Development Media International's Childhood Survival Program

What problem are they trying to solve?

However much money is spent on health services, they will only work effectively if people use these services.¹ This is difficult when people have little access to accurate healthcare information, and knowledge gaps or myths about healthcare persist.

What do they do?

Development Media International (DMI) uses a range of platforms and communication channels, including radio campaigns, to promote behaviors that reduce childhood mortality in lower-income countries. These radio campaigns especially focus upon reducing mortality from three leading causes of under-5 deaths in low- and middle-income countries (LMIC): malaria, pneumonia and diarrhea. In particular, much of the radio content focuses upon encouraging parents to seek treatment from health workers in response to early symptoms of malaria, pneumonia, and diarrhea in their children. You can hear an example radio show (with captions) here.² Other radio content contains information about preventing illness, for example, by sleeping under a malaria net or using oral re-hydration salts in response to diarrhea, e.g. see an example video here. In addition, these shows also focus upon increasing the number of deliveries that occur within healthcare settings, as well as getting women to attend antenatal care appointments.

Why do we recommend them?

We think that DMI’s program will reduce childhood mortality from these diseases by around 2-4 percentage points, among children whose parents listen to the shows.³ This is based upon our evaluation of DMI’S randomized controlled trial (RCT) – an RCT conducted by the London School of Hygiene and Tropical Medicine on a DMI campaign in Burkina Faso – which found increases in childhood consultations and diagnoses for malaria, pneumonia, and diarrhea in response to the program (e.g. a 56% increase in malaria consultations for under-5s in the first year of broadcast)⁴, as well as other RCTs testing the impact of mass media upon care-seeking behaviors in low-income countries more broadly.⁵ Through the use of radio, DMI are able to reach a vast number of people very cheaply (reaching a parent of an under-5 child for around $0.20).

We are impressed by DMI’s data-driven approach; they conduct extensive work into understanding the behavioral barriers to improving child health in the areas that they operate in. These results highlight that (in the areas where they operate) there are significant gaps in healthcare knowledge. For example, their research in Madagascar suggested that most people do not think a child with diarrhea can die from dehydration, breastfeeding should be reduced when a child <6 months old has diarrhea, and that a significant minority believe malaria is a common disease like a cold which does not require medical attention.

Importantly, early-stage pneumonia, malaria and diarrhea can be treated easily at local clinics in the areas where DMI operates⁶—with the use of antibiotics, ACTs for malaria, and oral re-hydration salts. These treatments are usually available free-of-cost to the parents, and at a low governmental cost. Consequently, we believe that educating parents to recognize these early symptoms, and to understand the importance of getting their child to a local clinic quickly, is highly impactful. In addition, our impression is that mass media interventions in general receive relatively little funding (perhaps because the intervention is not as intuitive as direct treatment, despite being very effective)—meaning that there are significant funding gaps to fill.

More resources

DMI's website

Notes

1. Head et al., ‘Can Mass Media Interventions Reduce Child Mortality?’ ↩

2. Our CEA focuses upon these aspects of DMI’s campaigns, although we acknowledge that other aspects of DMI’s campaign (e.g. encouraging bednet use) may make DMI more cost effective. ↩

3. This is based on our assessment of DMI’s RCT, and includes our own internal and external validity adjustments (see here). ↩

4. Sarrassat, S., Meda, N., Badolo, H., Ouedraogo, M., Some, H., Bambara, R., ... & Head, R. (2018). Effect of a mass radio campaign on family behaviors and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomized trial. The Lancet Global Health, 6(3), e330-e341. Note that we think this RCT is under-powered, so we applied large adjustments to the reported effect sizes. See our mass media investigation. ↩

5. Glennerster, R., Murray, J., & Pouliquen, V. (2021). The media or the message? Experimental evidence on mass media and modern contraception uptake in Burkina Faso. Banerjee, A., Chandrasekhar, A. G., Dalpath, S., Duflo, E., Floretta, J., Jackson, M. O., ... & Shrestha, M. (2021). Selecting the most effective nudge: Evidence from a large-scale experiment on immunization (No. w28726). National Bureau of Economic Research Lund, S., Nielsen, B.B., Hemed, M. et al. Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial. BMC Pregnancy Childbirth 14, 29 (2014). https://doi.org/10.1186/1471-2393-14-29 ↩

6. DMI assess supply-side concerns prior to scaling up within a country; they do not work in areas where the treatments that they advocate for are likely to be unavailable. ↩