Hacking the last Mile: Using audio health messages in local languages for health education

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There is a unique thing about our Motor parks among their many dysfunctionalities – information dissemination. The park’s operators have mastered the art that by the time you are leaving the park, you must go home with one piece of information. As you move from one park to another, the delivery of the messages is the same, with the additional feature that they are language sensitive. They understand their audience and deliver messages in the language they speak. So, let’s call this the Motor Park effect.

Our organization RedAid Nigeria recently became a local entity through the localization model adopted by the German Leprosy and TB Relief Association (DAWH). We have operated in the Nigerian health sector for more than 60yrs, actively working with vulnerable and hard-to-reach communities in fighting diseases associated with poverty like Leprosy, Tuberculosis, Disabilities, and other Neglected Tropical Diseases. In our years of service, our mandate has been to change those behaviours that hinder access to healthcare in a safe and timely manner. Many of these diseases are preventable and treatable without their many consequences if detected on time and if access to medical care is available. The data on annual cases of these diseases like Leprosy is not favorable, we still have over 2000 Leprosy cases annually. Yes, we do. You may even be more shocked at the inhumane actions meted out against persons affected by Leprosy and other diseases associated with poverty. We published a book on their story titled “A question of Justice”, a GLRA Oral Leprosy History project in partnership with the Sasakawa Health Foundation. You can download it from our website (www.redaid-nigeria.org). We have employed different strategies in making sure that vulnerable communities have the right and credible information about their health status. We conduct skin camps in schools and healthcare centers and carry out sensitizations and awareness outreach in communities in partnership with State Ministries of Health. We work with Community Volunteers to implement projects that are patients centered and community-driven. We have recorded many successes with success stories from many communities in Southern Nigeria irrespective of the imminent task and daunting challenges.


Why Audio?

Motor parks have shown the medium can be effective tool for information dissemination. The pandemic also threw everything, especially the health sector into a frenzy, there was a lot to do with limited space and resources but humanity must survive. It was a crazy year and what followed was even crazier, it laid bare gaps in health systems, challenged the social protection schemes where it exists, and exposed our emergency preparedness, or lack of it. On the other side, it threw up more innovation to set us back on the part of achieving Universal Health Coverage under the Sustainable Development Goal (SDG) 2030. We participated in the #SmartDevelopmentHack of the Federal Ministry for Economic Cooperation and Development (BMZ) which was looking for digital solutions for the challenges of COVID-19. Out of 1000 applications, DAHW and its partner organizations (Nigeria, Brazil, Ethiopia, India, and Uganda) were chosen as one of the 20 teams. We collaborated with Audiopedia Foundation to implement the project “Enhancing Access to Health Education” and the objective was to provide audio health education to marginalized populations. In its adaptation in Nigeria, we started off with the Phase-1 project from April to December 2021 titled ‘’ Improve Knowledge and Access to Health and Development information of illiterate women and girls in two urban slums in Southeast Nigeria using Audiopedia.’’ Audiopedia is a digital and scalable solution for sharing audible and credible information which enables local NGOs and CBOs to use tailor-made web applications to make audible health education accessible in local languages, it is a product of Audiopedia Foundation. The Phase 1 project involved 400 illiterate women and girls from Ngenevu and Agu-owa communities, suburbs in Enugu, Enugu State, Nigeria. The women were purposefully selected based on the criteria that they must be illiterate or semi-illiterate residing in either of the communities and must own a smartphone or smart feature phone. They were divided into two intervention groups of 200 women and girls each through a simple random technique. However, we selected a control group of 100 women and girls from another community called Iva-valley in Enugu with similar characteristics to the intervention communities. With the help of 20 Community Volunteers, 200 women and girls with smartphones in Ngenevu community received Audiopedia messages through WhatsApp, and the other 200 women and girls in Agu-owa received Audiopedia messages through a loaded external memory card inserted in their phones, while the 100 illiterate women and girls in Iva-valley enrolled to serve as a control group. These messages originally in English were translated and voiced in Igbo language with the help of volunteer Students from the Linguistic Department of University of Nigeria, Nsukka. A semi-structured questionnaire designed by a research consultant was used for data collection; before, during and after the intervention. The questionnaire contained informed consent, questions on demographics, and knowledge of participants on selected health and development (e.g. GBV, Maternal health, WASH, Covid-19, Social-economic and women empowerment schemes) issues. The report from Statistician Dr. Ossai Edmund Ndudi showed that the highest educational status of all the women who participated in the project was secondary education, however, about 70% of them had less than secondary education but primary education. The knowledge of the women on health and development was tested using 20 life events-related questions. At baseline, the proportion of those with good knowledge were 47.0%, 63.2%, and 69.0% among the WhatsApp group, phone with memory card group and control group respectively. At the end of the intervention, the proportion of those with good knowledge among the WhatsApp group and phone with memory card group increased significantly to 98% and 100% respectively, while the control group increased to 86.2%. The findings demonstrated the efficacy of the use of a digital and scalable solution for sharing audible and credible information among illiterate women and girls.

The Motor Park effect
With the success of the Phase 1 with the controlled community, we decided to replicate the Motor Park effect with a wider audience. The Phase 2 started from January to November 2022 titled ‘’Mainstreaming Audiopedia as a tool to improve knowledge and access to health and development information in Nigeria.’’ The project aimed at bridging the health and development information gap among illiterate women and girls including other members of the community in Nigeria through the use of various audio-enabling devices to access audio Health messages. Using the existing health infrastructure in Nigeria, we focused on 10 NTDs endemic States in Nigeria; Anambra, Bauchi, Bayelsa, Cross-River, Ebonyi, Delta, Ondo, Ogun, Rivers and Plateau States. Working with 12 Local Government Areas per State (120 LGAs) and 20 selected health facilities per LGA (2400 Health Facilities) for the dissemination of these audio messages in four major translated and voiced languages (Hausa, Igbo, Pidgin and Yoruba). The idea is that when you walk into a health facility in your community, while waiting to be attended to, you will have the opportunity to hear various health topics in your local language. One of our doctors captured well it in this format ‘’when you prescribe paracetamol, prescribe a health topic too.’’ Working with these health facilities, we deployed topics based on community needs. We have successfully translated and voiced these 33 health and development topics in the four major languages: Leprosy, Buruli Ulcer, Lymphatic Filariasis, Tuberculosis, Yaws, WASH, Cleanliness, Women’s Health, Substance Abuse, Nutrition, Sexually Transmitted Infections (STIs), Pregnancy and Birth, Breastfeeding, Growing Older, HIV and AIDS, Disabilities, Infertility, Problems of the Urinary System, Cancer, Mental Health, Pneumonia and Tuberculosis, Malaria, Violence against Women, Abortion, Sexual Violence, Family Planning, Family Planning – Natural and Permanent Methods, Child Injury Prevention, Child Health, Advice for Girls, Suicide Prevention, Family Conflicts and Safety at Work. We have started distributing 450 Solar powered MP3s with these topics loaded in a memory card across the 10 States to cover the gaps in some facilities that have no such instrument to serve a large audience.

Finally, it is our desire that going forward Health education will be delivered in local languages as our intervention has shown its effectiveness. We have recorded big successes from the mainstreaming of the intervention with the aim that by walking into your local health facility, you will go home with a health knowledge. This can be replicated by other NGOs and CBOs as we hope to achieve the Universal Health Coverage by 2030.

Ajuluchukwu Edechiene
Project Manager
RedAid Nigeria.

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