The blog ended last week with a few questions for the case study of preventing diarrheal deaths in Egypt, and how information and communication technology were utilized to play this role. Firstly, the ORT product had to be designed, labeled, and branded in an appealing way that would get the most mothers to use it. This took many steps of going and assessing what mothers thought; the first try, according to somebody who worked on this project, was not successful. Mothers would indicate that they knew about ORT, but they would not use it – the label design, which seemed innocuous, looked like something completely opposite of what it actually was. Rather than looking like a mother shaking salt and sugar to make this formula for her baby, it apparently looked like the baby had flies surrounding it – with this, the new project logo, a seated mother feeding her small child, gained much more popularity and was widely successful.
What’s so special about the case in Egypt is the way that the National Control of Diarrheal Disease Project took the product and marketed it to the public in a hugely cost-effective way. As Levine describes, the “most pivotal component” of the program was the social marketing and mass media campaign. The primary outreach audience were mothers, and also health professionals. There was phenomenon that coincided with the release of this national media campaign, and this new phenomenon allowed for a lot of outreach. What was it? Television! According to Levine, the number of households with a television had skyrocketed to 90% by 1984, compared to 38% in 1980. With such a huge increase in the number of households with television, it provided a great opportunity to reach out to families and households that were previously inaccessible. This is especially the case for rural, illiterate households where print media would have been ineffectual. With television as a new vehicle for conveying the information, the program utilized the communication technology of that time to implement a successful program targeted at vulnerable populations. This media campaign appealed to mothers, and was especially targeted at poorer populations – the language was simple, and the theme of maternal love was abundant. Also, a popular soap opera star was a spokeperson for this campaign. This media campaign was hugely successful, and much of it was because of the available technology to reach out to many households, and the ability of the campaign to fully utilize the available technology as a vehicle for communication. After the first national campaign in 1984, more than 90 percent of the mothers knew of ORT, and the use of ORT rose to 60%. With the success in conveying the information, infant and childhood mortality dropped by 36 percent and 43 percent, respectively, over the course of 5 years. Even more impressing is the reduction in diarrhea mortality in the same five years: it fell from 82 percent for infants and 62 percent for children. The use of information and communication technology in the case of Egypt is a large component of the campaign’s success, and it facilitated a cost-effective intervention. It should be noted that this approach does not work for all situations; in Bangladesh, BRAC took a different approach rather than using mass media technology and was also very successful in reducing diarrheal deaths.
I hope that this case provides a good example of the important role information and communication technology can play in public health projects. Next week, I will focus on diabetes management and telemedicine.
Sources:
Levine, Ruth. Millions Saved: Proven Successes in Global Health.
Thanks for the great case study. It would be interesting to look at the urban-rural divide on some of these technology issues. For instance, maybe you’re able to reach the majority of urban residents are using this cost-effective televised health campaign. Does this then free up more money to work a more in depth intervention in rural areas (which may constitute the majority of the 10% of households without television in Egypt)? How is that last 10 percent reached? I know there’s a lot of research going on know on the use of cell phones and text messaging as a way to disseminate health information. I don’t know what the actual statistic is, but I would guess even more people have cell phones than televisions… Information and communication technology is definitely has a lot of potential in the public health world!
I’m so glad you mentioned BRAC! I worked there summer of 2004 and I’ve been trying to get the name out there. It is interesting to note how important advertising is. The ad that looked like flies illustrates how test audiences are important. I wonder if they had any for that ad. And as csgibson says, it would be interesting to consider cell phone technology. I have recently talked with people and we agreed that many poor people have phones. It would be a great way to reach people. I wonder what they do in Bangladesh. I learned about ORT but I didn’t learn about how they publicize it.
This was a very good example of just how much the media can play a role in public health. Being very experienced in watching US TV, I often wonder just how effective our own television ad campaigns are in getting messages out. For example, the anti-smoking “Truth” campaign comes to mind. Both of these two public health campaigns were marketed to very specific audiences and had very specific themes.
This Egyptian study was marketed to mothers and the US anti-smoking ad campaign was geared towards young adults. The Egyptian study focuses on maternal love while the anti-smoking campaign tried to portray not just the hazards of smoking but also that it was not “cool” to smoke. Although I am not exactly sure how much the US ad campaign contributed to the decline in adolescent smoking, it is another interesting case study. These two examples provide valuable support for including media in global health efforts.