Can Radio Drama Improve Child Health and Nutrition in Somalia?

"People who listened to a radio drama and magazine programme about child health and nutrition in Somaliland knew more than non-listeners about how to prevent and treat children’s illnesses, and practised what they learned."

This 12-page brief discusses the evaluation findings of Tiraarka Qoyska (Pillars of the Family), a 75-episode weekly radio health programme produced by BBC Media Action, with support from UNICEF, that ran on BBC Somalia from 2011 to 2013. The brief explains that Tiraarka Qoyska was designed "to increase the uptake of six supporting priority behaviours that, if more widely adopted, could improve child health." Through an interactive health magazine segment and a drama called Dareemo, Tiraarka Qoyska encouraged such behaviour as early and exclusive breastfeeding for six months, increasing complementary feeding for children after six months, and increasing intake of food and fluids when children have diarrhoea. Caregivers were also encouraged to wash their hands with soap or ash before eating, before feeding children, and after toilet activities, as well as safely disposing of faecal matter. The research presented in this briefing was conducted in Somaliland because of security risks in Puntland and South Central Somalia; however, the programme was aired in all three Somali regions. (See Related Summary below for more information.)

Evaluation findings indicate that "more than one in five adults in Somaliland listened to Tiraarka Qoyska at least once, equivalent to almost half a million people." Based on qualitative and quantitative research, the evaluation found that a large majority of the show's listeners had learned something new about health and had changed some of their daily habits as a result of listening to the programmes. The radio shows were associated with improved knowledge, attitudes, and health practices among mothers of babies under one year old in Somaliland, particularly related to prevention and treatment of illness. The evaluation found that the programme was particularly well received in rural and less populated regions, thereby "reaching people in Somalia typically considered hard to reach and the poorest of the poor."

As stated in the research briefing, the combination of drama and discussion formats was successful as different formats appealed to different audiences. Men were most interested in the discussion programme, while younger and older women preferred the drama. Including two formats in one programme, therefore, helped cater to a wider audience. A large majority of listeners (84%) reported learning new things about health from the programmes and changing some of their daily habits. Results were most significantly associated with the drama. "Listeners most recalled tragic drama storylines, such as babies dying from illnesses, illustrating the potentially fatal results of not adhering to recommended health practices. These stories also made the strongest impression on people and are directly linked with the types of behaviours in which listeners have demonstrated better results than non-listeners, specifically appropriate child care during sickness."

On the other hand, the research found that there was no link between issues most recalled during the magazine component and improved health indicators among listeners. "This may suggest that emotional engagement with the drama motivated listeners to rethink common misconceptions that inform practices. It may also make them more receptive to the relevant information discussed in the magazine programme even if they did not remember it later." Research also found that when the barriers to uptake of recommended behaviour were practical or environmental, the project was less successful in achieving its objectives. For example, although knowledge of better nutrition for infants had increased, behaviour had not changed and this could be due to the high cost of nutritious food in the region. Equally, the lack of toilet facilities could be a barrier to behaviour change around disposal of faecal matter, another key issue covered in the drama and discussion.

The research brief offers a number of conclusions drawn from the evaluation survey:

1. Radio, particularly BBC Somali, can effectively reach people in remote areas, but careful consideration must be given to formats.
2. Drama has been shown to have a particularly powerful role in encouraging audiences to absorb and act on new information. The tragic storylines led to an emotional response among the audience, and this has been linked with shifts in knowledge, attitudes, and behaviour in the survey.
3. To maximise impact, sufficient time is needed to develop an audience base and contribute to change in deeply rooted practices and beliefs. In Somalia, preliminary signs that people were broadly aware of and learning from the programme appeared only after more than 30 episodes were aired.
4. The practical barriers mentioned above can be partly addressed by strengthening stakeholder partnerships to ensure that people have the means to change their behaviours (for example, access to nutritious foods, vaccines, and latrines).