How do we prove impact?

DMI and LSHTM are now testing the predictions of our model in a real-life setting. The only way to prove conclusively that we (and we alone) are having the impact on child mortality that we claim is to conduct a randomised evaluation that provides the intervention to some groups of people and not to others. 

We are therefore conducting a cluster-randomised trial to test the impact of a radio campaign targeting all causes of child mortality, in Burkina Faso, West Africa. We are broadcasting this behaviour change campaign to seven randomised geographic areas (clusters) across Burkina Faso, and using seven additional clusters as controls.

The trial lasts for 2.5 years and began broadcasting in March 2012; midline results (on behaviour change) are expected in March 2014, with full endline data (including child mortality outcomes) being published in late 2015. This is the most robust evaluation that has ever been conducted of a mass media intervention in a developing country.

A controlled trial using radio would not normally work, due to the risk that people in 'control' areas would listen to radio stations broadcasting from 'intervention' areas. However, Burkina Faso has a very localised, radio-dominated media environment, so we can use local FM radio stations to broadcast our messages to intervention areas without 'leaking' into the control areas. The map below shows intervention areas in blue and control areas in red.

Example radio outputs from the trial

Malaria radio spot Breastfeeding radio spot
Breastfeeding radio spot 2 Hygiene radio drama

 

This trial has been funded by the Wellcome Trust and the Planet Wheeler Foundation. The evaluation, which includes baseline and endline mortality surveys with a 100,000 sample size, will be the most rigorous evaluation ever conducted of a mass media intervention.

If lives are saved on the scale that the model predicts, this approach should become a high priority for governments across the developing world. Most supply-side interventions take years or decades to take to scale. Mass media, by contrast, can be taken to scale within months.

If similar five-year campaigns are implemented in 10 African countries, the model predicts that one million lives should be saved. This process would, for the first time, place mass media campaigns in the mainstream of public health interventions, based on robust scientific evidence. We are currently designing health behaviour change campaigns in these countries and are looking for partners and funders through our Media Million Lives initiative.