Two-Way Radio: Using Radio and Mobile Phones to Engage with Somali Women and Youth

"In a country with insecure and inaccessible regions, our pilot project demonstrated the value of Africa's Voices approach as a tool for remote monitoring and real-time citizen feedback - helping to amplify the voices of hard-to-reach communities and bring them closer to UNICEF's teams."

This report describes a pilot project carried out by Africa's Voices Foundation (AVF) in partnership with the United Nations Children's Fund (UNICEF) Somalia that involved delivery of eight 30-minute interactive shows, weekly, on 20 radio stations across Somalia. The central purpose was to explore the potential of interactive radio for gathering data on Somali people's views on polio and measles immunisation and maternal, neonatal, and child health (MNCH). AVF and UNICEF were motivated by the belief that programmes seeking to improve the lives of those in need must be evidence-based and informed by robust, varied, and high-quality data if they are to be effective. Of particular importance in this context, a country where 1 in 7 children dies before his or her fifth birthday, are data that reveal knowledge levels, practices, and beliefs regarding immunisation and MNCH - vital for the development and implementation of campaigns that reflect the socio-cultural realities of Somalis. "Informed by thorough consideration of the ethics of citizen data and respect for participants, we [AVF] focus on engaging with citizens, on their own terms, to amplify their voices."

Fuelled by the widespread use of mobile telephones in Somalia (50.9% of the population have access to mobile phones) and of radio (with at least 60 stations across the country), interactive (2-way) radio, when the audience can call or text in, is increasingly popular. "In these local language forums, citizens are spontaneously motivated to express their views in a social space they value and that reflects their cultural norms." Produced in collaboration with Somali media partner Free Press Unlimited during 2015 and early 2016, the radio shows sought both to gather crucial insights (e.g., the socio-cultural obstacles to getting children vaccinated) and to spark discussions that can actively shape beliefs and challenge misconceptions. Each episode was based on a different topic and asked the audience a related question (see Table 1 on page 6). For instance, the question asked on the radio programme might be "Would you use traditional medicine to prevent or cure a child of polio? Yes or No? Why?", which would be followed by the SMS survey question "In your opinion, what is the best way to prevent polio?" Designed with inclusivity, engagement, and entertainment in mind, the programmes featured expert guests (including a doctor and a sheik) and music. Scripts were designed to encourage participation from all demographic groups. For example, as interactive radio discussions are usually dominated by men, at least half of the audience messages read out were from women to encourage female participation. To advertise the radio shows and boost listenership, short promos were broadcast on the radio stations 3 days before the programme, and UNICEF staff distributed region-specific posters.

Over 8,400 people sent free SMS (text) messages to UNICEF's RapidPro platform from all provinces of Somalia: 44% were women, 86.4% were 15-29 years old, and 54.9% were parents. After filtering out repeated and one-word messages, AVF researchers analysed 19,392 messages from 7,633 participants and visualised them for UNICEF using an interactive online dashboard, reports, and presentations. The analysis was based on qualitative and quantitative techniques, including grounded theory, thematic analysis, word co-occurrence networks, and binary logistic regression. The semantic analysis of messages was carried out with support of native speakers. The analysis revealed insights on barriers to citizens adopting health behaviours - insights that will help to shape UNICEF's programmes. Selected insights include:

• Nearly half (47.5%) of participants mentioned polio as one of the diseases children should be vaccinated against, followed by measles (34.8%) and malaria (10.0%). Younger parents (15-19) are less likely to vaccinate their children (64.2% of those had vaccinated their children) as compared to older parents. Parents living in urban areas tend slightly more to vaccinate their children (73.2% of those), as compared to parents who live in rural areas (68.9%). Less than half of the participants (41.2%) believe in the effectiveness of traditional medicine - including local herbs and plants, as well as reading the Koran to patients - to cure polio. Perceived risk of polio is the most important factor impacting vaccination uptake. The perceived risk of polio is lowest in rural areas (only 51.9% perceive the risk) compared to urban areas (68.5%) and nomads (70.0%). Participants tend to associate reduced risk of polio with ideas of cleanliness – hygiene and spiritual. Participants perceive lower risk of getting polio for people who live in rural areas who have access to clean air and more sun. Reasons given for others not vaccinating their children included ignorance, negative attitudes towards vaccination, and the idea that polio is a "haunted wind" (polio is referred to as "debeyl/dabeysha" in Somali, which also means "wind"). This reinforces the idea that polio is not a virus but a disease spread by the wind and possible to be cured spiritually. Lack of health facilities, medical staff, and monitoring of children's vaccination status are also seen as barriers for polio-free communities.
• Seeking medical treatment comprises going to a MCH clinic, hospital, pharmacy, or a medical doctor. Parents in the age group 25-29 years tend more to seek medical health for their babies (90.6% of those age group) as compared to other age groups, especially parents in age group 20-24 years (75.8% of those). The great majority of parents who said they do not seek medical care for the treatment of their babies said they seek treatment only through religion (91.7% of those who do not seek medical care). That includes going to a sheik, reading the Koran, or praying to Allah. "These paths are not always incompatible as certain religious beliefs, for example related to breastfeeding, promote positive healthy behaviours. Therefore, certain religious beliefs can be promoted to support healthy practices."

Reflecting on the AVF approach to programming and evaluation itself, the report notes that, while accurate figures are difficult to obtain, conservative estimates suggest that 5-10% of a radio listening audience participate. Therefore, 84,000-168,000 people are estimated to have listened to the radio programmes. Considering these figures, it cost US$0.60-1.00 per beneficiary. "The interactive radio pilot had an impressive reach, and gathered voices from a wide range of demographics and regions....Importantly, the data gathered was of high quality and led to rich and deep insights. A common assumption is that remote, technology-based research methods harvest shallower insights than more traditional, face-to-face research. This pilot study demonstrates that this need not be the case. The crucial factor is in the design, implementation and approach to the research. Africa's Voices recognises the importance of media forums as social spaces for the expression of local views and collective beliefs."

Subsequently, UNICEF Somalia and Africa's Voices developed a long-term partnership and are currently working on 3 more interactive radio seasons (8-10 weeks each) to gather and analyse citizens' opinions on a range of health topics. To reach more people, they have increased the number of radio stations to 26 - now reaching 45% of territory across 60 districts in Somaliland, Puntland, and South-Central Somalia. Discussions will be exploring a broader range of health topics, with a particular focus on the role of gender relations in determining health practices and outcomes. "The opportunities for communication-driven development programming, remote monitoring, real-time citizen feedback, situational and programmatic assessments, and a range of other programming priorities, are clear."