NightWatch 2.0: The Role of Mobile Phones in Malaria BCC
1Malaria No More
Journal MTM 1:4S:11-12, 2012
Two years ago, as governments across Africa began ramping up delivery of mosquito nets, diagnostic tests, and malaria treatments, we asked ourselves: how can we ensure these investments in malaria control tools translate into malaria control behavior (and therefore, into malaria control success)? Our answer: NightWatch. The idea is simple: send out messages with a signature style – delivered by recognized local celebrities – through multiple media channels every night, reminding people to protect themselves from malaria.
Developed by Malaria No More and Lalela Project, the NightWatch program aims to increase the utilization of malaria control tools, such as mosquito nets, through a targeted communications campaign. NightWatch campaigns in Senegal, Tanzania, Cameroon, and Chad all began with radio and TV spots, but immediately expanded to reach individuals through their mobile phones with SMS reminders to sleep under a mosquito net. NightWatch SMS messages are free to subscribers – and to Malaria No More – thanks to generous in-kind donations by leading African telecoms. Mobile partners MTN (Cameroon), Airtel (Chad), and Tigo (Senegal) have generously sent SMS messages to over 10 million subscribers. The messages are distinguished from “spam” by coming from trusted sources – the companies themselves, the Ministries of Health, and celebrity spokespeople.
Our research shows that SMS is expanding the reach of NightWatch and impacting behavior. In Cameroon, the “K.O. Palu” (“Knock Out Malaria”) NightWatch program reached over 6.8 million adults. In a nationally representative survey (n=2,176 adults 15+) conducted in March/April 2012, 22% of all respondents recalled receiving an SMS and one or more other elements of the campaign (anthem, radio or TV ads), and 8% – representing over 875,000 adults – only recalled the SMS without other elements; 30% recalled some element(s) of the campaign but not SMS and 40% did not recall the campaign. Thus, SMS not only increased the reach of the campaign by 15% over what it otherwise would have been, but also reinforced the messages for a large portion of the total campaign audience.
Analysis of the link between NightWatch campaign exposure and malaria control behavior in the Cameroon 2012 survey data shows a strong impact of the campaign on net use. Cameroonians exposed to the campaign were 13% more likely to sleep under a net, and 24% more likely to have their children sleep under a net, than those not exposed. Even after controlling for other factors through propensity score matching analysis, K.O. Palu NightWatch exposure was associated with 7 percentage point higher net usage by adults (12 percentage point higher net usage by respondents’ children) in households with at least one net.
However, our research suggests that the added value of SMS is still limited. Analyzed on its own, exposure to SMS still had a positive impact on net use, but not as large or significant as the impact of the K.O. Palu anthem or the joint impact of NightWatch elements together. Therefore, we are focusing on next steps: how do we build on the early success of SMS to use mobile phones better, to make NightWatch more interactive and engaging?
We’ve already begun experimenting with more interactive and engaging ways of incorporating mobile phones into NightWatch. In Tanzania, audience members were encouraged to vote via SMS for winners in the televised 2011 Tanzanian Gospel Music Awards; of more than 3 million subscribers who received voting reminders with malaria messaging, 192,000 responded by voting – and received another malaria-themed message. But we want to go further – using pre-recorded voice messages from celebrities to reach illiterate phone users, linking our successful malaria anthems to ring tones and call tones, having a presence on social media (accessed on mobile phones), and incorporating call-ins and SMS input into local radio programs.
With generous support from the IWG mHealth catalytic grant mechanism, funded by the Norwegian Agency for Development Cooperation (Norad) and implemented in partnership with the World Health Organization (WHO) and mHealth Alliance, Malaria No More will expand NightWatch mobile phone tools in Tanzania in 2013-2014. The lessons learned in Tanzania will then be used to enhance the mobile phone elements of NightWatch in other countries as well. Elements of the program that are successful in Tanzania can be rolled out with mobile phone partners in Cameroon, Chad, and Senegal. The results of the NightWatch mobile expansion will also be shared within the malaria control community to encourage adoption of interactive and engaging communication strategies by national malaria control programs.