Why supply-side initiatives are not enough

June 29, 2012

Will Snell says companies working on ‘inclusive business’ products and services need to think about fostering demand as well as innovative solutions to supply.

Seven million children die every year of preventable causes before reaching their fifth birthday. We can keep five million of them alive every year by increasing coverage of simple interventions, such as exclusive breastfeeding or handwashing. And we can keep most of that group (over three million children) alive just by improving their parent’s knowledge of basic health issues, and changing their behaviours accordingly.

The major point here is that not enough attention is given to increasing demand in developing countries for health. Instead, most of the money is spent on increasing supplies – of doctors, hospitals, drugs, and so on. These are all necessary, of course, but it is several hundred times more expensive and slow to scale up supply-side initiatives in poor African countries than to scale up demand-side initiatives.

For example, many rural mothers in Africa cannot recognise when their child has a dangerous illness; even if they can, they do not know what to do about it. The instinctive response when a small child has diarrhoea is to stop feeding it, in order to make the symptoms stop; as a result, over a million children die of dehydration every year, quite unnecessarily.

What are these demand-side initiatives, then?

Increasing demand for health involves creating awareness of key issues and encouraging healthy behaviours (such as breastfeeding) and health-seeking behaviours (such as seeking treatment for malaria). This is done through behaviour change campaigns. These fall into two broad categories:

  • Community-level campaigns (using techniques such as street theatre and community mobilisers)
  • Mass media campaigns (using a combination of TV, radio, newspapers, billboards and mobile phones)

Mass media campaigns can be taken to national scale rapidly and relatively cheaply, even in countries where healthcare service provision is weak. The main requirement is high media penetration. In most African countries over 75% of people regularly listen to radio or watch television, and these numbers are increasing every year. It is possible to reach a target audience by broadcasting on a small number of popular stations (even if that audience is poor, rural women).

Because of their ability to scale, mass media campaigns are over 100 times more cost-effective per person reached than community-level campaigns. Our model for predicting the health impacts of mass media campaigns suggests that the cost per year of life saved is between $2 and $10. This is cheaper than any other health intervention, including childhood immunisations ($8-$16), bednets to protect against malaria ($2-24), and anti-retroviral treatment for HIV/AIDS ($673-$1,494).

We can save a life for around $100, simply by broadcasting radio messages that encourage parents to adopt healthy behaviours to protect their children, such as breastfeeding infants and washing their hands before meals. For example, a radio campaign in Cambodia increased the proportion of pregnant women who took iron supplements to prevent anaemia from 10% to 44%, and increased their awareness of the danger signs of acute respiratory infections (such as pneumonia) in children from 10% to 40%.

Raising awareness of health issues through media campaigns is cheap, easy and incredibly effective. By scaling up such initiatives throughout ‘bottom-of-the-pyramid’ markets, we could save millions of lives.

Will Snell is Director of Public Engagement & Development at Development Media International.

Development Media International (DMI) runs radio and TV campaigns to change behaviours and save lives in developing countries. DMI uses scientific modelling to save the greatest number of lives in the most cost-effective way, and is hoping to scale up its work to 12 new African countries through inclusive business partnerships with companies.