USING THE MEDIA TO SAVE MOTHER AND CHILD LIVES IN ORISSA

1. An introduction to DMI

2. The impact of previous media campaigns

3. An outline of the media project

4. A quantitative model for the selection of messages

Devika BahlExecutive Producer, Development Media International

The role of DMI

Selected by the WHO/Partnership for Maternal and Newborn Child Health, following a competitive tender, to implement the media component of Deliver Now in Orissa.

Project will begin on 20 September 2008.

Broadcasting will start in January 2009

Project will end in June 2009

Some background on DMI

1. WHO ARE DMI?

health campaigns in recent years, with experience in over 30 states.

It is led by Roy Head, who created and ran the Health Division of the

staff also come from the BBC, including the Head of its India leprosy and AIDS campaigns, Peter Gill, and the Executive Producer of Jasoos Vijay, Devika Bahl.

2. WHY WAS DMI CREATED?

DMI was created for one purpose: to distil this accumulated experience into a set of systems that will allow campaigns to be conducted far more comprehensively, and thus save more lives, than has been possible until now.

Leprosy campaigns

HIV/AIDS campaigns

Trachoma (blindness) and hygiene campaigns

TB campaigns

Mother and child health campaigns

BBC LEPROSY CAMPAIGN, INDIA 2000

Impact in India: 200 000 people treated

Percentage of respondents who believe that leprosy is hereditary

Source: 3 KAP surveys conducted by ORG Centre for Social Research in 5 states. Each sample size 1000, randomised. Subject to a sampling error of +/- 4% at the 95% confidence level

172m people changed their minds

JASOOS VIJAY, INDIA 2002-6

Jasoos Vijay: results

140 million viewers

Regularly in top-10 TV ratings, the leading drama

Global Business Coalition Award for Business Excellence 2008

But can we do better than this?

All our projects rely on partnerships

Once the relationships are created, and staff trained, we can campaign on more than just one issue.

An experiment with this concept in Cambodia, working on several Mother and Child Health issues in close sequence:

Diarrhoea treatmentDiarrhoea prevention (handwashing)PneumoniaIron supplements for mothersBreastfeedingPromoting pre- and ante-natal check-upsPromoting delivery with a skilled birth attendant

AN EXPERIMENT WITH MULTI-ISSUE CAMPAINING, CAMBODIA 2004

Results: behaviour change

Parents reporting washing their childrens' hands to prevent diarrhoea

1021.7 25.2 28.4

0102030405060708090

100

Baseline (2004) Low exposure(2006)

Mediumexposure (2006)

High exposure(2006)

No

Yes

TARGETTING ARI, CAMBODIA 2004

Impact of ARI campaign

Impact across multiple targets: pregnant women taking iron supplements

Impact across multiple targets: knowledge about immediate breastfeeding

Impact across multiple targets: ante-natal check-ups

Pregnant women only

The Orissa media campaign

1. WE WILL BE ABLE TO CONVEY 5 MESSAGES

There will also be some room for secondary messages. These will be discussed with partners when the project starts. But we have room for just 5 primary messages.

2. OUTPUTS:

5 TV spots (60 seconds, 1 message each)10 radio spots (1 for AIR, 1 for FMs: 1 message each)1 mini-drama (3-5 minutes, showing all messages)

The Orissa media campaign: partnerships

WE HOPE TO WORK WITH:

- Ministry of Health and Family Welfare

- WHO

- White Ribbon Alliance of India and its Orissa chapter

-

We welcome all advice and suggestions from every organisation who is dedicated to the field of mother and child health.

Messaging

1. WE WILL BE ABLE TO CONVEY 5 MESSAGES

There are many, many messages that could be conveyed. So we have to be selective.

2. THE CRITERIA FOR SELECTION:

which will maximise the numbers of lives saved, and morbidity

3. TIMELINE FOR MESSAGE SELECTION

Today: preliminary introduction and consultationSeptember 20th: project formally starts, continued consultationsOctober 15th to 30th : finalisation of message brief, based on formative research, quantitative analysis and consultations

Messaging: a quantitative method

THE CRITERIA FOR SELECTION:

which will maximise the numbers of lives saved, and morbidity

NEW RESEARCH:

Research has been developed over the past 6 months withLondon School of Hygiene and Tropical Medicine(Professor Simon Cousens, Professor Anne Mills)and DMI (Roy Head).

Will be published by The Lancet in 2009.

Messaging: a quantitative method

THE BASIS OF THE MODEL:

Survival Study Group.

This model calculated how many child lives could be saved through existing interventions (breastfeeding, bednets, etc), based on over 1000 academic papers.

The researchers used extensive evidence of how much media campaigns can change behaviour, applied that data to the existing Lancet model, to find out how many lives media campaigns could save. Predictions have has also been calculated for how many lives campaigns on each individual message can save.

Messaging: a quantitative method

IMPORTANT FACTORS:Some behaviours are easier to change than others: breastfeeding, or giving a child fluids when it has diarrhoea is relatively easy. Other behaviours (eg giving birth in a health facility) are dependent on service availability.And everything is dependent on how many people can view or listen to the messages on the media.

Hence: the model is adjusted for service availability, and for media penetration, in 10 countries, including India.

LIMITATIONS:1. The calculations have been based on all-India figures for the moment.

Orissa-specific figures will be calculated in due course.

2. The figures are based on a 3 year, high-budget campaign. So while the absolute numbers are too high, the relative impact of different messages remain valid.

3. The figures are for child deaths only, and exclude maternal deaths, so maternal messages need to be added.

Which messages save the most children's lives in India:predictions of the London School Lancet- DMI model

(if 1 message only)Intervention (prevention) Message Predicted lives

saved over 3 years (all-India)

Breastfeeding (BF) Exclusive BF for 6 months, continue for 24 39195Insecticide Treated Material Bednets (ITM) Use bednets for the whole family, particularly mother

and baby 1234Complementary feeding (CF) Promote CF, and active, frequent feeding. Also

promote the positive values of water, milk and fruits. Promote a varied diet, using local foods. Provide recipes. Discourage consumption of industrialised foods. Monitor weight gain. 28160

Measles vaccine Get vaccine. 8166Extra care for LBW infants Feed small babies more often, keep them warm,

avoid bathing 27841Thermal care & early breastfeeding 3963Antibiotics - PRoM Get to health facility as soon as waters break, and

499Water/Sanitation/Hygiene Promote hand-washing, water purification,

environmental hygiene, proximity to animals, smoke in homes. 9731

Vitamin A Get supplement from health centre 9771Tetanus toxoid See a doctor if you are pregnant 4254Antiretroviral (ARV) treatment and replacement feeding 194Ante-natal care (ANC): exam for eclampsia, syphlis See a doctor if you are pregnant 7992Diagnosis (Rx) and Treatment (Tx) of aymptomatic bacteriuria See a doctor if you are pregnant 1028Antenatal steroids 1325Skilled maternal & immediate neonatal (NN) care Give birth in a health centre 5027Intervention (treatment)ORT Continue feeding, appropriate fluids, ideally ORS or

equivalent. Take child to health centre at signs of dehydration. 64814

Antibiotics: pneumonia Know danger signs of ARIs; seek treatment. 15794Antimalarials Seek treatment for malaria 1754EmOC (Emergency Obstetric Care) Prepare for emergency. Danger signs. 2738Antibiotics: dysentery If blood in stool, go to a health worker 8061Emergency Neonatal Care 6242Treatment of neonatal pneumonia Know danger signs of ARIs; seek treatment. 5710Vitamin A Seek treatment for measles 1824

Candidate messages

FOR CHILDREN (FROM QUANTITATIVE MODEL):

1. Promote Oral Rehydration Therapy2. Promote breastfeeding

3. Promote either: complementary feedingor: awareness of pneumoniaor: extra care for low-birth weight babies

FOR MOTHERS :

knowledge of the right behaviours make a difference; and how much do people already know?

Promote giving birth in a health facility (Note: dependent on services)Promote family planning (Note: has this been focus of previous campaigns?)Encourage preparedness for an emergency (Note: highly dependent on services)Promote ante-natal and post-natal care (Note: worked well in Cambodia)Promote iron folate (Note: went from 10% to 40% in Cambodia)