Kevin Costner Syndrome

This editorial begins with the claim that "Most of our health managers (dedicated and earnest) and donors (generous and kind) working on Malaria, HIV/AIDS, Tuberculosis (MAT) are afflicted by a persistent case of the Kevin Costner Syndrome." As Dr. Everold Hosein explains, Kevin Costner is a well-known actor and film producer working in the United States. In the 1989 film called "Field of Dreams", Costner plays the role of a farmer who has a dream that if he built a baseball field in his cornfield, long-dead baseball players he had always revered would return to finish a famous baseball game. Mocked by community members and loved ones, Costner's character persisted in building the baseball field, repeating the mantra "If you build it, they will come".

For Dr. Hosein, "therein lies the Kevin Costner Syndrome. It manifests itself in our MAT health programmes designed with the view that all we have to do is provide the cure and the drugs, "build the services", and people would come automatically to our clinic doors for the offered cure. This may work in the movies...But, folks, in public health this has not worked for 50 years and it will not work for the next 50. Fantastic medical-technical solutions and superb services do not sell themselves. If the Kevin Costner Syndrome persists, so too will MAT."

How, then, does one "treat" this "Kevin Costner Syndrome"? According to this author, what is needed is "new, invigorated social mobilisation and communication strategies rigorously focused on specific, discreet behavioural outcomes". To elaborate, Dr. Hosein cites WHO's Communication for Behavioural Impact (COMBI) as an example of a promising strategy (for more information on this model, click here). In this context, Hosein is critical of what he calls "the fantasy that even if some communication is needed it can be done cheaply and can be kept to the modest production of posters, pamphlets, billboards, and T-shirts". In short, then, Dr. Hosein urges "serious funding and deliberate attention to communication programmes for MAT with rigorous attention to behavioural outcomes."

Click here for the full editorial on the Massive Effort website.