Una aproximación a la crisis de la teoría del bien jurídico

The aim of the original Wazazi Nipendeni multimedia campaign was to encourage women to avail themselves of health services targeted at improved neonatal health outcomes. Content had been developed over a number of previous partnerships, each of which had a slightly different thematic focus, including:

• prevention of mother-to-child transmission of HIV/Aids;

• antenatal care;

• family planning;

• malaria prevention;

• nutrition (for mother and baby);

• danger signs;

• having an individual birth plan; and

• post-partum care.

The GSMA mNutrition project strengthened the service by contributing substantial additional nutrition content. Added content covered life stages up to five years.

A key feature of the GSMA mNutrition programme content generation process was the procedures put in place to ensure quality of information. TFNC was instrumental in ensuring that the content was accessible and consistent with national nutrition strategies. UX research was conducted early on in the project to ensure that messages were appropriate, how they might fit with different types of consumers (the archetypes), and how to improve the customers’ experience of the service:

• GeoPoll tested a small sub-sample of messages for comprehension and relevance.

• ThinkPlace conducted user focused research using human-centred design principles.

• Frog later conducted further UX research based on in-depth interviews.

Evidence from the quantitative study appears to confirm the quality of messages. Value and satisfaction metrics among treatment household members were high:

Mobile phones, nutrition, and health in Tanzania: Business modelling endline report

• Between 82.7% and 91.6% of households read all the mNutrition content they received.

• Over 90% of users either always or very often found the messages useful (see Figure 4).

Figure 5 shows that information on maternal nutrition was regarded as most useful (but not by a large margin).

• Over 90% of users (93.5% of females and 92.2% of males) would recommend the service (likely or highly likely).

• 89% of females and 81% of males self-reported implementing at least one tip.

Figure 4: How often was the mNutrition content deemed to be useful?

Source: Gilligan et al., (forthcoming, 2020)

Mobile phones, nutrition, and health in Tanzania: Business modelling endline report

Figure 5: Most and least useful mNutrition message topics, by gender

Source: Gilligan et al., (forthcoming, 2020)

Findings from the quantitative study appear to confirm that users did indeed change their behaviours, as it found that accessing the Wazazi Nipendeni service had improved a range of nutritional outcomes. Diets among young children in the treatment sample had improved, as follows:

• Dietary diversity for children aged 6–35 months – The number of food categories consumed increased by 0.107 (p-value 0.073).

• The likelihood that children aged 6–35 months met the minimum dietary diversity – Children in the treatment communities were 3.8 percentage points more likely to have consumed from four food groups (p-value 0.093).

• Children aged 6–23 months in the treatment communities were 6.9 percentage points more likely to satisfy minimum acceptable diet.

Diets among women of reproductive age (primary females) had also improved:

• The likelihood that the primary females satisfied minimum dietary diversity for women had increased by 4.0 percentage points (p-value 0.062).

Secondary outcomes relating to knowledge and behavioural practices had also improved:

• There were improved knowledge of IYCF practices among men.

• There was a statistically significant impact on the combined household-level measure of nutrition knowledge.

Mobile phones, nutrition, and health in Tanzania: Business modelling endline report

5.4 Channels

In the 2015 Tanzania DHS survey 53% respondents had heard of Wazazi Nipendeni. Note that the five year TCCP programme started in 2010 and finished in 2016, so the DHS survey will have been conducted when the programme had achieved nearly maximum reach. Radio was clearly the single channel that achieved greatest reach: 87% of people had heard about Wazazi Nipendeni from the radio (Table 1). About a quarter of respondents had heard about the campaign on the television, with another quarter doing so through printed media (poster/ magazine/ newspaper/

billboard).

Table 1: Responses to question ‘How did you hear about the Wazazi Nipendeni campaign?’⁷

How did you hear about Wazazi Nipendeni? Frequency

(n=5,398) %

Radio 4,710 87%

Television 1,463 27%

Poster/ magazine/ newspaper/ billboard 1,186 22%

Family/ friend 582 11%

Community health worker 459 9%

Health facility 421 8%

Does not know/ remember 80 2%

Mobile phone 61 1%

Internet 17 0%

Other 1 0%

Source: Authors’ own, based on DHS dataset (accessed September 2019)

During the initial campaign as part of the Tanzania Capacity and Communication Project (TCCP), printed materials were distributed to a range of health facilities where women come into contact with health professionals, e.g. hospitals, health centres, dispensaries. The mHealth Tanzania-PPP worked in partnership with the health sector, providing training for health professionals, who were then able to help women register on the system. There are three ways of registering for the Wazazi Nipendeni text messaging service (analysis can be found in Section 6):

• Assisted by health facility worker – women can be signed up when they come for antenatal care visits etc.

• Assisted by community health workers – community workers can sign women up when they visit them in their homes, or other local venues.

• Self-registration – instructions were given in the multimedia campaign. People dial the short code and then are guided through a small number of profiling questions (category of user, and stage of pregnancy/ age of child).

• Registration data show that 57% of users were registered by partners. It is not possible to determine exactly how many of the ‘other’ users actually registered by themselves, but 59%

were registered using USSD, suggesting that they were in fact registered, or at least assisted by a health worker. This means that up to 83% of users were registered by partners. Although mass media channels can be effective in raising awareness of the Wazazi Nipendeni

7 Multiple response – respondents may have heard of Wazazi Nipendeni through multiple channels, i.e. adds up to more than 100%.

Mobile phones, nutrition, and health in Tanzania: Business modelling endline report

campaign, it is face-to-face contact through partners that is instrumental in signing people up.

TFNC also believes that people who register with a health professional will have a positive bias to comply with messaging, have a better understanding of how the service works, and be more likely to appreciate how they can benefit from the service.

Figure 6 confirms that health workers are the most highly trusted sources of information on health matters (government more so than NGO facilities). It is interesting to note that even among control communities, people have high levels of trust in information from automated text messages, confirming that text messages are regarded as being reliable and of high quality. Patterns of who people actually get information from (Figure 7) broadly reflect levels of trust, although they emphasise the importance of government health workers.

Figure 6: Trust in sources of health information⁸

Source: Authors

8 Percent who agree they would trust information from each source.

Mobile phones, nutrition, and health in Tanzania: Business modelling endline report

Figure 7: Sources of health information

Source: Authors

The qualitative research identified a number of features of SMS messaging that fits well with women’s lifestyles:

• text messages can be read repeatedly – audio messages may be heard incorrectly;

• as messages remain on the phone, they can be shared with friends and colleagues at any time; and

• text messages are private – they remain on the phone, which tends to be regarded as a personal device; audio messages can be overheard by others.

It should be noted that the SMS channel may be particularly well suited to the Tanzanian context, given that literacy levels are relatively high (for sub-Saharan Africa)⁹, and the country is united by the language of Swahili.