Changing Social Norms and Creating Demand for Institutional Delivery Through a Multichannel Communication Campaign in Kigoma, Tanzania

Presenter: Victoria Marijani, World Lung Foundation

Background:  Since 2008, World Lung Foundation’s (WLF) Maternal Health Program has collaborated with the Government of Tanzania to reduce maternal and neonatal mortality by improving availability of good-quality comprehensive emergency obstetric and neonatal care (CEmONC) in health centers of Kigoma. Despite the availability of the service there has been low institutional delivery in Kigoma, key barriers being low knowledge of danger signs of pregnancy, poor birth planning, and low motivation for institutional delivery. To address the above, a strategic communication campaign was proposed for Kigoma in 2014.

Methodology: Focus group research was conducted with men and women aged 15-49 years. Three sets of messages (danger signs, birth planning, importance of institutional delivery) by three kinds of executional styles (aspirational, authoritative, concern-arousing) were tested. Results of the formative research were used to guide the finalization and selection of campaign materials. The final campaign included: five radio ads, community communication and print materials. Effectiveness of the campaign was evaluated in pre-campaign and post-campaign household surveys of adult aged 15 – 49 years.

Results: Focus group research identified concern-arousing messages to be the most effective, followed by those with authoritative tone. Campaign evaluation showed high campaign recall of 92%, highest by radio, followed by outdoor executions, community health workers. Campaign messages were well received and rated as easy to understand, believable and relevant. There was a significant increase in recognition of pregnancy danger signs, positive attitudes towards institutional delivery. Campaign awareness was associated with a nearly fourfold increase in the odds of delivery in a medical institution and increased positive perceptions of health facilities/workers.

Conclusion: The campaign led to positive intentions towards institutional delivery. This is likely to increase institutional delivery, met need for EmONC in Kigoma which will save many lives. Similar campaigns can be used in settings like Kigoma.