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DMIDEVELOPMENTMEDIAINTERNATIONAL
Changingbehaviours.Buildingevidence.Goingtoscale.
TODIM20.JAHRHUNDERT
34%KinderU5sterbenandreibehandelbaren Infektionskrankheiten
– Lungenentzündung(14%),– Durchfallerkrankungen(10%)– Malaria(10%)
1mioKinderunter5/Jahr
<50%derKinderwerdenrechtzeitigindieKlinikgebracht
– Lungenentzündung46%– Durchfallerkrankung39%– Malaria43%
DIEHERAUSFORDERUNG
LEITFRAGENDESEFFEKTIVENALTRUISMUS
1. WIRKUNG- Howmanypeoplebenefitandbyhowmuch?
2. EFFIZIENZ- Isthisthemosteffectivethingyoucando?
3. VERGLEICHBARKEIT-Whatarethechancesofsuccessandhowgoodwouldsuccessbe?
HOWMANYPEOPLEBENEFITI.Wirkung schätzenII.Wirkung messenIII.Wirkung erzielen
Kommunikationsforschung
I.WIRKUNGSCHÄTZEN
MassenmediensinddurchihreReichweite kosten-effizient
Kampagnendesign istausschlaggebend(e.g.Intensität)
Vergleichvon16Kommunikationsprogrammen(Horniketal.2001) ErfolgvonProgrammenmitgeringerIntensitaet 28%
ErfolgvonProgrammenmithoherIntensitaet 82%
Channel %Exposed(a) EffectofExposure(b)* ChannelEffect(axb)
Clinic 22% 18% 4%
Outreach 16% 20% 3%
Radio 60% 14% 8%*UnstandardizedRegressionCoefficient
Sources:Hornik(1989),NaugleandHornik(2014),Horniketal(2001)
Praxisbeispiele
India|Leprosy
%whobelieveleprosyishereditary
56%
32%
19%
0%
10%
20%
30%
40%
50%
60%
Baseline Phase1 Phase2
Ethiopia|Trachoma
74% 72%
26%
52%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Baseline
Endline
HandwashingTrachomaprevalence
I.WIRKUNGSCHÄTZEN
Mathematisches Modell
Assumptions(LivesSavedTool)%currentcoverage(Baseline)%Targetcoverage
II.WIRKUNGSCHÄTZEN
Assumptions(DMI)%predictedbehaviourchange%servicecoverage%mediapenetration
%Childmortality%Childsurvival
%changeincoverage
(1-currentcoverage)*predictedchangeincoverage
Numberoflivessavedand%mortalityreduction
Predictions- 16-23%reductioninchildmortality
HOWMANYPEOPLEBENEFITI.Wirkung schätzenII.Wirkung messenIII.Wirkung erzielen
MeasuringImpact– BurkinaFasoRCTII.WIRKUNG- MESSEN
HOWMANYPEOPLEBENEFITI.Wirkung schätzenII.Wirkung messenIII.Wirkung erzielen
WIRKUNGERZIELEN– SATURATION+
1|Saturation
Broadcastspots8-12timesperday(radio),or3times(TV),anddailylongerformats
Broadcastinlanguageswhichatleast75%ofthetargetpopulationcanunderstandwell
Broadcastonstationsviewedorheardatleastweeklybyatleast75%ofthetargetpopulation
2|Science
Usemathematicalmodellingtoestimateimpact ofeachmessage
Allocateairtimetoeachmessagebasedprimarilyonpredictedimpact
Measureandattributeimpactsusingrobustevaluations
3 |Stories
Integrateformativeresearchfindingsintothecreativeprocess
Ensureemotionalclimaxofdramasreflectbarrierstobehaviourchange
Testallmaterialsbeforeandafterbroadcastwiththetargetaudience
Saturation
AchieveingSaturation
III.WIRKUNGERZIELEN– SATURATION
REICHWEITE
VERSTÄNDLICHKEIT
INTENSITÄT(Exposure)
13Szenaristen6Sprachen(Djoula,Moore,Fulfulde,...)
140Spots(1‘)10malamTag75,000Wiederholungen15,000StundenLive-Radio
Medienkanäledie75%derBevölkerungerreichen
Tabelle-Kostenbeispiel(1-jaehrigeKampagneinTanzania)
Kanal Frequenz Sendekosten/Jahr ErreichtePersonen Kosten/Person
Radio (5spots/Tag) $150,000 33.5mio $0.004
TV (3spots/Tag) $280,000 15mio $0.019
SMS (1sms/day) $2.8mio 100,000 $28($0.078perSMS)
Kostenbeispiel
III.WIRKUNGERZIELEN– SATURATION
Science
Medienanalyse– Wirkungsanalyse– Verhaltensanalyse– Pretesting
III.WIRKUNGERZIELEN– SCIENCE
CampaignDesign
MediaAnalysis Impactprediction MessageI.
BehaviourAnalysis MessageBrief Script
Pretesting
Production
II.
Stories
Ergebnisse
So…HOWMANYPEOPLEDIDBENEFIT?
FIRSTRCTTOSHOWIMPACTOFMEDIAONBEHAVIOURS
20,1
25,3
18,2
15,7
17,5
10,2
4,7
8,0
9,3
13,4
7,7
0,9
5,6
9,4
13,6
8,3
-1,4
17,0
10,6
4,6
Diarrhoeatreatment-seeking
ORS/liquidsfordiarrhoea
Antibioticsforpneumonia
Malariatreatment-seeking
Bednets
Latrines
Earlybreastfeeding
Exclusivebreastfeeding
Birthinhealthfacility
Savingmoneyforpregnancy
Intervention Control
Fig.%changeinbehaviours
DOSERESPONSEEachadditionalweekofbroadcastingadds0.9%change
ISTHISTHEMOSTEFFECTIVETHINGYOUCANDO?
I.Kosteneffizienz messen (DALYs)II.Kosteneffizienz im Vergleich
I.KOSTENEFFIZIENZMESSENKostenanalyseanhandvonDisabilityAdjustedLifeYears(DALYs)
KostenanalyseanhandvonDisabilityAdjustedLifeYears(DALYs)
II.KOSTENEFFIZIENZIMVERGLEICH
Costeffectiveness–Howdoesourinterventioncompare?
Intervention Cost per DALYaverted
Treatmentuptake
Treatment-seekingbehaviouralcampaign(DMI) $20-$50
Vaccines RotavirusandJapaneseencephalitisinhigh-burdencountries <$50 HepatitisB,RotavirusVaccines $60-$350 PolioVaccines $1,000-$3,000 Community-basedinterventions
Outreachandcommunity-basedchildhealthinterventions(various)The impact of such interventions varies and their cost-effectivenessremainslargelyunknown.
<$100
Sanitation Household-levelwatertreatmentinruralareas $180-$200 Ruralsanitation,pipedwaterandcholeravaccine $2,000
Nutrition Micro-nutrients,educationandsupplementaryfeeding $240-$340
DEVELOPMENTMEDIAINTERNATIONAL
Changingbehaviours.Buildingevidence.Goingtoscale.
HOWGOODWOULDSUCCESSBE?
Intervention MortalityReduction CostperlifesavedScaling up treatment-seekingbehaviouralcampaigns
7-8%reductioninmortality $660
Scalingupmidwiferyservicesandobstetrics
34% reduction in maternal, foetal and neo-natalmortality
$2,200
Bis2030werden81%derKinderunter5JahreninLändernsüdlichderSaharaleben
Radiokampagnenin8Ländernkönntenbis2020150,000LebenrettenzuKostenvon<$50proDALY,oder$660progerettetemLeben.
DamitwärenwireinederkosteneffizientestenInterventionenzurReduktionder
SterblichkeitsrateaufBevölkerungsebene.
VERGLEICHBARKEIT
LITERATUR
• HeadR,MurrayJ,Sarrassat S,SnellW,Meda N,OuedraogoM,etal.Canmassmediainterventionsreducechildmortality?TheLancet.2015Jul;386(9988):97–100.
• Naugle DA,Hornik RC.SystematicReviewoftheEffectivenessofMassMediaInterventionsforChildSurvivalinLow- andMiddle-IncomeCountries.JHealthCommun.2014;19(sup1):190–215.
• Hornik RC,McDivitt J,Zimicki S,Yoder,PS,Contreras-BudgeE,McDowellJ,Rasmuson M.2001.CommunicationinSupportofChildSurvival:EvidenceandExplanationsFromEightCountries;inHornik RC(ed.)PublicHealthCommunication:EvidenceforBehavior Change.2001.NewYork:Routledge,pp.219-250
• HortonS,LevinC.Cost-EffectivenessofInterventionsforReproductive,Maternal,Neonatal,andChild
Health.DiseaseControlPriorities.2016;Availablefrom:http://dcp-3.org/sites/default/files/chapters/DCP3%20RMNCH%20Ch17.pdf
• LivesSavedTool
• Sarrassat S,Meda N,OuedraogoM,SomeH,BambaraR,HeadR,etal.Behavior changeafter20monthsofaradiocampaignaddressingkeylifesavingfamilybehaviors forchildsurvival:midlineresultsfromaclusterrandomisedtrialinruralBurkinaFaso.GlobalHealth:ScienceandPractice.2015;3(4):557–576.
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