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Entertainment Education
Programs
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The Radio Communication Project (RCP) is designed to generate demand for family planning services and to improve the quality of services. The RCP is a program that integrates mass media, distance education and interpersonal communication and counseling training programs. It features workshops, radio-based health worker training in family planning and a national radio drama series. Together these activities aim to improve the quality of contraceptive services, empower clients to actively seek contraceptive information and services, and promote the concept of the well-planned family.
The
Radio Communication Project's two complementary radio series
are a dramatic serial titled Cut Your Coat According to
Your Cloth and an interactive distance education series
titled Service Brings Rewards. Both series utilize
an entertainment-education format and are developed through
the design approach to media production. The RCP also includes
radio spots and musical jingles to reinforce the themes of
the drama serial and the distance education program; posters
addressing key family planning issues; and formal district-level
interpersonal communication and counseling (IPC/C) training
workshops, geared towards health-workers and their supervisors.
The IPC/C training workshops take place during the same period
and share the same objectives as the distance education serial.
Further, the RCP aims to extend the reach of the messages
contained in the programs through a variety of community based
activities. These community-based interventions are being
implemented in selected districts in collaboration with The
Center for Development and Population Activities (CEDPA) and their network of local NGOs in Nepal. These local NGOs
include the Nepal Red Cross, the Family Planning Association
of Nepal and the Center for Research on Environment, Health
and Population Activities. These NGOs have undertaken a variety
of activities including street theater performances, dissemination
of local IEC materials, establishment of radio listening groups
and the organization of and research on Condom Day.
The most exciting finding of the impact evaluation of the first phase of the Radio Communication Project is the synergy between the radio series. Project designers had hoped that when providers improved their interpersonal communication and counseling (IPC) skills, clients would find it easier to participate in decision-making about their own health. The impact evaluation results indicate that positive client IPC behaviors were indeed higher with trained providers and that these positive client behaviors increased over time. However, client participation increased over time even with untrained providers. This increase in client participation can be attributed to client exposure to the radio serials. About 45% of clients and 72% of providers had listened to one or both of the radio serials. The quality of client-provider interaction was better if EITHER the client or the provider had been exposed, and best if both provider AND client had been exposed. The largest over-time improvement was observed in interactions in which both provider and client had been exposed to at least one of the radio programs. This clearly indicates that it is beneficial for programs to target both the supply side and the demand side of health service delivery and utilization.
People exposed
to one or more of the radio serials had dramatically improved
attitudes on key issues related to family planning use, for
example, image of family planning users, side effects of methods,
son preference, expectations of treatment by providers, and
benefits of family planning on family well-being. Prior qualitative
and quantitative research in Nepal has identified 5 factors
consistently associated with family planning adoption. These
include: (a) positive attitudes, (b) spousal support, (c)
contact with providers, (d) perceived social norms in favor
of FP, and (e) exposure to IEC family planning messages. After
controlling for background variables, women with all 5 factors
were 40 times more likely to adopt family planning than women
with none of the factors. Spousal communication and approval
emerged as the strongest predictor of family planning use.
Women who had talked to their spouse were 3 times as likely
to adopt family planning as those who had not. Exposure to
the radio serials was a strong predictor of the other four
factors. This indicates that the serials had a direct effect
on ideation and behaviors which in turn affect family planning
use.
The impact evaluation
for the Radio Communication Project indicates that among all
the RCP components the drama series and the spousal communication
spots had the greatest reach. In Dang district, where project
activities were most intense, the listenership by the general
public of the distance education series (intended for providers)
was almost as high as the listenership for the dramatic series.
Client flow in rural sentinel sites in the pilot district
showed a significant upward swing in service utilization after
the project began.
The success of the Radio Communication Project is evidenced in the rebroadcast of the original dramatic series between June and December 1997. The distance education series which was aired in the Mid-western region of Nepal has been revised to meet the needs of the national population. A well-attended distance education National Launch Ceremony was held on November 19, 1997. The distance education series was broadcast nationally between December 1997 and March 1998. Sequels for both the dramatic series and the distance education series (Phase II) were aired between January 1998 and January 1999, with a broader mandate: they addressed reproductive health issues, including Safe Motherhood and HIV/AIDS prevention. Additional radio spots and jingles were also developed to promote Phase II of the project. Supervision and monitoring for the Distance Education Program was also undertaken in four target districts (Sunsari, Chitwan, Dhankuta and Dang). Preliminary results from the integrated evaluation for the Radio Communication Project, Phase 2 indicate that the project is continuing to have a positive impact on health related attitudes and practices among those exposed to its messages. Phase 3 of the project went on air in January 1999, with a continued focus on family planning, specifically on contraceptive side-effects, while including additional health topics like safe motherhood, infant and child health and vector borne diseases. Formal IPC/C training workshops were conducted with Health-Post and Sub-Health Post in-charges in Sunsari district of Nepal, with a focus on peer-supervision. An additional district of Kailali was added as a site for formal monitoring and supervision of the Phase 3 of the distance education program. Phase 4 is in the planning phase and will go on the air in April, 2000.
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