Learn how we use evidence-based behaviour change campaigns to improve and save lives in low-income countries.
Learn about how DMI brings together two different worlds: demonstrable scientific practice and creative storytelling.
Location Child survival
In Tanzania, maternal deaths account for nearly one fifth of all deaths of women aged 15 – 49. Meanwhile, largely preventable diseases such as malaria, pneumonia and diarrhoea are causing the death of 270 Tanzanian children under 5 years of age every day. We have strong evidence from our randomised control trial in Burkina Faso to show that our campaigns have impact on improving maternal and child health outcomes at scale.
Imarisha Afya, meaning ‘to promote health’ in Kiswahili, piloted a version of this campaign in Tanzania, where we have extensive experience of running successful campaigns on early child development, nutrition, and family planning. The campaign was broadcast for a total of six months in Tanzania’s Lake Zone region, which has the highest child mortality rate in the country.
Tanzania
Maternal health and child survival – encouraging parents to seek treatment for malaria, pneumonia, diarrhoea, and promoting antenatal care and health facility deliveries
25 x 1-minute radio spots produced in Kiswahili
Our spots were broadcast for six months from November 2021 to May 2022 across six community and commercial radio stations in six districts in northern Tanzania.
Science
Results from our 2012-2015 child survival RCT showed that our mass media campaigns can change behaviours to improve maternal and child health outcomes at scale in a low-income setting. Health economists have concluded that this approach is one of the most cost-effective interventions for saving children’s lives.
Imarisha Afya piloted an expansion of our maternal and child health campaign in the Lake Zone of Tanzania. As child mortality is particularly high in this region, our campaigns can maximise life-saving impact by encouraging treatment-seeking behaviour for malaria, pneumonia, and diarrhoea. We have more than seven years’ experience of running successful radio campaigns in the Lake Zone and have have cultivated strong relationships with networks of radio stations, carefully selected to ensure our campaigns have optimal audience reach to encourage treatment-seeking behaviour change.
Our radio spots were pre-tested in three phases via focus group discussions (FGDs) with groups of mothers, fathers, and elders.
Stories
For this campaign, we adapted some radio scripts from our highly successful child survival RCT to the Tanzanian context, and produced new spots to complement these. These spots were created through extensive focus group discussions with families to understand the barriers to care-seeking for malaria, pneumonia and diarrhoea, as well as maternal health behaviours. The campaign themes focused on: treatment seeking for malaria, treatment seeking for pneumonia, prevention and treatment for diarrhoea, ante-natal care, and promotion of skilled deliveries. Weighting between the themes was informed by impact modelling.
Saturation
We broadcast our spots on six radio stations across the Lake Zone, chosen based on their coverage and popularity in the target region. Using our unique Saturation+ methodology, each radio station broadcast a DMI spot 10 times per day, seven days a week. We also conducted post-broadcast feedback research to gather audience reactions.
We conducted a process evaluation to observe and assess:
Overall, the evaluation found that the Imarisha Afya campaign maintained high fidelity to the social behaviour change strategy used in the Burkina Faso RCT. Ensuring adaptation to the Tanzanian context involved a more simplified production given the single broadcast language, and other greater complexities, such as the higher dependence on official ministry permissions and approvals, especially due to the COVID-19 pandemic.
The evaluation also found that broadcasting at saturation levels had been successful in getting crucial health messages to the intended audience. Feedback reports showed that the campaign had helped change gendered norms and behaviours. For instance, radio spots that encouraged men to accompany their wives to the antenatal clinic had changed people’s perception that reproductive health issues are solely a woman’s responsibility.
DMI has received funding for a three-year, national scale-up of Imarisha Afya. We will build on the successes and lessons of this campaign as identified by the process evaluation. This includes conducting further analysis of all child and maternal health data to identify regional and seasonal variation which will inform more fine-tuned, targeted messaging. The national scale-up, Tunza Afya, has been welcomed by the Tanzanian Ministry of Health as it will contribute to the government’s goal of averting more than 100,000 child deaths, nearly 20,000 maternal deaths, and more than 40,000 stillbirths by 2025-2026.
We are grateful to the Saul Foundation, a private trust, and private philanthropist, for funding this project.