Improving Maternal and Child Health through Media in South Sudan

"Since 2012, BBC Media Action has been funded by DFID to produce a range of programmes and deliver capacity-strengthening activities aiming to support improved reproductive, maternal, neonatal and child health (RMNCH) in South Sudan. This report evaluates the project's impact."

BBC Media Action produced a weekly radio health magazine programme, Our Tukul (Our House) [see related summaries below], from 2013 to 2016 with a focus on RMNCH in South Sudan. "During the first year of the project, BBC Media Action also produced the weekly radio drama Life in Lulu under the Global Grant. These programmes were broadcast nationally, and were designed to influence knowledge, attitudes, discussion and social norms identified as most likely to drive the RMNCH behaviour of women and their families. BBC Media Action also produced public service announcements (PSAs) in 2013 and from 2015. All of this programming was broadcast across 16 radio partner stations in an evolving and often challenging context characterised by outbreaks of violence, mass displacement, food insecurity and escalating inflation." The work included strengthening the capacity of local radio stations to produce "similar high-quality, audience-driven health programming".

This report synthesises all research and analysis completed under this project. The document details project background including measurement of types of and access to media in South Sudan, problematic in some areas due to conflict and resulting population displacement. The project sought to use mass media, primarily radio, and interpersonal communication (IPC) to address RMNCH behaviours, including health seeking behaviours such as antenatal visits, health facility deliveries with skilled birth attendants, newborn care practices, exclusive breastfeeding, and immunization. "The project also sought to address the lack of understanding around birth spacing and early pregnancy, countering some unhelpful traditional beliefs."

Over time, the theory of change was revised due to challenges in: the capacity of partner stations, language issues, changing audience needs, and supply side issues, mostly resulting from the deteriorating situation of the country. Page 14 outlines changes that include: broadcasting in Dinka, Latuko, and Zande instead of exclusively in English and Simple Arabic; revising content for a population with limited access to healthcare services; shifting the Life in Lulu programming to other donors wh focused its content on peace and conflict resolution and humanitarian issues; and changing relationships with radio stations due to a need to focus on delivery of Our Tukul, rather then more generalised capacity building. Challenges included those of partnering with the Ministry of Health, which became occupied with medicine and vaccine delivery, aa well as partnering with health providers who gave information outside the World Health Organization and UNICEF guidelines on exclusive breastfeeding.

Key findings include:

• a reach of .09 million people. The displaced and the settled populations expressed, in equal measure, a perceived influence and value.
• listening by language groups who needed more language diversity than English and Simple Arabic.
• actionable knowledge about the benefits of colostrum (first milk), and the importance of exclusive breastfeeding, while action on accessing care through health facilities was dependent on availability of service, though 78% of audiences felt that they had learned about those behaviours. 
• listener reports: "Nearly four in 10 listeners (38%) reported discussing health practices with others...", though financial constraints made these conversations on change difficult for some women.
• station capacity: Radio capacity for outputs improved with skill levels, though there is still a need fro capacity building "to generate revenues, retain staff and ensure that training benefits are not lost with staff turnover."

Its conclusions, in brief, include:

1. The challenging country context "(e.g. the limited availability of quality healthcare nationally and the ongoing humanitarian crisis) limited the extent to which the project was able to contribute to improved health outcomes..... In 2015, South Sudan ranked 159 out of 179 countries for maternal and child well-being indicators in Save the Children’s State of the World’s Mothers Report."
2. "Despite this, audiences were generally optimistic about the shows’ influence and value, and reported gaining knowledge and making some behavioural changes as a result of tuning in."  Our Tukul listeners were able to reflect on the content of programming "suggesting that the programming played a role in improving their health knowledge and reinforcing their existing knowledge. Listeners also reported some changes to health practices as a result of what they had heard – especially to home-based behaviour, such as taking more rest during pregnancy or adopting healthier breastfeeding habits." Health-related and behavioural changes need to be accompanied by improved availability of health care resources and services to support shifts in social norms and increased confidence in care seeking.
3. "...Local radio station partners reported that the capacity-strengthening support had improved their technical skills, editorial confidence and engagement with audiences." Despite deteriorating economic conditions, listeners reported positive differences in stations' outputs while station staff reported increased journalistic, managerial, and editorial skills due to training."