The role of mobile in increasing nutritional behaviour change in Malawi
“In 2016 my wife was pregnant and I was following this service because I wanted to follow the right nutritional procedures so that my wife should give birth to a strong and healthy baby.” – Ramsy, Rural, Farmer, 27
Airtel Malawi, in exclusive partnership with HNI, provides a value-added service (VAS) branded as Airtel 321 to their network subscribers. The service includes topics on agriculture, nutrition, weather and gender-specific content which can be accessed via simple phone, a feature phone or a smartphone. The 321 service is available under similar agreements between MNOs and HNI local across sub-Saharan Africa, Asia and the Middle East. As part of the mNutrition initiative, the GSMA collaborated with HNI in Malawi and the research was the first to be completed from the mHealth component.
Scale and re-launch of the Airtel 321 service in Malawi
Airtel 321 launched nutrition, maternal and child health content back in September 2015. It received initial traction and acquired over 50,000 unique users in the first month it was launched. Despite this usage spike, the repeat usage on the service was low – through GSMA in-house analysis, we have found that some users were dialling in without accessing actual content, and many users were not returning to the service after an initial trial. The baseline phone surveys established that the need for such content was in fact very high as users had relatively low levels of knowledge about correct nutritional practices during pregnancy and the first 100 days of life, and their actual behavioural practices were poor.
Our user research manager conducted in depth field studies to identify the key areas around user engagement and communicating the messages in a way that drove behavioural change. The principles that were applied during the research can be found within the recently published toolkit, which shows how human-centred design can be used to derive the real needs of the end users.
Bringing all elements of the research together and through a joint product workshop with Airtel and HNI teams, we identified some key aspects of the product that needed improvement and made a series of improvements to the service:
We monitored the changes on the service to see whether they would affect user behaviour. Last March, we conducted the endline phone survey to evaluate whether these service improvements had helped increase knowledge and behavioural change. The results were extremely positive.
The mobile messaging managed to drive a 17 per cent increase across the board in nutritional knowledge. The largest increase was in on-demand breastfeeding practice, with a 30 per cent increase from baseline (indicated in Figure – 2). This intervention has the greatest potential for impact on the health of a new-born child, with the potential to prevent 13 per cent of all deaths in under-fives in the developing world (Lancet 2013).
Furthermore, we have seen an increase in actual nutritional practices across the board, with an average increase of 22 per cent across all questions.The greatest increase in nutrition behaviours was in the practice of exclusive breastfeeding, with a 35 per cent increase from baseline (as indicated in Figure 3).
Survey methodology: two phone surveys six months apart, with 800 participants for each. Second survey conducted three months after major changes were implemented. Complementary to this was a series of focus group discussions.
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