Winner of the Best international NFP case study of our Making a Difference Competition. This project was carried out by Kantar Millward Brown Singapore on behalf of Our Better World / Singapore International Foundation

“This simple and impactful case study is set for making a tremendous difference across all NFPs globally”

Six years ago, Our Better World (OBW) was created as the digital storytelling initiative of the Singapore International Foundation. This was the result of the opportunity that arose from the sweet spot of these three trends:

• A media landscape filled with negative news or mindless entertainment
• Ground-up non-profits/social enterprises doing great work but relatively unknown to the public
• People feeling passive about giving back and not knowing how they can help

Telling stories of people doing good in Asia, to inspire the online audience to take action, became the mission of OBW.

The initial years of OBW saw proof of concept when non-profits/social enterprises attributed part of their growth to the stories OBW told. However, the team believed that greater success could be unlocked through deeper understanding of the online audience.

In Asia, there was no research in digital storytelling for social impact. Unlike in the US, where research is funded by large philanthropic organisations which believe in using media for good, the concept was ahead of its time in Asia.

Primary research was needed to understand national psyches and uncover drivers of culturally and socially relevant story themes, to better connect with audiences across Asia. Only by understanding this, would OBW be able to nurture and grow an online community of action takers. OBW approached Kantar to form a partnership to undertake this primary research.

Given the lack of such research in the region, Kantar designed the qualitative research to be both wide and deep. A dual approach was developed: personal interaction on the ground, combined with the wide reach of digital – deployed in Singapore, Malaysia, Indonesia, India and the Philippines.

Face-to-face interviews gave researchers insight on meaningful, emotionally-charged experiences among participants. Digital forums created spaces for dispersed OBW community members to gather and freely voice, evaluate and develop ideas, and tap into their hearts and minds.

This approach fused exploratory, evaluative and projective perspectives in the analysis, enabling not just an understanding of current realities and their contexts, but also the building of deeper insights for future strategies.

The research analysis decoded what “contributing to social causes” means for people, based on two attitudinal anchors: a personal, deeply emotional and social experience, and an antidote to an unsympathetic world. Furthermore, a spectrum of motivations in social contribution was identified – ranging from a desire to change (e.g. overturn atrocities) to a desire to enhance (e.g. improve lives and communities).

Building on this, the insights helped to construct the defining characteristics of meaningful stories by market and the role digital can play to influence attitudes. In brief, the construct looks like this:

• India: Social change – the desire to confront a flawed system, where storytelling themes revolve around changing social inequalities; the role of digital being sensitisation
• Malaysia: Social preservation – the desire to uphold ethics in the midst of social decline, where storytelling themes revolve around values and ethics that inspire a sense of nostalgia; the role of digital being a reminder
• Philippines and Indonesia: Social cohesion – the desire to improve communities, where storytelling themes revolve around initiatives that positively impact communities; the role of digital being to garner support
• Singapore: Social welfare – the desire to improve the lives of others, where storytelling themes revolve around individual actions and initiatives that improve the lives of others; the role of digital being amplification

In addition to the construct, a trigger to action was identified – the most effective stories were ones that evoked a combination of complex and intense emotions.

Overall, this framework connected consumer motivations with storytelling, and provided OBW a much-needed formula for defining authenticity and meaning for impactful storytelling, spanning the production of videos to social media copy. The following examples highlight how research helped to meet this objective.

1. India: Post research, OBW told a story about child sexual abuse, calling for social change and action, which saw 1,020 volunteer enquiries. This was a significant jump in impact compared to a pre-research story about animals, that, whilst heart-warming, lacked strong call for change, and resulted in only 105 volunteer sign-ups.
2. Singapore: Post research, OBW told a story about a volunteer group helping to provide gowns for babies who pass away prematurely, garnering over 340 volunteer enquiries for the cause. The story focused on how volunteer actions have helped bereaved parents. A previous story which called for volunteers for a hospice, but angled on what the volunteers did, resulted only in 24 additional volunteers for the organisation.

Research has helped empower OBW with confidence and a stronger base for compelling impact storytelling. The impact from applying the insights is increasingly evident.

Beyond OBW, the findings are also applicable for non-profits/social enterprises in Asia. Organisations can use the insights to craft their own strategic communications to cater to different audience motivations, to drive more impact.

OBW wants to play a catalytic role in spearheading research, applying insights for best-in-class digital storytelling for social good in Asia. What has been accomplished so far serves as a strong foundation for new partnerships and support, and OBW is now seeking further research investment to be made in this fast-evolving digital space. Not only would OBW apply fresh insights for better impact outcomes, it would also share them with the relevant sectors, contributing towards the media playing its role as a force for good.

About the Authors:

Winner of the Most innovative NFP case study of our Making a Difference Competition. This project was carried out by Surgo Foundation in partnership with the Bill & Melinda Gates Foundation and the Clinton Health Access Initiative

“Huge potential impact in India and internationally where diarrhea kills large numbers. This is a really excellent, thorough and innovative and effective piece of research”

Diarrhea is the second leading cause of death among children worldwide. It kills mainly by causing dehydration. Fortunately, a simple, cheap, and scalable solution exists – the use of oral rehydration salts (ORS). Yet India sees more than 200,000 diarrheal-related deaths every year. Its most populous state, Uttar Pradesh (UP), accounts for a substantial portion of these.  ORS is available and relatively inexpensive in UP, but surveys showed that only 30% of children with diarrhea in the state were treated with ORS. Why were children not receiving this potentially lifesaving medicine?

In Uttar Pradesh, India, 84% of caregivers of children with diarrhea seek care from rural medical practitioner (RMPs) – informal community providers who often lack medical training. Several organizations trying to tackle this problem hypothesized that improving RMPs’ access to ORS and informing them about best practices for treating diarrhea would significantly improve the uptake and use of the treatment. A statewide program was begun to provide ORS directly to RMPs at prices that would improve their profit margins. This was combined with training RMPs on how to prescribe the treatment properly. However, after three years of investment, levels of ORS use among children had not improved. Surgo Foundation began working on the project with the aim of answering the ‘why’ – why ORS uptake was so low? Did families and providers understand the benefits of ORS treatment? Did RMPs have sufficient access to the drug to prescribe it? What else could be driving the low uptake of this critical drug?

In the first phase of our work, Surgo analyzed and integrated insights from several surveys, including a state-wide, large-scale quantitative survey of caregivers and a “mystery client” survey. This enabled us to map and understand the ORS treatment “cascade” – each step along the child’s path from having diarrhea to visiting an RMP, being correctly diagnosed, receiving ORS, and using the treatment. Our goal was to see where the largest drop-offs occurred on the path to ORS use.

The phase 1 research found that RMPs had ample access to ORS in the open market, which meant that the direct retailing of the product by NGOs was not filling the previously hypothesized gap. Surgo also identified a stark “know-do gap” among RMPs when it came to dispensing ORS to children with diarrhea. Around 80% of the RMPs knew they should use ORS, yet only 20% of children with diarrhea received ORS directly from RMPs. In essence, even though a majority of RMPs knew ORS was the right treatment, they weren’t prescribing it. These findings showed that the theoretical underpinning of the original project was not correct – lack of access to ORS and a knowledge gap among RMPs were NOT the main barriers to ORS use.

In phase 2, we undertook ethnographic research with RMPs and their mentors, and with caregivers, to better understand the “why” of low ORS uptake. We aimed to capture their views, practices, motivations, and treatment decisions. Our research allowed us to develop hypotheses on the mental models, beliefs, and emotions of both RMPs and caregivers. We found that caregivers judged the effectiveness of a treatment by how quickly it provided relief to the child. This led them to prefer antibiotics, which relieve symptoms even though they do not treat the diarrheal condition. Caregivers also held strong beliefs about the efficacy of medicines based on what form they came in: powders were seen as least effective, pills, syrups, and injections as better, and intravenous drips as best of all. In sum, because ORS was a powder, caregivers didn’t perceive it as an effective treatment.

These insights provided Surgo with a basis for our phase 3 research, in which a specially designed decision-making game incorporating behavioral-science concepts was used to identify and test the factors driving RMPs’ treatment decisions. We found that the behavior of RMPs was determined by a trade-off among three considerations: economic insecurity, the desire to make money, and the desire to provide the right treatment. Since people were unable to pay large sums to RMPs, there was fierce competition among RMPs to get as many patients as possible, and to retain their loyalty. This was where economic insecurity and the wish to make money came into conflict with prescribing the best treatment. In an effort to appear “expert” and meet caregiver expectations (and thereby retain their business), many RMPs focused on providing immediate relief for the symptoms of diarrhea. This meant prescribing IV fluids, injectables, and antibiotics – and avoiding ORS, even though this was in fact the correct treatment.

With this deep and nuanced understanding of what was driving ORS uptake, we developed a radically revised theory of how to increase the use of ORS to treat diarrhea in children. Instead of focusing exclusively on RMPs, programs should create demand for ORS by reframing caregivers’ perception of the treatment. This would help RMPs to bridge their “know-do” gap and prescribe ORS with confidence. We recommended a portfolio of new interventions, including:

• Targeted media campaigns to shift the paradigm of ORS so that it was not seen as a treatment, but rather as immediate care
• Mass marketing of ORS to create demand among caregivers of infants and children
• Phasing out direct retailing of ORS to RMPs (this led to significant cost-savings)
• Interventions to increase RMPs’ sense of economic security

Collectively, these strategies led to an increase in ORS uptake in UP from 30% to 50% in under two years. Our approach to getting a deep and nuance understanding of the ‘why’ before jumping into solutions has significant implications for diarrheal treatment and child mortality programs globally.

This program was implemented in partnership with the Bill & Melinda Gates Foundation, which funded the ORS delivery program in UP, and the Clinton Health Access Initiative, which implemented it. The study was designed, led, and analyzed by Surgo Foundation. We thank Ipsos and Final Mile for their contributions to the research.

About the Author:

Winner of the Best local/domestic NFP case study of our Making a Difference Competition. This project was carried out by Forcier Consulting on behalf of Catholic Relief Services D.R. Congo.

“This very important piece of research is something that could make a real difference to half the population.”

Every month girls face an additional barrier to education: their period. For Forcier, studying the relationship between menstruation and education means more than just attempting to understand absenteeism. Our goal was to provide strong field-based evidence to NGOs, the DRC government and all actors in the health and sanitation field. We believe that good research must go far beyond simple statistics, which is why we always chose to adopt a holistic approach to data collection and analysis, which in this case includes extensive research surrounding community attitudes, beliefs, and hard to see implications. In 2017, Catholic Relief Services selected Forcier to accomplish one of the largest studies on knowledge, attitudes, environment, and practices regarding menstruation in the Democratic Republic of the Congo (DRC). The overall objective was to determine whether menstrual management practices have an impact on school absenteeism for girls, and to evaluate how the Congolese government’s “Healthy Schools and Villages” program, supported by UNICEF, can contribute in improving menstrual hygiene management. Data was collected by local Forcier enumerators in the provinces of Kinshasa and Haut-Katanga, as well as in camps for internally displaced persons in North-Kivu, thereby allowing for an analysis in urban, rural, and emergency contexts.  In the province of Kinshasa and Haut-Katanga, both respondents living in areas impacted by the “Healthy Villages and Schools” program and respondents not living in these areas were interviewed, and, in all three provinces, both girls in school and out of school were interviewed. The results of this study will help NGOs, the Congolese government and UNICEF adapt their interventions so as to better respond to the menstrual hygiene needs of girls and women in the country.

Forcier put forth a holistically designed mixed-methods approach for this research. In order to garner a broad understanding of the different barriers menstrual hygiene can represent for women, it was essential to collect information from the various groups of people who can influence how girls and women manage their menses. Forcier conducted 2601 quantitative surveys with 10 to 17 year old girls and their female guardians and 1022 quantitative surveys conducted with 10 to 17 year old boys. Forcier in addition, uses qualitative interviews to obtain contextual details and experiences of people with opinions that can shed light on hard to see implications. Qualitative interviews were conducted through the use of focus group discussions. 60 Focus Group discussions were conducted with girls, fathers of girls, teachers, community leaders and health practitioners. To ask questions to 10 to 15 year old girls in camps for displaced persons, an especially vulnerable population, child psychiatrists used dice game to make them more comfortable discussing these issues and to overcome taboos about menses. Analysis was conducted by triangulating the quantitative and qualitative data collected, as well as information garnered through a thorough literature review.  The research was designed to allow for findings to be presented for the individual provinces in which data was collected as well as the country as a whole.

The research, made up of 3623 quantitative interviews and 60 Focus Groups, identified the main obstacles preventing girls in the DRC from meeting their menstrual hygiene needs.  Girls are unable to adequately manage their menstrual hygiene because of a lack of sufficient knowledge and understanding of menstruation in the country. Whether village leaders, educators, parents, or the girls themselves, many members of Congolese society are not properly informed on the causes of the menstrual cycle nor, critically, how to teach girls to manage their menses in a safe, private, and healthy manner.  This is largely the result of a substantial taboo that surrounds menstruation, in part consequence of a conservative social order that associates the menstrual cycle with girls’ sexuality, and which impedes open discussion with girls both before, during, and after menstruation first begins.  Additionally, poor infrastructure, especially in villages and schools – in particular, a lack of clean, girls-only and private bathrooms – prevents girls from adequately taking care of themselves when they have their menses. A lack of available and affordable tampons or sanitary napkins further complicates girls’ ability to ensure their menstrual hygiene, and adds to their fear of being seen in public at these times. As a result, girls often stay at home when they have their menses – sometimes days at a time – forgoing their usual activities, including sports, church, and, most crucially, school, for fear of being “discovered” and “shamed” by members of their community.

The findings of this study are vital because they will allow Catholic Relief Services and other organizations working on hygiene, education and gender issues to better tackle the specific challenges that girls face in living in a healthy way and in receiving an education.  Indeed, this research on menstrual hygiene management is one of the first of its kind, on a too often overlooked aspect of development that is crucial to understand for the sake of empowering women. In particular, this research will help the Congolese government, along with UNICEF, reinforce the “Healthy Villages and Schools” program that seeks to improve sanitary and hygienic conditions in thousands of villages and schools across the country, including in camps for internally displaced persons, by highlighting the need to raise awareness on menstrual hygiene, improve infrastructure and make available sanitary napkins. This will, in turn, allow girls to live more comfortable, healthy lives and live up to their true potential.

About the Author: