Lessons learned from the evaluation of the global mNutrition initiative to change health and nutrition behaviours using mobile phone technology

Summary:

Progress to tackle all forms of malnutrition remains unacceptably slow and there is urgent need for new innovative approaches to ensure that we can accomplish SDG 2 of ending hunger, achieving food security and improving nutrition by 2030. mNutrition is a 5-year global initiative that uses mobile phone technology, and in particular mobile-phone based behaviour change messages, to improve the health and nutritional well-being of children and adults in low income countries. mNutrition is supported by the UK's Department for International Development (DFID), organised by Groupe Spciale Mobile Association (GSMA), and implemented by in-country mobile network operators (MNOs) across 12 countries in Sub-Saharan Africa and South East Asia. A consortium of researchers from Gamos, the Institute of Development Studies (IDS) and the International Food Policy Research Institute (IFPRI) together with partners from Ghana and Tanzania used a comprehensive mixed-methods approach to conduct an independent and rigorous impact evaluation of the initiative. The talk will present the findings of the impact evaluation and will also discuss lessons learned about best practices in the design and implementation of mobile phone-based nutrition services to facilitate a) behaviour change and b) a sustainable business model.

Background/Objectives:

Undernutrition remains a major challenge globally. Agricultural and health systems are not meeting current and future global nutrition and health needs. Furthermore, public extension systems are often inefficient, have limited capacity and a poor track record of delivery, especially in terms of supporting women and the most marginalised populations. The growing access to mobile phone technology in low-income countries offers new opportunities for the delivery of behaviour change communication, with potential for large scale implementation. However, while there is a lot of interest in leveraging mobile phone technology for behaviour change, there is still a lack of evidence on impact.

Description of Intervention and/or Methods/Design:

To address the evidence gap the mobile phone-based mNutrition initiative has been rigorously evaluated. The aim of the evaluation was to assess the impact, cost effectiveness, and commercial viability of the mobile phone-based behaviour change initiative. The evaluation covers the period from October 2016 until September 2019 and took place in two countries: Ghana and Tanzania. The team employed a theory-based mixed-methods approach, with a quantitative experimental approach using randomised controlled trials (RCTs) involving more than 3,000 households in each country; qualitative, longitudinal in-depth case studies in a sub-sample of the quantitative treatment sites; and a comprehensive business modelling approach that included multiple stakeholder interviews and business data analysis.

Results/Lessons Learned:

Mobile phones are ubiquitous, but not necessarily an inclusive technology. Women and poor households in particular were excluded from mNutrition due to gendered barriers, poor network coverage and illiteracy. Sustained engagement with the initiative was low and can be explained by several implementation and contextual design issues (some of which are easy to address). Face-to-face contact during sign-up and throughout could improve up-take but introduces additional costs that negatively affect the financial viability of the service. Contextual barriers (mainly poverty) also prevented households from translating behaviour change advice into action. Given the low up-take, it is unsurprising that only very marginal (non-significant) impacts of mNutrition on health and nutrition were found. However, people who successfully engaged with mNutrition perceived the service as accessible, useful and credible. They liked the practical and actionable advice, valued the time-and area specificity of the content and appreciated the privacy offered by a mobile phone-based service.

Discussion/Implications for the Field:

Mobile phone-based services are not a magic bullet, but can trigger behaviour change for households who actively engage. More thinking about complementary technologies including 'low tech' options (e.g. radio) and approaches to promote sustained engagement are needed. Linking mobile phone-based services with other programmes (e.g. social protection) that help to address the underlying barriers to change (i.e. lack of resources) might increase impact. Finding financially viable models remains challenging, especially as there is often a disconnect between commercial ways of working (aiming to maximise financial return) and donor ways of working (aiming to maximise social impact).

Abstract submitted by:

Inka Barnett - Institute of Development Studies (IDS)
Jessica Gordon - IDS
Becky Mitchell - IDS
Cement Sefa-Nyarko - Participatory Development Associates Ghana
Deogradius Medardi - Oxford Policy Management
Stephanie Brockerhoff - Oxford Policy Management