Case Study 8: Nepal - Cut Your Coat According to Your Cloth and Service Brings Reward

Cut Your Coat According to Your Cloth and Service Brings Reward are two radio drama serials broadcast concurrently on Radio Nepal, aimed at increasing the contraceptive prevalence rate and use of health services. JHU/PCS created the Radio Communication Project (RCP) in conjunction with the Nepal Ministry of Health. Two audiences are targeted simultaneously to improve demand for family planning on the one hand, while improving delivery on the other. The RCP was broadcast on a pilot scale in Dang district in 1995/6 and then nationally on Radio Nepal from December 1997 to date.

Cut Your Coat is a 15-minute weekly soap opera, which encourages rural couples to limit their family size and space births. Messages are blended into a story in which two village elders vie for power, while community members struggle to reconcile traditional values and contemporary concerns. Colorful villains, heroines, and heroes, and plenty of suspense keep the audience eager to tune in to the next episode. At the end of each episode the narrator poses a question and listeners are encouraged to write in with answers. Roughly every three months there is a summary episode, which recaps the story, reviews previously presented topics, and provides an interactive listeners forum with letters, contests and prizes.

Service Brings Reward is a distance education program to update general medical knowledge and interpersonal communication skills of rural, clinic-based health workers. Twenty-minute episodes are aired once a week - 15 minutes of the story involving a health worker and other community members, followed by 5 minutes of health information and interactive feedback. The main message is health workers' responsibility to have up-to-date information and to teach clients about family planning, with the emphasis on the importance of interpersonal communication. Health workers are encouraged to listen in groups and send in questions and answers by mail. Field monitors visit each health post in the target area twice a year to talk with workers and to record interviews for later broadcasts.

Since this project is primarily about family planning, HIV/AIDS is only touched on within the context contraceptive methods - particularly condoms. Each topic is covered first for health workers to increase their knowledge and skills. Then, a few weeks later it is covered on Cut Your Coat so the general audience will know to expect when they visit the health post.

The writer is famous for his poetic writing and humor, and there is no denying the high popularity of the program among the intended audience. Letters indicate that listeners totally believe in the characters and are concerned about their welfare.

Management: The Radio Communication Project is managed by the JHU/PCS office in Nepal. JHU's senior Technical Advisor in Baltimore provides regular guidance on scriptwriting. The overall planning and scripting is reviewed and approved in Nepal and the U.S. The Series Coordinator oversees the administration of the RCP and each drama has its own Executive Producer.

Staffing: There are ten key Nepali staff members and one international Technical Advisor. The key staff positions are: the RCP Series Coordinator, two Executive Producers, two scriptwriters and the Audio Producer. The project subcontracts the recording to a private studio, which has its own staff, but is overseen by the Audio Producer. All actors and musicians are professionals with part-time contracts. Actors have other jobs and commitments and are not always available for recording when needed. Since this was the first social radio drama in Nepal, initial training was essential to establish a strong core of local writers, producers, and actors.

Writing and Production: The Design Document spells out in exhaustive detail the series' purpose, measurable objectives, content, audience profiles, message focus, timelines, monitoring and evaluation procedures, job descriptions and promotional campaign plans. It also covers the range of messages, the sequences of messages and the precise wording that is appropriate to the audience. All medical words are defined in a glossary, to help the scriptwriters explain terms in a style that listeners can understand. The Design Document is the "Bible" on which all aspects of the two series are based, and ensures consistency and synergy between the two serials.

The design team comprises some 35 people, including health specialists, ministry representatives, audience representatives, and the writer, producer, and director. A smaller group reviews and amends their work, then eight key signatures are put to the Document, including that of the funders, broadcasters, various departments of the Nepali MoH, and representatives of JHU. Government review and coordination can be a lengthy and cumbersome process, but having a permanent member of RCP as liaison between project and government has ensured close collaboration.

The number of episodes devoted to each topic depends on its importance, difficulty and newness for the listening audience. Sometimes a new topic is discussed every week, other topics are discussed for several weeks in a row, and some episodes are free of messages, in order to develop the story. The series scriptwriter creates a story that will appeal to the chosen audience and then blends the messages into the story naturally, gradually, and subtly. Summary programs and listeners forums allow the project to explain or repeat anything not thoroughly understood by the audience.

The RCP uses a system of "Edit-Free Production," because digital recording is not yet available in Nepal. This means that the scriptwriter follows the content guidelines set out in the Design Document to the letter. Then the Audio Producer ensures that scripts are thoroughly rehearsed and recorded in such a way that they require minimal editing. A Script Monitor attends every recording session to approve any small changes that might be needed for timing reasons or to overcome specific acting difficulties. In order to provide some flexibility in response to audience feedback, recording of each episode usually takes place no more than three weeks in advance of broadcast, which allows time for last-minute message changes.

Formative Research: In the early 1990s, JHU supported several large-scale surveys of family planning needs and media use in rural areas, which showed that couples could be reached most effectively by radio. It also found that rude and discouraging interactions with health workers were often cited as the reason for poor utilization of health services. Formative research gave writers great insight into the likes and dislikes of the audience and was used as the baseline for subsequent impact evaluations. JHU also conducted qualitative research of audience members in order to design the on-going programs. Before each new series, the first three episodes are pilot tested to ensure that the characters are realistic and that the story is entertaining.

Monitoring and Audience Feedback: Ongoing monitoring is the responsibility of the staff evaluator. For the first phase of the project, a private research firm conducted regular interactive sessions with Village Development Committees. In the ensuing four phases, PCS has conducted monitoring activities in close collaboration with the Ministry of Health. District health supervisors encourage listening and discussion of health topics among health workers and provide critical feedback to PCS for future episodes.

Audience feedback is encouraged by on-air quizzes and by providing selected health service providers with pre-addressed aerograms. Letters are periodically read on the air. JHU also produces a health workers newsletter, with updates from the Ministry of Health, letters, poems, and questions/answers.

Supporting Activities:Service Brings Rewards has accompanying technical reference manuals, family planning brochures, discussion/episode guides, wall charts, reproductive health flip charts, promotional materials and aerograms for health workers. Every health post and sub-health post in Dang district was given a radio to encourage group listening. District-level advocacy training workshops were conducted for District Public Health Officers and Regional Health Administrators in all five development regions of Nepal, with content that dovetailed with Service Brings Reward.

Four radio spots and three musical jingles promoted Cut Your Coat and reinforced themes, particularly the importance of spousal communication. Print materials, including posters designed separately to appeal to men and women, addressed the common belief that vasectomies cause physical weakness and encouraged men to play a greater role in contraceptive decisions. Promotional materials, such as caps, pens and small plastic radios with the RCP logo, were given to prizewinners, teachers, Village Development Committee members and other influential community members. Street drama events were organized to replicate and enhance the radio messages. Health volunteers facilitated community-level Cut Your Coat listening and discussion groups. One district is piloting incorporating Cut Your Coat into existing literacy groups.

Sustainability: The RCP is currently in its fifth phase and shows no sign of ending. There were plans for the RCP to be taken over by the Nepali government, which would presumably reduce JHU involvement to occasional technical advice. USAID or some other international donor would continue funding, as there are no plans and few possibilities for local commercial sponsorship.