Tremendous advances have been made in global health in the past few decades, from fewer infant deaths to progress in ending polio, yet many programs are falling short of achieving their desired impact. This is not for a lack of effective drugs, vaccines, or infrastructure, but rather for lack of the desired change in human behaviour. Behaviour change, while not new to global health, is under-prioritized, poorly understood, and poorly addressed. To increase uptake of health products and services, we need to move beyond simply raising awareness, to interventions that build motivation and trigger demand. This requires taking a page from the private sector, and shifting our perspective away from viewing people as passive beneficiaries to treating them as active customers with individual motivations.
Nike and Procter & Gamble know that a one-size-fits-all approach is not the most effective way to create demand for their products. Companies invest significant amounts of time and money to develop a sophisticated understanding of their customers by exploring their behaviours, beliefs, and emotions. They inquire why people choose their product and then group customers along these invisible lines to target their marketing, in a practice known as psychographic-behavioural segmentation.
We at the Surgo Foundation applied this practice – using new types of data and methods to approaching a problem – to prove that it can work equally well in global health. Diarrhoea is a leading cause of death in children, primarily through dehydration. It can be treated very cheaply with oral rehydration salts (ORS), yet in the Indian state of Uttar Pradesh, rural medical practitioners were using ORS to treat diarrhoea only 20% of the time.
Our initial research dispelled the existing notions that ORS either wasn’t available (it was) or that the rural medical practitioners did not understand its benefits (they did). We then undertook ethnographic research with caregivers and medical practitioners to capture their views, practices, and motivations. We found that caregivers demand antibiotics because they want quick relief for the child, and they believe powders are less effective than pills or injections. Through a decision-making game with practitioners, we learned that making money was a key factor behind treatment decisions, so they would yield to caregivers to retain their loyalty.
With this deep and nuanced understanding of why people behave the way they do, we recommended a portfolio of new interventions that included mass marketing to create demand, and steps to increase the economic security of medical practitioners. Within two years, ORS uptake rose to 50%. We are now applying these methods to other large-scale programs, to answer questions such as how to target the right contraceptive to the right person at the right time.
The field of global health needs to adopt the private sector’s systematic, scientific, and scalable approach to generate deep insights about our customers and the system they are embedded within early in the process, before jumping to expensive and less effective solutions. It is time to marry the science of global health with the science of behaviour change to ensure we are saving and improving lives by putting the customer first.