Reaching low-income consumers living in rural areas in South Africa

Aim of the presentation: To demonstrate how to reach consumers living in rural areas. Health Promoter: Employed by DOH Health Educator: Contracted by CEP

Size of the target population Profile of consumer that should receive the message. Low-income consumer living in rural areas. Settlements with less than 500 inhabitants Profile of consumer that should receive the message. Low-income consumer living in rural areas. Settlements with less than 500 inhabitants 9 Provinces 3074 Clinics 52 Districts

Media usage Television Radio Newspaper One out of two adults use a cell phone Limited smart phones Television use by rural households in South Africa

Low-income consumer living in rural or township areas Regional obstacles Far from major towns Distance to travel to clinics or commodities Lack of electricity and sometimes running water Limited use of technology

Why should health messages be delivered to low-income consumers? Staple food is: Maize meal porridge Bread Black tea with sugar Poverty stricken Poor nutritional status Not enough knowledge to make healthy choices

Message that is delivered Value of dairy in the diet Dairy is nutritional value for money

Language – do not speak English Illiterate – tailor-make leaflets Often own their own cow, milk cow Deliver hygiene and health messages Have cultural beliefs of which some are about dairy Teenage girls should not drink dairy as they become fertile at young age Dairy gives worms (but actually due to poor hygiene conditions) Lactose intolerance – avoid dairy because previous generations avoided dairy. Follow examples of the elderly (often self diagnosed) Lack of refrigeration Misperceptions about the role of coffee creamers- use it as milk replacers for children Technology is limited to cell-phones Television popular, but electricity limited/expensive What are the barriers to effective communication?

Reaching the group through trained health educators Consumer Education Project of Milk SA (CEP) provides training opportunity to train-the-trainer Consumer Education Project of Milk SA (CEP) provides training opportunity to train-the-trainer CEP Contract with service provider that can overcome obstacles at rural level CEP Contract with service provider that can overcome obstacles at rural level Obstacles with Authorities Sceptical towards ‘marketing activities’ messages SA Food-based dietary guidelines Balanced diet Training by dietitian Obstacles with Authorities Sceptical towards ‘marketing activities’ messages SA Food-based dietary guidelines Balanced diet Training by dietitian Liaison with authorities: Dept of Health District office Dietitian of District office Liaison with authorities: Dept of Health District office Dietitian of District office

Training of Service provider’s Health Educators Each HP responsible for one clinic in rural area Train the Trainer Training of DOH Health Promoters (HP)

Training of Service provider’s Health Educators Consumer Education Project Set goals per year Develop communication messages Develop training aids Train the Health educators Test health educators Ensure present professional Each HP responsible for one clinic in rural area Train the Trainer Training of DOH Health Promoters (HP) Trained by the CEP dietitian and Health Educators Trained by CEP dietitian – English Trained by Health educator – vernacular language Demonstration of presentation to HP Message is repeated 3 times

Usually grade 12 school level (highest level) Training in health issues Limited knowledge of nutrition Language barrier – not fluent in English Learning material simple and easy to understand Teaching aids must be robust – withstand travel conditions Lack of use of technology Mostly cell-phones – data costs money Limited knowledge of computers Lack of access to computers Cost of internet Travel Long distance Lack of transport Expensive transport Obstacles: Profile of health promoter to deliver message to the low-income consumer

Health promoter is equipped to deliver the dairy and health message to the low- income consumers. Provided with: Lesson plan and PPT Leaflet s A4 dairy clinic tool Posters for clinic Dairy-based nutrition booklet Invest $30/person (R400 ZAR)

Program reach 44% of districts in SA 871 Nutrition advisors and Health promoters

Thank you for listening Christine Leighton