Love Me Parents: An Evaluation of Tanzania's National Safe Motherhood Campaign

"The Wazazi Nipendeni campaign demonstrates the importance of multi-media campaigns in improving safe motherhood outcomes among pre- and post-natal women in Tanzania."

This report discusses the findings of an evaluation conducted in November 2013 of the Wazazi Nipendeni or Love Me Parents multimedia campaign in Tanzania, which sought to improve maternal health by increasing early attendance at antenatal care (ANC) clinics, encouraging uptake and adherence to sulfadoxine-pyrimethamine (SP) for malaria prevention during pregnancy, promoting birth planning, and improving knowledge and behavioural outcomes to prevent maternal and neonatal childhood mortality. Launched in November 2012, the campaign included radio and TV spots, billboards, an informational short message service (SMS) number, and a range of print materials. According to the report: "The evaluation found that exposure to a large number of campaign sources had impact on increasing delivery at a health facility and sleeping under a net, while overall message exposure had influence on taking SP and knowledge about malaria prevention during pregnancy" (see Related Summaries below for more information).

To assess the impact of the Wazazi Nipendeni campaign, in November 2013, 1,708 pregnant women or women who had given birth in the last six months were surveyed at ANC sites, and 30 in-depth interviews were conducted with health providers in ANC clinics in two regions. Quantitative data found that over one-third of women surveyed reported exposure to the Wazazi Nipendeni messages in the previous month. The most common source was radio (83.3%), followed by exposure via a brochure (37.3%), poster (22.8%), and TV (20.5%). Of those surveyed, 17.8% of respondents were exposed to one source, and 17.1% were exposed to two or more sources. Frequency of exposure varied considerably by source type, with radio demonstrating the highest levels of frequency.

The evaluation found that exposure to campaign materials was positively associated with behavioural outcomes in a number of areas. In short, "the more sources from which women reported hearing about the campaign, the more they prepared for the birth of their child." Women exposed to the campaign visited ANC clinics more regularly, more often delivered in a healthcare setting, were more likely to sleep under a mosquito net to prevent malaria, and were more likely to test for HIV. For example, "for each increase in message sources to which a woman was exposed, there was about a 61% greater likelihood the woman slept under a mosquito net the previous night" and "exposure to the campaign increased the odds of the women being tested for HIV by 18%."

On the other hand, campaign exposure did not transfer these same influence to partners' behaviours. For example, exposure to the campaign was not significantly associated with a partner testing for HIV or of a woman planning for her partner to accompany her to the health facility for delivery.

The evaluation report reflects on implications and recommendations for future programming. A selection of these are briefly outlined here.

• Exposure: Overall campaign exposure was cited at 35.5%, though national omnibus surveys show exposure to the campaign of up to 46%. The radio spots were aired through the national broadcaster, and it is suggested that adding regional radios would have enabled a broader reach. In Tanzania, 66% of men and women over the age of 18 reside in rural communities, and so the second phase of the campaign intends to explore how to best reach this underserved, less educated, and less wealthy population. This may include using community outreach and mobilisation by engaging with local leaders and volunteers. Radio was identified as a key source. However, while this evaluation found little uptake of the SMS service, "between November 2012 and January 2014, 331,664 pregnant women, new mothers, supporters and general information seekers registered for the SMS service, with a high degree of satisfaction among women interviewed who registered", indicating that this strategy is one that needs some consideration. Women also reported a high degree of satisfaction with the individual birth planning brochures they completed with their health providers, partners or others. "It is therefore important to continue involving providers in individual birth planning in Tanzania, and to distribute health campaign messages over radio as a source most frequently utilized by Tanzanian women."
• Delivery in Health Facility: A significant number of women who reported they did not deliver in a health facility cited that they could not make it to the hospital in time. "Future campaign messaging could emphasize the importance of moving closer to the health facility - staying with a friend or relative, or in a maternal waiting home, where possible - as one's due date approaches."
• Individual Birth Plans (IBP): The Wazazi Nipendeni campaign included messaging and tools to assist providers, pregnant women, and their partners and birth supporters in the individual birth planning process. The main tool was the IBP brochure used by health providers to counsel clients during ANC sessions by discussing and filling out the plan together. While not all facilities had the IBP brochure on hand, those that did used it as intended. Approximately one-quarter of those who received the IBP brochure reported filling it out, but few shared the information with partners and others, thus "Phase II could emphasize the importance of sharing the plan with others."
• Malaria: The majority of participants mentioned that either mosquito nets or preventive medicines should be used during pregnancy, but only 11.7% listed both strategies as a standard for prevention. As well, "it was found that the majority of women did not know of any complications malaria could cause for the baby or pregnant woman (63.1%)." Future campaigns should communicate key facts about complications malaria could cause for babies.

The report concludes that this evaluation "demonstrates that a nationwide media campaign on improving maternal health outcomes can have significant effects on protective behaviors and knowledge among pregnant women. Interviewed women reported not only engaging in protective behaviors, but also relaying campaign messages to others, thereby further increasing the campaign's reach through indirect channels of interpersonal communication."

Editor's note, February 3 2022: Apologies, but this document is no longer available online. Please contact the point person above to inquire.