Publications

---

Communication Impact! 1

Distance Education Works (January 1998)

Improves Quality of Care by Stimulating Client Demand and Provider Skills

Two enter-educate serial radio soap operas were broadcast in Nepal in 1996. Each of the serials consisted of52 episodes. One, Cut Your Coat According to Your Cloth, was written to encourage the general public to appreciate the importance of a "well-planned family" and to seek contraceptive services from their health workers. The other, Service Brings Rewards, was designed as a distance education series to improve the technical knowledge and the counseling skills of rural health workers with regard to contraceptive services. While Service Brings Rewards addressed the supply side of health services, Cut Your Coat According to Your Cloth was designed to increase demand.

Both serials had substantial impact. At two rural clinics in Dang, client visits more than doubled during the campaign periods (Figure 1). Almost half of the villagers queried (45%) listened to Cut Your Coat According to Your Cloth and almost three quarters (72%) of the health workers listened to Service Brings Rewards. Skills improved and were highest when both the health workers and their clients had listened to one or both programs - demonstrating the synergistic impact of the two coordinated programs.

The Distance Education Program uses an innovative format, combining drama and interactive question and answer segments. Each of the 52 episodes contains two drama segments and two interactive segments. The program hosts asks the listeners to give immediate oral responses to questions about what they have learned from the scene of the drama that they have just heard.

Interactivity is also included during the 5-minute "listener forum" segment at the end of each program. Listeners are invited to send letters with questions and comments about the programs, which are read during this segment. Listeners also are encouraged to discuss program content with their colleagues and check program content with their support print materials.

"I feel like being at the top of Mt. Everest when I listen to your radio program. This program has been immensely valuable to me - like gold." - Tara Sagar, radio listener, Gothgaon district, Nepal

Responding To Needs

Service Brings Rewards was created in response to two needs:

• face-to-face training is nearly impossible for the vast majority of Nepal's rural healthworkers, because of the difficulties of the terrain and shortage of funds for training, and

• many Nepali people has expressed their dislike of going to health workers for family planning services. They feared being given incorrect, inaccurate or at best insufficient information, and being treated in a less than friendly manner.

Radio was an obvious medium through which to help overcome the first need. Drama was an exciting choice to meet the second need. Events and situations in the drama provided listening health workers with a clear and personal understanding of their clients' needs, and role-model characters demonstrated effective client-provider interactions. For example, in one scene from the drama, the health worker meets three young girls who are trying to learn more about a "taboo" subject. She is able to assure them that it is their right to know about their reproductive capacities and she counsels them gently and wisely (see Box 1).

Innovative Design

A major contribution to the successes of both of the Nepal serials was their meticulous design. A design team was established consisting of content specialists, media specialists, ministry and audience representatives, researchers and funding agency representatives. The team worked together in a week-long design workshop to create a design document. The writers used these design documents to introduce the key messages into the story naturally, gradually and subtly. The messages agreed upon during the design workshop were influenced by, and in turn influenced, the new National Family Planning Counseling Training Program which included print materials, workshops, and a series of advocacy orientation meetings for regional and district level policy makers.

To succeed, distance education programs must be systematically designed, interactive, motivational, and suited to the needs, current knowledge, and learning style of the audience, and be supported by media.

Service Brings Rewards concentrated on providing health workers with specific information and skills, which research had shown they needed. The main aim of the series was to show health workers how to instruct and counsel their clients, so the information was presented in the simple methods and language that health workers should use, rather than in highly technical language. Health workers were provided with support print materials, while radio spots and jingles reinforced the messages of both serials.

Cut Your Coat According to Your Cloth encouraged community members to take a more positive view of health workers and seek useful guidance from them on modern family planning methods. The other aim of the serial was to overcome reticence about visiting health workers and belief in rumors. One character, the flute-playing FirFire, used local proverbs, such as "Don't cry about the crow stealing your ear, until you have checked both your ears," to persuade people to learn the facts about contraceptives rather than being swayed by rumors. The wide range of characters in this serial, from the argumentative village leaders to the foolish servant who believed in ghosts, provided reference points for many listeners, who recognized their own villages in the fictional village of Salghari.

Positive Impact

Impact is measured by:

1. focus group discussions
2. pre/post tests with health workers (Figure 2)
3. analysis of nationally representative surveys
4. a panel design study
5. three waves of clinic-based observation
6. exit interviews with clients

The Radio Communication Project in Nepal succeeds by strategically integrating distance education and entertainment-education to address both the supply and demand sides of health services. The project demonstrates that the use of enter-educate serial drama can effectively motivate social change and teach specific counseling skills.

To learn more about the Nepal Radio Communication Project, contact:

© 2005 The Johns Hopkins University. All rights reserved.
Security and Privacy Policy, 111 Market Place, Suite 310, Baltimore, MD 21202, webmaster@jhuccp.org

Photos courtesy of Photoshare, a service of The INFO Project.