Development Media International (DMI)

I studied at Cambridge University (double-first in Economics and Politics) and U.Penn (MA in Communications), then joined the BBC to direct documentary films. Something was missing and I felt increasingly drawn to international work. I took jobs with UN Peacekeeping, setting up the UN's first radio station (in Cambodia) and its largest TV operation (during the Bosnian war). In 1997, I became convinced that health campaigns had the largest potential impact but they needed professionalising. I persuaded the BBC and WHO to join forces, creating the BBC World Service Trust, and for 8 years I oversaw many of the world’s largest health promotion campaigns. These included a campaign in India which led to 200,000 people being treated for leprosy. In 2005, I received the Joseph Rowntree Charitable Trust ‘Visionaries’ Award and left the BBC to set up Development Media International (DMI), aiming to bring greater scientific rigour to health campaigning.

Millions of children die every year from three big killers:  malaria, diarrhoea, and pneumonia. We now have proof that DMI’s mass media campaigns can prevent many of these deaths. We conducted the first randomised controlled trial (RCT) to test the impact of radio campaigns on these three diseases. It showed huge increases in treatment (56% for malaria, 39% for pneumonia, 73% for diarrhoea) and a saving of approximately 3,000 lives.

We propose to scale up this work, which costs just $196 to $756 per life saved, making it highly cost-effective. We know the countries where we could save the most lives and have the staff and skills to deliver high impact child survival campaigns.

We know of no more direct way to elevate humanity than by saving the lives of thousands of children and allowing every one of them to have the chance to fulfil their potential on earth. 

Three of the biggest killers worldwide are malaria (620,000 deaths), diarrhoea (1.6 million deaths), and pneumonia (2.6 million deaths). In Sub-Saharan Africa, 78 children out of 1,000 live births die before the age of 5 – twice the world average (39/1,000) (IGME, 2018). Most of these deaths are preventable. 

Over the last thirty years tremendous progress has been made on the supply of drugs and medical services. But even the most sophisticated health systems in the world cannot save a single life if children are not brought for treatment. Parents need to know what to do: what the symptoms of serious infection are, when it’s an emergency, and where to seek treatment. Without that, many millions will continue to die. 

DMI creates behaviour change campaigns that improve health and save lives in low income countries. We deliver radio, TV, and mobile campaigns on maternal and child health, giving caregivers the knowledge they need to protect and save their children’s lives.

DMI is a non-profit organisation based in London, with offices in nine countries in Sub-Saharan Africa. Our Saturation+ approach to communications utilises insights from advertising and behavioural science and is based on three core principles: Saturation, Science and Stories.

1. Saturation: Broadcasting messages 6-10 times per day, 365 days per year
2. Science: Understanding our audience using extensive formative research, evaluating our impact rigorously, and
3. Stories: using the power of short (60 second) dramas to ensure the behaviour change messages are engaging and memorable.

While everyone knew that mass media can reach a lot of people, no one (not in the advertising world, not in epidemiology) demonstrated that media campaigns could shift behaviours. We now have that proof. In 2018 we published (Murray et al., 2018) the results of the first-ever scientific trial to show mass media can change behaviours and save lives. We conducted this trial for one purpose: to prove the concept and then scale up. 

Direct beneficiaries:

• Children under 5 are the principal direct beneficiaries of DMI’s child survival campaigns. DMI’s child survival campaigns focus on encouraging treatment-seeking for malaria, pneumonia, and diarrhoea, as well as promoting other behaviours that save under-5 lives, such as exclusive breastfeeding and complementary feeding, ultimately reducing morbidity and mortality.    
• Mothers and pregnant women, and families are also direct beneficiaries of DMI’s campaigns. Our scientific trial showed a reduction in maternal deaths as a direct result of the campaign.

Indirect beneficiaries:

• This includes all caregivers, family members, and other people closely associated to the direct beneficiaries. These groups benefit from DMI’s campaigns by being exposed to the information shared, by being empowered to adopt healthy behaviours, and in many cases by benefitting emotionally, socially, and/or economically from the improved health and the reduced morbidity and mortality of the direct beneficiaries.

We work to understand our target audience’s needs by conducting field-based formative research on the barriers to the behaviour changes we aim to effect. We pre-test our spots with target audiences, conduct audience feedback research and iteratively adjust our messages. 

DMI’s work builds awareness of diseases, such as malaria, pneumonia, and diarrhoea, and effective treatments for them, such as antimalarials or oral rehydration salts, to people in low-income countries who did not know about these diseases and treatments, or might have been discouraged from seeking treatment due to social, cultural or religious barriers. Driving behaviour change amongst these populations is how we contribute to solving some of the most pressing health problems of our world. 

Everyone understands that mass media can be powerful. Indeed there is no other way (outside the education system) of reaching millions of people at a time. But could it really save lives? By 2007, having run health campaigns for 10 years, I was convinced that it could potentially save many 1000s of lives. The problem was that public health is dominated by epidemiologists and health economists: scientists who respect only the hardest of evidence. And there had never been a successful randomised controlled trial to prove that mass media could save lives. I learnt how to construct mathematical models and write scientific papers, and eventually received $12m of funding to test my theory in Burkina Faso. The trial was a success, saving 3,000 lives and proving for the first time that mass media could change people’s behaviours. There was a 56% increase in malaria treatment, a 39% increase in pneumonia treatment and a 73% increase in diarrhoea treatment: these are the three big killers in Africa and saving lives in this way became the raison d’etre of DMI: what we had to offer to the world. 

Because human life can be saved by knowing the simplest things. Two examples:

My own son was born 6 weeks premature. We were in one of the most technically advanced hospitals in the UK, yet what was prescribed was exclusive breastfeeding and skin-to-skin contact. So that’s what we did: he was on my chest 12 hours a day. Both these interventions are available to every parent in the world. Yet if my son had been born in Africa, he probably would not have survived.

Let’s imagine a mother whose child has diarrhoea. She notices that each time she gives it food and water, more diarrhoea comes. She concludes, perfectly logically, that the food and water is causing the problem. So she stops giving it. And this is how half a million children die every year: not of the diarrhoea, but of dehydration. Because their parents didn’t know what to do.

We know of no more powerful emotional bond than the love of a mother for her child and to have these small snippets of knowledge feels like a human right. My job has been to prove that giving them this knowledge is also a highly cost-effective way of saving lives.

DMI is well positioned to deliver this project because we have rigorously tested that our approach works and because we have an operational model proven to deliver behaviour change campaigns at scale. We are the first organisation to successfully demonstrate through two RCTs (one on child survival and one on family planning) that mass media campaigns can change behaviours and save lives.

DMI has considerable operational experience of implementing behaviour change campaigns at scale in low-income countries. We have successfully delivered mass media campaigns in countries across Sub-Saharan Africa and are currently active in Burkina Faso, Côte d’Ivoire, Ethiopia, Madagascar, Malawi, Mozambique, Tanzania, Uganda, and Zambia. We have 75 staff, all motivated and expert in delivering these campaigns. 

There are good reasons why randomised trials of mass media had always failed until our own. Broadcasting messages in some areas of the country and not others sounds easy; but it means you can’t use national media. If you ignore the biggest TV and radio stations how can you have an impact?

I knew the answer. We needed to find a country with high child mortality, but where almost no one listens to the national media. Did it exist? I didn’t know, but we had 100 low-income countries to choose from and just 6 weeks to do it.

At the time I was running DMI from my back bedroom with barely any staff. But I did give lectures at a university. I persuaded a small army of students to join me as interns: they got credit while helping me analyse 100 countries. 

Eventually we found the one: Burkina Faso, where 10% of children were dying, but where, for political reasons, the national radio station broadcast only in French. Almost everyone listened to local radio stations in their own, local languages. It was the one place on earth where a randomised trial was possible.

I remain enormously endebted to those students!

By 1997 I had spent my early career at the BBC as a television director, and with UN Peacekeeping. It became clear to me that within international organisations there was almost no expertise in mass media. They confused news management with advocacy with behaviour change campaigns. They recruited badly, they spent money badly, and 80% of campaigns were failing. 

The potential of the mass media to increase knowledge and save lives, nevertheless, was huge. I made a simultaneous approach to the BBC and the World Health Organisation, arguing that the whole field of health campaigning needed to be professionalised and that there were hundreds of BBC staff members who would love to lend their skills to such a challenge. By 1998 the BBC had created the BBC World Service Trust and I’d been appointed Director of Health. 

By 1999 I’d raised funding for leprosy campaigns in 5 countries from the WHO, the UK and Japan. By 2000 we were responsible for 12,000 people being cured of leprosy in Nepal and 200,000 being cured in India. By 2001 I had 100 staff and we were ready to start tackling HIV/AIDS. It wasn’t yet science, but it was the start.

DMI’s methodology brings together the creative world of mass media advertising with the scientific world of epidemiology and health economics.

DMI’s creative approach is to align the 3-act structure of creative drama with the most important messaging. That is, the most dramatic moment of the drama is also the moment to convey the most important message.

DMI’s approach to distribution relies on the experience of the advertising world. Unlike most public health campaigns, which tend to broadcast on an infrequent basis, DMI broadcasts radio messages 6-10 times per day. This allows us to saturate large populations with engaging health messages that are the key to stimulating behaviour change.

We use scientific approaches to formative research to make sure we understand how different micro-populations think and reason, and broadcast our spots in up to 13 languages per country.

We use mathematical modelling to allocate airtime for different messages, based on the predicted numbers of lives saved.

Finally we evaluate our campaigns using the most rigorous scientific methods, which no other organisation has managed to achieve for mass media. 

DMI expects its work to impact humanity by improving the health and wellbeing of the target populations in our countries of operation. To achieve this impact goal, DMI’s interventions adhere to the following theory of change:

• DMI runs its campaigns according to its proven Saturation+ methodology (Murray et al., 2015), which is based on the following three pillars: (1) Saturation: Broadcasting messages 6-10 times per day, 365 days per year, (2) Science: Understanding our audience using extensive formative research, evaluating our impact rigorously, and (3) Stories: using the power of short (60-second) dramas to ensure the behaviour change messages are engaging and memorable.
• We have strong evidence, particularly from our independently evaluated randomised controlled trials (RCTs) on child survival (Murray et al., 2018) and family planning (Glennerster et al., 2020, forthcoming), that Saturation+ campaigns can change behaviours. Our media campaigns deliver two kinds of change:
  • (1) individual change: The campaigns affect knowledge, awareness, motivations, attitudes and beliefs of individual listeners of our campaigns, and
  • (2): social change: an awareness of the importance of the target behaviours is created at the community level. Subsequent community dialogues about these behaviours and themes reinforce awareness and create an enabling environment.
• The combination of the individual-level and social-level behaviour changes delivered by our Saturation+ campaigns causes lasting changes to behaviours and social norms. The large audiences we reach through our campaigns understand the importance of the target behaviours and how to adopt them, and are ultimately motivated to adopt promoted healthy behaviours. 

By creating lasting individual-level and social-level behaviour change, DMI’s campaigns are able to improve health and wellbeing, and in many cases, save lives. 

The number of people we are currently serving: 

Our current campaigns reach over 57M people in Burkina Faso, Cote d’Ivoire, Ethiopia, Madagascar, Malawi, Mozambique, Tanzania, Uganda, and Zambia. DMI has saved over 1,000 lives and improved the health behaviours of over 8.5M individuals over the last 12 months.

Our child survival campaigns in Burkina Faso and Mozambique currently reach at least 15.5M people.

The number of people we expect to be serving in one year: 

 At the time of writing, our campaigns for next year are planned to reach the same target populations as this year’s campaigns, meaning we will reach at least 57M people in Burkina Faso, Cote d’Ivoire, Ethiopia, Madagascar, Malawi, Mozambique, Tanzania, Uganda, Zambia. Where possible we will refine our distribution strategies to reach even more people. We aim to save over 1000 lives and improve health behaviours of over 10M individuals.

We expect that our child survival campaigns in Burkina Faso and Mozambique will continue to reach at least 15.5M people and we hope to launch a child survival campaign in Tanzania reaching 13-18M people.

The number of people we expect to be serving in five years:

It is our goal to deliver mass media behaviour change campaigns reaching over 100M people in at least 10 countries, improving health behaviours of 15M+ individuals and saving over 8,000 lives by 2025. By expanding our child survival campaigns to Tanzania and 2-3 countries in West Africa, we hope to reach over 40M people with child survival messages.

DMI is poised to accelerate the scaling of our high impact interventions. Our 5-year ambition is to reach over 100M people in at least 10 countries and to change the behaviour of over 15M people.

Goal 1: Responding to the primary and secondary effects of COVID-19 will define our goals for the coming year. We are delivering tailored COVID-19 campaigns in 6 of our 9 countries of operation and are following WHO advice to continue our campaigns on topics such as child survival and family planning, adapting them to the context of COVID-19.

We also aim to optimise our campaign design and delivery according to in-country needs and the changing media landscape, with the specific aim of honing our approach to social media behaviour change campaigns.

Goal 2: DMI is launching a third randomised controlled trial. In partnership with the London School of Hygiene and Tropical Medicine (LSHTM) and Innovations for Poverty Action (IPA), we will investigate the impact of mass media on parenting behaviours and early childhood development outcomes in Burkina Faso.

Goal 3: Since our successful child survival RCT, DMI has taken its child survival campaigns to national scale in Burkina Faso and Mozambique. Over the next year we aim to secure funding for a child survival campaign in Tanzania, and 2-3 countries in the West Africa region where a media campaign could cost-effectively reduce child mortality.  

1. DMI’s priority institutional donor, DFID, will merge with the Foreign Commonwealth Office (FCO), likely marking a significant shift in the UK’s international development funding priorities (which currently include a strong commitment to Ending Preventable Deaths) in the coming years. This might have short-term implications particularly for our Tanzania portfolio and our regional East African family planning programme as well as long-term implications for DMI’s funding strategy.
2. DMI’s Saturation+ methodology requires large amounts of airtime to achieve impact, making it a significant cost driver of our campaigns. This is a barrier to our 5-year goal of expanding our operations to at least 10 countries. Our new DMI REACH delivery model (where we run projects with just 2-3 staff instead of 10-20) streamlines costs, but we will continue optimising it and exploring alternatives.
3. The media landscape is fragmenting. People consume a greater variety of media (radio, TV, and particularly social media) and the number of stations and channels is increasing. This is a barrier to our 5-year goal of reaching over 100M people.

1. We will pursue partnership opportunities with alternative bilateral funders and consortium leads both at HQ and in our regional offices. We also aim to explore partnership and funding models outside of our current sectors (social behaviour change communications, media, international development) and are eager to learn how best to market ourselves within and outside them.
2. We are exploring closer working relationships with media partners as well as government authorities to secure long-term discounts on airtime. We are also reviewing our DMI REACH delivery model to optimise it and assess alternatives.
3. We will need to adapt our methodology in the long-term so that we may continue to have impact despite the increasing fragmentation of the media landscape. This will require developing more complex partnerships with multiple radio and tv stations and maximising the use of social media. To maximise the use of social media, we will need to learn from and consult with leading experts and organisations in the field of social media behaviour change.

1. Government: All DMI’s projects require extensive collaboration with Governments. DMI works with Health Ministries and Health Promotions Departments (or relevant/equivalent departments) to obtain ethical approvals for research, monitoring, and evaluation of our campaigns, content approvals of our creative outputs, and policy and technical guidance. All DMI campaigns adhere to national policies and complement national health strategies and programmes. In many cases, DMI works to build government capacity by providing technical advice on our behaviour change programmes and methodology.
2. Local media: DMI contracts radio and TV stations reaching large portions of our target population to broadcast our messages. Where possible, we build local radio station capacity by training them to run our interactive programmes and provide them with equipment such as generators, computers, and broadcast monitoring software.
3. Research organisations: We work with leading local and international universities (eg. University College London, London School of Hygiene and Tropical Medicine) and research organisations (eg. Abdul Latif Jameel Poverty Action Lab, Innovations for Poverty Action) to collect data and evaluate the impact of our campaigns.
4. High-impact ‘supply-side’ partners: Many of our projects are designed and delivered in conjunction with highly effective ‘supply-side’ partners (eg. Marie Stopes, the International Planned Parenthood Federation, IMA World Health, the International Red Cross) that work to improve health system infrastructure and deliver crucial services and medicines. We aim to increase our partnership- and consortium-based project portfolio.
5. Local and international creatives: we hire and contract predominantly local/African creative talent to lead our scriptwriting and production processes.  

Our product is human knowledge: in particular, knowledge that stimulates behaviour change that results in improved health.

Our key beneficiaries are generally individuals and communities in Africa and the governments that serve them. Our research indicates that they place huge value on the knowledge we bring (caregivers, after all, have possibly the strongest motivations that we know of: keeping their children safe and alive, as is reflected in their statements to our researchers). But they are not, in general, the people who will pay for our work. It is possible that in future, governments of low-income countries will take on this work for themselves. That is our ultimate ambition, but it is not the case at present.

Our funding comes from philanthropic and governmental and multi-lateral donors. What we offer them is a very rigorous approach to impact evaluation and a strong track record of success. The “product”, in this sense, is proven impact. So far this has been very successful, particularly among donors who value a quantitative approach.  

The majority of DMI’s income is project-based funding (grants and contracts). This funding comes from a variety of institutional and multilateral funders as well as foundations and individual philanthropists. Recent funders include DFID, USAID, UNFPA, UNICEF, Bill & Melinda Gates Foundation, Wellcome, the Skoll Foundation, and GIZ.

DMI receives unrestricted annual grants from organisations such as the Mulago Foundation and GiveWell. DMI also receives donations from individuals, given mainly through networks and organisations such as GiveWell, The Life You Can Save, and the Centre for Effective Altruism.

We will continue to leverage these diverse funding streams to support our work. DMI has a dedicated business development team that writes grant and project proposals and manages relationships with current and prospective funders. As the organisation grows to reach its impact goals for the next 5 years, we aim to increase the capacity of the business development team so that funding may continue to be pursued at a scale that is adequate to the organisation’s size and portfolio.

Our current child survival radio campaign portfolio includes the following projects in Burkina Faso and Mozambique:

• Saving Lives (Burkina Faso)
  • Total grant amount: $1,900,000 USD
  • Funded by a philanthropic foundation
  • Project schedule: October 2019 – October 2021
  • Expected reach: 11.3M people

• Intensaude II (Mozambique)
  • Total grant amount: $3,900,000 USD
  • Funded by a philanthropic foundation
  • Project schedule: October 2020 – October 2022
  • Expected reach: at least 4.3M people

We are seeking funding for a child survival campaign in Tanzania, and have submitted a funding application for the below project.

• Imarisha Afya: Maternal and Child Health in Tanzania - using mass-media to address the impacts of COVID-19 on Global Goals 2 and 3
  • Total grant amount: $3.5M USD
  • Funder: DFID
  • Proposed schedule: April 2021 – April 2024
  • Reach: 13-18M people aged 15 and older

We are also planning to raise funds to scale up our child survival work in West Africa. Funding applications have not yet been submitted, but we hope to have campaigns running in 2-3 of the below countries by 2022.

Priority countries:

• Benin
  • Cost/annum of a national Saturation+ radio campaign: $875,000 USD
  • Estimated reach: 5M people
  • Minimum campaign length: 2 years
• Guinea
  • Cost/annum of a national Saturation+radio campaign: $1,030,000 USD
  • Estimated reach: 4.5M people
  • Minimum campaign length: 2 years
• Niger
  • Cost/annum of a national Saturation+ radio campaign: $875,000 USD
  • Estimated reach: 9M people
  • Minimum campaign length: 2 years
• Sierra Leone
  •  Cost/annum of a national Saturation+ radio campaign: $940,000 USD
  • Estimated reach: 3.6M people
  • Minimum campaign length: 2 years
• Togo
  
  • Cost/annum of a national Saturation+ radio campaign: $750,000USD
  • Estimated reach: 4.6M people
  • Minimum campaign length: 2 years

Estimated expenses for 2020: $6,385,206 

Impact drives everything that DMI and I do. I believe participating in the Elevate Programme would help DMI significantly amplify and increase its impact by addressing barriers 1 (uncertainty around our main source of institutional funding) and 3 (the changing media landscape) to our goal of reaching 100 million people and changing 15 million behaviours in the next 5 years.

Barrier 1: the unrestricted funding provided through the Prize will be allocated to the scaling of our tested, high impact child survival radio campaigns, utilised to plug the funding gaps we may have for our scaling plans. Additionally, increasing public awareness of our work, especially online, would allow us to amplify the impact of what we do. DMI would greatly benefit from working with the Elevate Programme and its network of experts to develop funding and particularly marketing strategies that are responsive to the latest trends, bringing our work to the attention of the public and to new partners and funders. 

Barrier 3: I am equally excited about exploring some of the big questions pertaining to our behaviour change campaigns on social media. Media consumption trends suggest that social media penetration and internet usage are rapidly increasing, providing an increasingly popular alternative to traditional mass media (TV, radio). Our expertise currently lies in TV and radio, so it would be highly beneficial to work closely with experts in social media to brainstorm how best to create and deliver high impact social media behaviour change campaigns for health in low-income countries. 

Funding and revenue model: We aim to explore alternative institutional funding sources to support the maintaining and scaling up of our campaigns and impact in Sub-Saharan Africa.

Mentorship and/or coaching: We aim to work with experts to explore how we can optimise our approach to social media behaviour change communications.

Marketing, media, and exposure: We aim to increase our exposure so that we can meet the following aims:

1. Continue to work in partnership with other high-impact health service delivery organisations to amplify our and their work.
2. Develop the best network of leading African producers, directors, and animators.
3. Build a stronger reputation as the best and most rigorous evaluator of mass media campaigns, working with leading academics and research organisations.

We would like to deepen our partnerships with the UN and WHO, so that our work continues to efficiently align with global health and development priorities and so that we can explore new opportunities to deliver our campaigns at scale.  

We would like to work with thought-leaders in social media behaviour change communications in order to advance our thinking on how we can maximise health behaviour change and save lives through social media.

We would also like to work with leading marketing consultancies that can help us present ourselves and our achievements in a way that attracts new potential partners and that helps build our reputation.