Do health and agriculture mobile value added services have any effect on unpaid care work? Lessons from a Randomised Control Trial (RCT) in Malawi

In recent years, we have seen increasing numbers of health and agriculture-related mobile Value Added Services (VAS) targeting low income population from developing countries. But how effective are those services in supporting behavioural change? A study in Malawi analyses the effectiveness of messages on nutrition and agricultural practices, and recommends improvements to negative effect of behaviour change or livelihoods programming on care work.

In recent years, we have seen increasing numbers of health and agriculture-related mobile Value Added Services (VAS) targeting low income population from developing countries. One of the aims of these services is to foster behaviour change by addressing information gaps. With telecommunication networks now penetrating remote parts of the developing world, and more people from lower income groups being able to access mobile networks, there is a huge potential for mobile to be a cost effective tool for delivering services at scale.

However, being a new approach, the evidence base around effectiveness of the intervention, sustainability of the business model, and - most notably - how it affects women’s empowerment and wellbeing is still limited. To broaden our understanding on some of these issues, Oxfam in Malawi had commissioned a research study linking Oxfam's Women's Economic Empowerment and Care (WE-Care) and mNutrition programmes. The research (available here on Policy and Practice) was designed to understand the effect of mNutrition services (mHealth and mAgriculture) on unpaid care work, and found that if time poverty and unpaid care work is not taken into account into the service design, then it might not have the intended positive effect on women’s wellbeing. 

Malawi was one of the six countries in which the first phase of the WE-Care programme (supported by the Hewlett Foundation) was implemented between 2014-16, to build evidence in order to influence policy and practice change around the issue of unpaid care work. At the same time, Malawi was also a part of the GSMA’s mNutrition programme (funded by DFID), aimed at designing and rolling out mobile based health and agriculture services for rural populations. WE-Care was closely linked with the mNutrition programme in Malawi, and the team conducted a Randomised Control Trial (RCT) to assess the effect of mobile based health and agricultural services on women’s allocation of time to unpaid care work.

The development of the RCT was informed by the findings from Rapid Care Analysis (RCA) and a Household Care Survey (HCS) conducted on the target population. A sample of 160 households were selected from Mchinji and Lilongwe Districts to take part in the RCT between January and March 2016, of which 80 female participants were randomly assigned to the treatment group and 80 female participants to the control group. Participants of the treatment group received a total of 24 text messages (SMS) on their mobile phones related to health, agriculture and food preparation, while those in the control group received a total of 12 messages with interesting facts and seasonal greetings. Design and implementation of the RCT was done in collaboration with the Ministry of Gender, Children, Disability and Social Welfare; the Ministry of Agriculture and Food Security; the Ministry of Health; Airtel Malawi; and Human Network International (HNI).

Despite the limitations due to the small sample size and the short duration of the intervention, the RCT provided some interesting insights that were highly informative for the mNutrition programme as a whole, and for the development of mobile content and services in Malawi specifically. Some key findings were:

  • There was a low uptake of messages directly related to nutrition, with effect on care activities/practices (e.g. cooking or breast-feeding), and the results showed no significant difference in the total care hours between control and treatment groups, and when compared to the baseline.
  • Women’s time dedicated to income generation activities was almost 70 percent higher in the treatment group compared to the control group, indicating a high uptake of these types of messages, and a tendency of the participants to prioritise acting upon reception of messages directly related to income generating activities over those linked to health and food practices.
  • Overall, there was a significant reduction in the sleep hours for women in the treatment group. This is aligned with research findings from other WE-Care countries, where Oxfam observed that women in livelihoods programmes dedicate more time to productive work, slightly less time to care work as a primary activity. but have higher overall workloads and have on average less time for leisure and sleep.

This research proves the importance of understanding the distribution of unpaid care work and time use as a necessary prerequisite for all those programmes, products and services that have women as target population. Based on the findings, the study team came up with three main recommendations for the mNutrition programme that may also be applicable for other mobile Value Added Services interventions:

  • Parallel messages and interventions that unlock part of the time dedicated to unpaid care work should be promoted while implementing a behaviour change intervention that requires additional time commitment from women. For example, messages or interventions that promote access to time and labour saving equipment that can reduce time spent on arduous care tasks, such as fuel efficient stoves, improved access to safe water or child care services. This would ease the pressing need for message prioritisation and provide more flexibility for behavioural change, without resulting in a reduction of time dedicated to sleep and personal care.
  • Agriculture-related advice (mAgri) should always be accompanied by other messages, like food preparation advice, that are more directly related to improved nutrition in the short term than those the current mAgri service is offering. This could be done by having content specialists involved in service design and would help balancing the increased calorie consumption derived from the additional time dedicated to farm work.
  • Alternative channels and interventions should promote spaces for knowledge sharing and information uptake, particularly with friends, community members and other members of savings or farmers’ groups. This will increase the likelihood of promoting wider-scale norms and behavioural change.

By Masud Rana, mNutrition Project Manager, Oxfam

Photo: Rachel Corner / Oxfam

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