APPROACH AND METHODOLOGY
Literacy Bridge will work with experts in agriculture and health to identify the most effective health and farming guidance towards reducing child and maternal mortality in impoverished regions of Ghana. Local teams will then develop and record engaging and informative messages, songs, and dramas into digital audio files. Literacy Bridge will load these audio recordings onto its Talking Book audio computers so that community women's groups can repeatedly playback and discuss the messages and allow Talking Books to be taken home by pregnant women and mothers of young children.
Talking Books can be re-loaded any time with hundreds of local language recordings and organized into easy-to-access categories. Literacy Bridge will make this new mass media platform available to non-profit and for-profit organizations, which will also receive recorded user feedback and quantitative usage data. Businesses depending on smallholder farmers for their supply chains can grow their profits through this low-cost investment in farmer education. Health agencies can use this platform to reduce health behavior change costs.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
In early 2012, Literacy Bridge will create the recordings and launch a pilot for this project, deploying 200 Talking Books to women's groups in 20 randomly selected communities. This project will collect initial data and expand to 1000 Talking Books in 75 communities by the end of 2012, impacting 24,000 mothers and their children. Prior to deployment, Literacy Bridge's evaluation partner will collect baseline data on these communities and 75 other randomly selected control communities. The treatment communities will be randomly selected to ensure a rigorous evaluation; however, Literacy Bridge will conduct formative research to understand the local conditions and values of all potential communities.
In 2013, Literacy Bridge's evaluation partner will conduct end-line surveys of all 150 communities and determine net outcomes of the adoption of targeted health and agriculture practices. Literacy Bridge will provide a detailed log of all overhead and incremental costs associated with the intervention. Together, the transparent cost logs and rigorous outcome evaluation will allow an unprecedented analysis of the true cost-benefit of this behavior change platform.
The majority of people living with extreme poverty and disease are also impeded by illiteracy, disability and inadequate infrastructure. For example, information about up-to-date health and farming practices does not typically reach subsistence farmers living in remote rural villages because agriculture experts and trained health workers are only able to visit some communities once per year, if at all, due to poor road conditions. It is also an inefficient information delivery method because a one-hour annual visit by such an expert may include a dozen or more recommended practices. For those who are able to attend these visits, the advice is often forgotten when it needs to be applied; illiterate people cannot take notes.
The problem is even worse for women farmers. Research conducted by Actionaid International in collaboration with Actionaid Ghana shows that women constitute more than half of the agriculture labor force in Ghana and produce about 70 per cent of the country's food. Ghanaian women do most of the planting, weeding, harvesting and transporting of food produce and are also dominant in food crop farming. Yet, they generally don't benefit from extension visits because the timing of the visits interferes with their household responsibilities.
According to the Food and Agricultural Organization, 1.2 million Ghanaians are undernourished while figures produced in Ghana indicate that 14 percent of children are underweight and 28 percent stunted due to malnutrition.
Reducing rural child and maternal mortality requires adoption of farming practices that maximize nutritious food production and health behaviors that reduce disease and delivery complications. Secretary of State Hillary Clinton, stated at CARE's 2010 National Conference and Celebration, May 2010. "For years, experts have been saying that [nutrition] is a problem that must be addressed through a comprehensive response that unites experts and programs from across different fields. But for too long, the agricultural experts didn't talk to the neonatal experts who didn't talk to the early childhood experts."
This Health & Agriculture Communication for Women & Children commitment includes both health behavior change messages and agriculture education for women and their families to learn about nutrition and agricultural best practices for producing the greatest yield of the most nutritious crops.
While mass media campaigns are often considered the most cost-effective approach to behavior change programs, their cost structure requires increased investment for multiple exposures to the same message. While people with literacy skills have the advantage of referring to print media when they need it and as often as they need it, those who are not literate must rely on broadcast media that is not available on-demand. This commitment addresses these problems with low-cost access to dozens of behavior change messages that can be listened to as they are needed, as many times as necessary.
Finally, many behavior change programs have claimed successful outcomes, and some of those have rigorously measured these outcomes using randomly selected treatment and control groups. However, very few programs have transparently represented the full market costs of these programs, which is critical if funders are to make cost-benefit analyses of various behavior change programs.