secondary
School, became his caretaker in hospital.
“The feeling was completely gone from his legs and feet,”
Lochoro says adding, “he had terrible pain in the back and when
his condition worsened, we took him to Matany Hospital. He was
admitted in the children’s ward and given pain killers. There was
no further treatment. He had diarrhea and he could not control
his body functions.”
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It was in their third week at the hospital that the doctor decided
to do an ultrasound scan. The results showed there was a mass
in Otita’s kidney and two masses in his liver.
After the diagnosis, the doctor suspected it was cancer and wrote
a referral letter to Mulago hospital, where Otita was transferred
and admitted to the Uganda Cancer Institute (UCI).
So far, Otita has been at Akiba House for three months and is
responding well to treatment.
He can now lift his legs although he cannot walk but once in a
while, he holds onto surfaces to support his movements.
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JULY 2015 – JUNE 2017
“I now feel okay and there is no pain. I can control by body now
and the doctors removed the catheters. My parents visit me and
then go back to Amudat where they both work, but we keep in
contact,” he says.
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TIT BITS ABOUT BURKITT LYMPHOMA
These swellings can grow rapidly. The disease can start in the
spinal fluid, abdomen, ovaries or testes. Burkitt lymphoma
presents with enlarging tumour masses in the chest or abdomen
but can spread to the nervous system and involve the liver, spleen,
and bone marrow. It is a fast-growing lymphoma that needs to
be quickly treated with intensive chemotherapy.
12. Context
Context in stories, provided through meaningful perspective and
relevant background information, helps the reader understand
better the topic/issue covered. Findings show that majority of
health stories had “adequate context” (56.4%).
While our findings show that the media generally reports health
conventionally, it’s commendable that context is still provided.
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Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2 Y1 Y2
Significant 1.8 1.6 7.0 1.3 7.1 1.5 33.3 18.2 12.5 6.7
context
Adequate 36.8 65.6 64.0 79.2 71.4 26.9 50.0 36.4 37.5 33.3
context
Some 45.6 1.6 12.8 14.3 17.1 37.3 16.7 45.5 50.0 60.0
Limited 14.0 31.1 7.0 5.2 4.3 25.4 0.0 0.0 0.0 0.0
context
No 1.8 0.0 9.3 0.0 0.0 9.0 0.0 0.0 0.0 0.0
context
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EXAMPLE OF A STORY WITHOUT CONTEXT
Headline: CIRCUMCISION NOT SOLUTION TO HIV/AIDS
Publication: New Vision
Date: 2 May 2017
Website: N/A
The state minister for health, Sarah Opendi has blasted the way
men are jostling to undergo nationwide Safe Male Circumcision
(SMC), which she said is not the permanent, lasting solution to
HIV-AIDS.
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Babirye said unlike women who crave for routine blood checkups,
the men are adamant to do so under the guise of having busy
work schedules.
Babirye said Buyende, Kidera and Bugaya Health Center IIIs can no
longer handle the patients from the six sub-counties and 348 LCs.
52
EXAMPLE OF A STORY WITH CONTEXT
Headline: TB patients share wards with other patients
Publication: Daily Monitor
Date: 21 September 2016
Website: https://www.monitor.co.ug/News/National/TB-
patients--wards--patients/688334-3389048-9m5ybjz/index.
html
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The hospital is also infested with bedbugs that are chasing away
patients. Mr Sharif Nalibe, the district health director, said he has
consulted the authorities in Kampala over the issues.
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Majority of health stories were packaged using a service delivery
frame (47.2%), followed by those on livelihoods and human
development (39.2%).
The findings from this variable also alludes to the surface level
coverage of health (evidenced through findings on overwhelming
hard news reporting, a focus on diseases, etc.), without a look at
the big picture of what the issues mean in terms of governance,
rights and rule of law, and what they portend for oversight and
accountability of the sector.
9 Ibid
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14. Newsmaker
Newsmakers are people who, individually or collectively, are the
reason for coverage. The study identified individuals or groups
who performed actions important to the story or were the subject
of a substantial amount of the coverage. We recorded the identity
of the given newsmaker or capacity in which he/she appeared in
the story. It was anticipated that a typical story could cover more
than one newsmaker, so we recorded up to 20 by indicating their
respective identities.
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Table 16: Newsmakers of health stories
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Several women sleep on mats and mattresses spread on the floor
as they wait for midwives and nurses. Some share the little spaces
with newborn babies.
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For this study, Kampala district was compared against the rest
of the country. Findings show that majority of the health stories
were located in Kampala (43%), compared to the rest of the
country combined.
Other than the fact that major print publications are headquartered
in Kampala, respondents noted that experienced and well-trained
reporters are also based in their main offices. Additionally, the
presence of Ministry of Health and other government officials
in Kampala makes most stories take a Kampala focus. In fact, a
respondent noted that cholera may break out in western region
but the reporter will quote a ministry official based in Kampala.
Another key explanation was that health sources willing to talk
are based in Kampala, while upcountry reporters lack contacts
in the capital city and vice versa.
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A breakdown of location of health stories shows that The
Independent had the most number of health stories from Kampala
(53%). This can be explained by the fact that the magazine is
largely circulated and audience-focused in Kampala. The Observer
(65.5%) and Daily Monitor (60%) had most of their health stories
generated from parts of the country other than Kampala.
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CHAPTER IV
CONCLUSIONS AND
RECOMMENDATIONS
Conclusions
The research findings offer a mixed picture. On the positive front,
there appears to be some progress in key reporting areas such as
provision of context, use of multiple sources and a healthy focus
on non-communicable diseases, which are a major global health
challenge. On the negative side, however, the predominance
of the hard news storytelling format with the accompanying
lack of depth, enterprise and investigation, limited diversity
in sourcing, and over reliance on officialdom, emasculate the
contribution of the media to more responsiveness, transparency
and accountability in the health sector.
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It’s commendable, however, that in the coverage of diseases, the
media are giving more attention to non-communicable diseases,
which is a current global health concern.
Recommendations
Newsroom investment in in-depth reporting
The persistent dominance of the conventional reporting format,
not just in this study, but in our public affairs research, point to a
need for the media to invest time and money in training journalists
to effectively report in-depth about health. This problem is further
illustrated by our finding on story trigger which reveals that most
stories emanate from events and spontaneous activities.
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While several newsrooms, notably the New Vision and Daily
Monitor, have reporting guidelines that require reporters to have a
mix of male and female sources, care should be taken not to only
tick the gender box; or to reinforce the stereotype that women
can be sources only when they are victims, or perpetrators.
Investing in self-improvement
From our study, the impression that some journalists are lazy
and prefer armchair journalism, especially in this age of social
media, came out quiet prominently. This calls for self-reflection
and self-improvement by individual journalists.
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