Handout 25A: Promoting ORT: integrating mass media print and visual aids

Delivering the goods

Many communities are still unaware of the benefits of ORT. The Ministries of Health in Honduras and The Gambia have taken up the challenge and are promoting ORT through an integrated educational campaign. William Smith reports on this exciting initiative.

Since 1981, a widespread educational programme — the Mass Media and Health Practices Project* — has been underway in Honduras and The Gambia, showing thousands of villagers how to recognize the signs of dehydration and to prepare and give oral rehydration therapy (ORT) correctly at home. These two countries were chosen because of their contrasting cultures and environments, to make it easier for techniques developed to be used in other countries later on. By combining specially designed radio programmers, simple graphic materials and targeted advice for health workers, the governments of both countries are using mass media to improve the delivery of ORT services showing that semi-literate communities can be taught to mix and give ORT safely.

* The project is sponsored by the Office of Education and Office of Health, Bureau for Science and Technology, US Agency for International Development.

Unique approach

In both Honduras and The Gambia, village attitudes, beliefs and practices guided the project design. Mixing trials. home observations focus groups and individual interviewing helped select the key audiences and define the most effective educational messages. Each country has developed its own unique approach to ORT delivery and village education. In Honduras, the government is providing locally produced oral rehydration salts called Litrosol for both home and clinical use.

In The Gambia. packets are available at health centres but a simple sugar and salt solution is also promoted (or home use because it is too costly to make the packets available in every home. The Gambian medical and health departments developed a standard formula for this home administered solution, using local soft drink (Julpearl) bottle and cap for measurement). One litre of fluid is made up from three Julpearl bottles of water, eight caps of sugar and one cap of salt. The correct way of preparing and giving the solution was broadcast to mothers on Radio Gambia (the national radio station). Printed material was distributed to reinforce the message and health workers talked with mothers to make sure they had understood.

Radio

Radio is an important aspect of the Mass Media Project in both countries because it reaches more people, more quickly and more often than any other medium being used. It has four particular purposes

1. Convincing rum people that diarrhoea is a serious problem.
2. Teaching and reminding them how to mix the oral rehydration solution.
3. Answering common questions identified during village visits.
4. Leading people to sources of additional help.

In both Honduras and The Gambia, many people own radios so these can be used effectively for public education. The Mass Media Project's radio broadcasts in The Gambia are chatty and informal conforming with popular programming style there. The broadcasts answer health questions quickly and accurately and open a dialogue with mother. The Gambian government has provided free time for hundreds of diarrhoea-related messages on Radio Gambia.

In Honduras, the project took advantage of a large network of commercial radio stations. The radio spots were short and catchy and intended to compete with high quality commercial advertisements. The featured spot, a 60 second song, became a nationally popular tune. Follow-up announcements emphasized child care during diarrhoea encouraged administration of Litrosol and stressed the importance of continuing breastfeeding during diarrhoea.

Graphics

The graphics used by the Mass Media Project to illustrate the health messages are simple and clear. The main materials interact directly with the radio messages and health workers to teach the important skills of mixing and giving oral rehydration solution at village level. This is particularly important in The Gambia because rural women are unfamiliar with printed material of any kind and need help with interpreting pictures. It was necessary, for example, to develop an appropriate visual way of showing the difference between sugar and salt and illustrating the Julpearl bottle and cap needed for comet measurement. A colourful 8" x 11" poster was developed which shows the bottle and cap being used to mix the rehydration solution. The "mixing pictures" of sugar, salt, and water are colour coded and linked to explanations given over the radio,

In Honduras, early field research indicated that mothers associated child care with loving images. This attitude was shown visually by a large red bears surrounding a picture of a breastfeeding women. The bears was also later associated with Litrosol and a young family added to the picture to reinforce the role of the husband in giving ORT.

Integration of communication techniques

The project's radio programmed strengthened the visual symbols in both countries through special jingles and romantic songs about motherhood, as well as providing basic information.

In Honduras, for example, the programme told mothers where to get Litrosol, how to mix it in the proper volume of water and how to measure it in containers easily found everywhere. Radio was also used to identify a special network of health workers and village contacts — red heart ladies — who had been trained to mix Litrosol. Some 1,200 red heart ladies new a red heart flag above their homes to attract village women to this local resource. The integration of the different methods of communication is a key feature of the Mass Media Project.

Happy baby lottery

To encourage more Gambian mothers to participate in the project and to maximize the integration of radio, printed material and input by health workers, a national contest was launched to popularize the home administered rehydration solution. Known as the Happy baby lottery the contest helped to begin the distribution of some 200,000 "mixing pictures" to mothers throughout the country. Radio Gambia broadcast repeated programmes to rural mothers on how to use the posters as entry tickets for the contest. The programmes also taught mothers how to interpret the mixing instruction on the poster. Health workers were trained to use the posters to teach mothers how to mix the formula as well as giving UNICEF ORS packets to severely dehydrated children in rural clinics.

Village contests

Distribution of the posters was followed by a month of 72 village contests. Every week, the radio announced the names of 18 villages to be visited by a judge wearing a 'happy baby' t-shirt. To enter the contest, mothers went to the nearest village displaying a happy baby flag and, if they mixed the solution correctly, won a prize — either a plastic litre cup or a bar of locally made soap. These prizes were chosen because they were appealing, locally available, inexpensive and consistent with project pals. The cup, for example, is a common container for drinking water and a convenient one litre measure for the sugar and salt solution.

The response to the lottery was enthusiastic. More than 11,000 mothers attended the village contests. Over 6,500 entered the mixing competition, while hundreds more watched, listened and learned the new advice on treating diarrhea. Winning mothers' names were included in a later draw for 15 radio-cassette players. A single community prize of rice and sugar was given each week for the village turning out the most mothers for the contest. Radio was used regularly to publicize the winners and to reinforce the mixing formula. The lottery ended when the Gambian president's wife drew and announced the names of the grand prize winners in a special radio broadcast.

The lottery is only one part of the Gambian government's use of mass media to fight infant diarrhoea. Special happy baby flag ladies, like those in Honduras, have been trained to give mixing advice to visage women. Regular radio broadcasts include traditional songs, drama and popular personalities to explain the dangers of dehydration and to stress the importance of breastfeeding during diarrhoea.

Conclusion

There has been an encouraging acceptance of ORT in both countries. During the first 12 months of the project in Honduras, hall of the mothers reached were using Litrosol. In The Gambia, after eight months of the campaign, half of the mothers, reported using the recommended sugar and salt solution to treat diarrhoea. An extensive three year evaluation is continuing in both countries.

Three elements have been critical to the success of the project:

1. Education and an effective delivery system An effective delivery system for the UNICEF packets and instructions on the sugar/salt mixing were combined with practical and widespread education on how to use the new remedy.

2. Flexibility Regular information from the field was used to make changes in methods and materials so that mothers questions could be quickly answered.

3. Rural beliefs and traditions formed the basis for the educational campaign.

Resources are available to provide modest assistance to other countries interested in developing a mass media programme of this sort. Much teas yet to be learned, but a systematic use of mass media integrating radio, print and dialogue between health workers and mothers can significantly improve the outreach of many health education programmer.

Further information on the project is available from Dr William Smith, Vicepresident, Academy for Educational Development, 1414 Twenty-second Street, NW, Washington DC 20037, USA.

(From: Diarrhea Dialogue. Issue 14, August 1983)