Amid a flurry of high-tech approaches, some find merit in low-tech techniques

DKT street theater provides family planning information in Bihar.

This was originally published on Humanosphere blog on March 7, 2016.

Because of the meteoric rise of the internet and cell phones in many developing countries, many global health programs have been rushing to embrace these technologies as efficient ways of reaching large numbers of people with information on such issues as family planning, HIV prevention and maternal and child health.

This is happening in countries like India, Tanzania, South Africa, and Ethiopia, where technologies like the internet, mobile phones, social media and geographic positioning systems are bringing health delivery into the 21^st century.

But some programs are eschewing high tech and sticking with low tech as the best way to bring vital health information to their low-income consumers, at least for now.

DKT International – which touts its use of social media, the internet and television in countries like Brazil, China and Turkey – takes a decidedly low tech approach in its Janani family planning program, which is headquartered in Bihar and works in seven states of northeastern India.

And there are good reasons for doing so.

First, those seven states have some of the lowest literacy rates in India. Bihar has the lowest rate of all the states in India – 64% in 2011 – and neighboring Jharkhand, at 68%, is not much higher.

Second, access to media is limited in many of these states. Bihar and Jharkhand have the highest rates of people not regular exposed to any kind of media – 60% of women in Jharkand and 58.2% in Bihar, the two most media adverse states in India, according to the 2005-06 National Family Health Survey.

These two factors — illiteracy and lack of access to media — is is especially true among the low-income, less educated people Janani seeks to reach.

So Janani has opted for low tech and face-to-face communication. Instead of radio and TV, they use things like wall paintings and billboards.

Instead of mass media, they use face-to-face communication like:

• Street theater, to educate and animate the important points of family planning.
• Community health days, in which Janani promoters conduct health education, check-ups and, if warranted, referrals to clinical services.
• Door-to-door client motivation conducted by Janani promoters.
• “Injectable Days”, where outreach teams bring injectable contraception closer to rural areas.
• State and regional fairs to disseminate family planning information and provide referrals.

Other programs are also finding old-fashioned face-to-face communication is sometimes the best approach:

In Ethiopia, the Beza anti-AIDS youth group uses music and dance to engage other youth groups on issues of sexual and reproductive health and give them the tools they need to protect themselves from HIV. The club offers a regular debate session in which they hotly debate such questions as “What is the right age to start having sex?” The Beza youth group is one of hundreds across Ethiopia supported by the International HIV/AIDS Alliance and its Ethiopian linking organization, the Organization for Social Services for AIDS.

In Madagascar, IntraHealth works with community members in defining quality community health services, identifying problems and then coming up with solutions. For example, prior to the program, there was no systematic emergency referral system from fokontany (a collection of villages) to the health center. Through the program, 6,388 fokontany set up systems to evacuate sick children and pregnant and/or laboring women. These weren’t high tech solutions such as ambulances or helicopters. Rather, they involved stretchers carried by community members, canoes or carts pulled by zebu.

These programs are not anti-mass media or anti-technology. They just want to use the media types best able to reach their hard-to-reach target audiences. In designing communication approaches for health programs, the most important thing is to understand your target audiences, and how they receive information. Sometimes Twitter, Facebook and television work well but, in many places around the world, low tech is still best.