Mtu Ni Afya ("Man Is Health"): Tanzania's Health Campaign

\ .41 DOCUMENT RESUME ED 216 682. AUTHOR TITLE IR 010 157 Hall, Budd L. . . Mtu Ni Afya ("Man Is Health"): Tanzania's Health. Campaign. Agency for International- Development (Dept. of State), Washington,D.C. Clearinghouse on Development Communication. International Council for Adult Education, Toronto (Ontario).;' Sdssex Univ. (England). Inst. of Development Studies.; Swedish International 9evelopment Authority (SIDA). Jun 78- INSTITUTION ''SPONS AGENCY PUB D T NOTE 79p. - , - EDRS PRICE DESCRIPTORS MF01/PC04 Plus Postage. *Change Strategies; Comparative Analysis; *Developing... 4'' Nations; Educational Radio; *Health Education; Literacy Education; Rural Population; Surveys . IDENTIFIERS *Forums"; *Tanzania ABSTRACT This account of the Tanzanian health 'campaign opens with a brief explanation of how radio forums fit into the mass media' scheme. Then, campaigns, run in other nations are reviewed, with emphasis on aspects pertinent to the Tanzanian experience. The Tanzanian campaign, named Mtu ni Afya ( "Mai is Health"), had three aims:,(1) to increase people' awarenessof how they can make their, lives healthier and to encourage both4groups and individuals to take appropriate-action; (2) to provide clear and simple information about the symptoms of specific diseases and their prevention; and 3) to encourage those who had participated in the national literacy campaign to maintain their skillq by reading campaign materials designed especially for the newly literate. In addition to describing this health campaign which was undertakep in 1973, more recent development projects in.Tanzania,are also discussed., Thirty- eight, - references are listed. (LLS) . 1 *t********************************************************************* * Reproductions 'supplied-by EDRS are.the best that can be made * * from the original document. * ****************************t****************************************** - _ N "co 0 Information Bulletin Number Nine The Clearinghouse on Development Communication 1414 Twenty-second Street, N.W. Washington, D.C. 20037 U.S. / U.S. DEPARTMENT OF EDUCATION NATIONAL INSTITUTE OF EDUCATION EDUCATIONAL RESOURCES INFORMATION CENTER (EPIC) ra itus document has been reproduced as received from the person or orianaatpn ongmattng ot . Motor changes have been made to improve IMt', ill reproducbon Points of view or opeuons stated In ths doc rn-mt do not necessaray tspresent office, NIE posmon or policy TANZANIK61-1EALTH CAMPAIGN Budd L Hall Director of Research International Council for Adult Education This study was made possible through financial support from: the Swedish International Development Authority the Institute of Development Studies, University of Sussex theInternational Council for Adult Education 0 g The U.S. Agency for International Development has funded the editing, printing, and distnbution of this document through a.contract between the Office of Education & Human Resources of the Development Support Bureau of AID and I heAcademy for Educational Development. The work has been performed by the Clearinghouse on Development Communication, an information service of the Academy. June 1978 1'4 2 . -f I . . o . , ' 66! . . .. CONTENTS List of TNe . .. Acknowledgment . ,Introduction ., ' . Liskof Figures - - : : v ., ; , r- . 1 . vi vii 1 X , -.. Ali t. . .. CHAPicRl. RADIO FORUMS AND MASS CAMPAIGNS IN OTHER COUNTRIES or 1 1 hadicFonens Defined .. C , 2 India's Rural Forums: t' 4 .. -G hanas Steps Toward Self:Hdlp N , 5 Mass Campaigns at Mobilize Large? PopulAtions 5 _Cuba's Literaqtamppign 7 ' ,Chinet "Wass Line- for Health : 9 , .Synthesis 4,r 43 CHAPTER. EVOLUTION OF RADIO STUDYGROUP CAMPAIGNS IN TANZANIA ... 4 ' TanzaniniFtrtRadio StodyG roues Uchaguzini Wako (-The C hoiceis Yours) WatcafiWaFurahai'Timefor Rejoicing") i- . Planning and Organization '. Evaluation and Results 15 17 17 18 i8 21 \ Girnpaign Costs Conclusions 22.> . CHAPTER 3. MTU NI AFYA ("MAN IS HEALTH"): PLANNING ORGANIZATION. ANDTRAINING Planning and Organization Campaign Aims '` 23 24 24 et 25 Campaign Tretalle . ... . `27 National Coordination Allocationof Responsibility : . 1 Mobilizalebn end Publicity %6 'Production and Distribution of Materials Training of Study-Group Leaders Recruitment Serginar Cont ent and Tralriing Methods Training Evaluation 4% 9 4. N. . CHAPTER 4.1.4TLINI AFvA ("MAN IS HEALTH"). STUDY GROUPS IN ACTION 39 40 40 40 How We re t he Study Groups Set Up? Roles Within the groups Group Memberships Meeting Times Who Pa dicipatedin Mu ni Afya? characteristics of Group Members Atte nclance Rates and Patterns Participation in Discussion Howpid the Study Groups Turn Learning into Action? Commen Problems 4. . Conclusion 27 27 29 34 35 36 37 t 41 41 41. . 3 42 44 45 47 48 Sr CHAPTER 5. MEASURESOF CAMPAIGN IMPACT Knowledge- Gain Test . 51 51 4 Selecting StudAroupi for Testing Developing the Test Test Results Health Practices Survey r * Choosing Target Areas Developing the Health Practices Checklist. Survey Results Campaign Follow-up and Integration with National Health Services 52 52 54 54 0 . 55 .. 56 .f. 61 i CHAPTER 6. TANZANIA'S MASS CAMPAIM: .F.FFECTS AND IMPLICATIONS FOR DEVELOPMENT PLANNERS 'Iffects of theCampaig .4. /*Implications for Developmentplanners 63 63 65 CHAPTER 7. A WORD ON RECENT DEVELOP1ANTS IN TANZANIA 69 APPENDIX: Tanzania's Health Campaign: Externally Financed Costs (Table 14) 71 BIBLIOGRAPHY 73 -. LIST OF TABLES b . 3 19 , i 3. Estimated Campaign Expenses: WakatiWa Furaha 40 Use and Quantity of Campaign Materials , 15. Radi6ProgramniagSchedule /6. Topics Covered in Group-Laader Tra in ing 7. S tudy-GroupAttendanceRates by Reciion 8. Study-005i )ParticipatiOn in Campaign-Related Activities 9. KnowledgeGain Test Results 21 .e -. . 31 el ; V . . . . Villages Surveyed 14. Comparison of Media Experiences 15. TanzaniA's Health Campaign Externally Firiariced Costs (Appendik) ,. 5 .... Houses in the Eight Villages Surveyed .. .36 '42 46 . .10. Knowledge-Gain Test ResulteUjamaa and Non-Ujam Study-Group Members 11. Health Practice Survey Results, by Village 12. Health Practices Survey Results, by Practice for 2,084 - 13. Latrines Bilk or Rebuilt During Campaign in ,e Eight 30 . , \ : - . . Comparative Results of Three Educational Approaches Usedinindia : 2. gampaigriEvaluationplan: WakatiWa Furaha , 53 57 , \ . 58 59 467 71 * LIST OF- FIGURES " qampaign Timetable 26 28 33 43 55 2.Allocation cif Re?ponsibility , 3. .Trdrislated Excerpt from Group Leaders' Manual 4. -Studi-GreupAtterdance PatterniOver All Regions 5. Healt.i h PracticestheCklist. ..1 ..: . .. \`" - 4 , 6- A ACRNOWWED,GMENT This study is the culmination of many people's conviction that TaRtania's A:dfu ni Afya ("Man is Health") campaign of 1973 marked a unique and exciting moment in history, I Many persons along-the way 4Iped milke thiS stud 'ossible, criticized portions -of tha\work, and supported me intellectually an otignally. r Paul,Mhaiki, Fr. Daniel Mbunda, Issa M :ndo, Fabian Nyarpbo, Vincent Mbaga, Nkwa6 Ng'wanakilala, Christropher Zikam ona, Len n1wt H. Grenholm, Henry Blid, and Hugh Barrett, all members of the Institut f Adult Edu;ation team, were in some Id* responsible for the campaign and have as is analysis. Michael Young and Tony Dodds of the International ExteQion College kindly helped me find a place to-begin writing and reflecting. Richard Jolly, Emmanuel De Kadt, John Oxenham, Malcolm Segal, Alastair White, and Maureen Dickson were part of the University of of Development Studies group that helped me put the Tanzanian study perspective as well as provided a responsive sounding board for ideas and reflections. SdgerSky and Christina Jimtin from the Swedish International Development Authority (SIDA) in Stockholm were always supportive and patient. k Paul Bertelsen of UNESCO and J. Roby Kidd of the International CounAlfor Adult Education encouraged me to begin writing. This study was supported financially by the Swedish International Development Authority, the Institute of Development Studies, University of Sussek, ,and tte International COuncil for Adult Education. Early drafts were typed by Jacqueline Sullivan and R6becca Kawasa of the International Council. Jot* Gunter of the Clearinghouse on Development Communication made it' possible for the report tote published and made available to others Page Shepard, a free-lance editor in Washington, has done a diligent job with the manuscript. Diane Hall has helped with many se tions and has endurea. Thar/s. a6 Budd L. Hall Toronto, 1978 63 VII 7 . lyTRODUCTION Tanzahia's Mtu ni Afya ("Man Is Health") campaign sparked the imagination of M.Kimwago, a poet fron*lohoro ujamaa village in Rufiji district. On June 16,1973, Dar es Salaam's Kiswahili newspaper Uhuru published his poem. MTU NI AFYA LESSON s the world is good As good aspotatoes We want t6 be will To be free in free air . But sometimes all this fades W MtuntAlya lessons are good for the family. / Glory be to the architects of this We welcome the idea To make us free And lead the way S For our grandchildren ' MtuntAlya lessons are good for the family . ..7s- -...----\ . ( . Let's clean our homes Let's dig latrines Doctors have inspired us If we want peace ) Latrines are the best shields MidniAlya lessons are good for the family \ Seminars have ben conducted We are all for it Radio study groups have been formed We !isten attentively' To get the message clearly __ MtunrAfya lessons are good for the family The seventh stanza I say No more to say -Father and mother Piease forgive Let's read The lessons of diseases MtuntAlya4essons are good for the family Let's be firm In eradidating disease Let's wake up at the cock's crow A Let's make it a routine And let no one ignore MtuniAfya lessons are good for the family. The man says let's not joke Let's talk andvdisCuss Learn early . To prevent disease Good health We are all learners MtuniAlya lessons are good for the family. Let's protect ourselves Let's care for our health + When we fall sick Let's call fOf medical help From medical experts AtuniAlyalessonsare good for the family I With the publication of this poen_the campaign passed outof the hands of the planners and into the hands of some two million Tanzanians enrolled in the radio study-groups. To all involved in the campaign, it became clear ihat something exceptional was happening something significant not only for Tanzania but for pariple everywhere interested in the campaign approach to mass education. In turn, Kimwago's poem inspires this study. The purpose of this study is twofold. The first aim is to describe and analyze in detail how the Mtu ru Afya campaign came about, how it was planned, whnt its underlying methodology was, and what impact it had. Second, the study examines the case for mass radio study-group campaigns as an integral and continuous part of national development strategies. Discussion of the Tanzanian health-education campaign is based on my involvement as a member of the coordinating committee charged with responsibility viii VI N.- . . ,, . for evaluation. It also draws on an earlier evaluation of Miu niAfya published in June 1974 by the Institute of Adult Eduz:ation in Dar es Salaam (Hall and Zikambona, 1974)., If only, hints of the spirit and and excitement that suffused this mass campaign experience Survive my rough treatment, I will be pleased. , v 4, f e 1 I., NO. am, . 'I f ... ix , 9 1 -,.. - 1 RADIO FORUMS AND MASS CAMPAIGNS IN .0THER COUNTRIES. . The Tanzanian mass-campaign experience grew primarily out of two branches of communications development: radio farm forums and mass campaigns. The initial farm forums (begun in Canada in 1941) had built upon' previous European experience with rad',istening groups (Rogers, et al., 1977). From Canada, rural radio forums had spread to India in the micf-1950s and 'to Ghana, Togo, and Dahomey in the, late 1960s. Thus, Tanzania's Mtu ni Alya campaign had deep roots in experience with farm forums. TheTanzanian campaigns also reflect the influence of Swedish study circles. This later influence was seen particularly in the methodology and leadership-training ysed in small groups: In its large-scale applicationland bread national political support, Mk; ni Afya had much in common with Cuba's liteiacy campaign and with China's campaigns to eliminate diseases in the 1950s. A parallel effort in South America alga shared Tanzania's aim of increasing people's awareness of their potential control over their own situations. This emphasis on consciousness-raising emerged in northeastern Brazil in the early 1 960Nn-the'Movimentode Educagao deSase (Basic Education Movement) deperibA by de Kadt (1970) and analyzep and elaborated upon by , Freire (1972). t' . , ) - . . This account of the Tanzanian health campaign opens with a brief explanation of how radio forums fit into tlt_mass-media scheme. Then, campaigns run in other nations will bereviewed, and aspects pertinent to the Tanlanian expenence*will be pinpointed at the conclusion of Chapter 1. I RADIO FORUMS DEFINED A Rogers, et al. (1d77) characterize tfit radio forurh in one.st.karicKparagraph. ri *,) A radio forum is a small listening and discusSten group that meets regularly in order to receive a special radio prodram,whichlhe memberithen discuss. On the basis of the program and discussion, they decide what types of relevant action to take. This sequence of activities is 'e)tpressed.in the motto of the Canadian forums: "Listen, discuss, act." Emphasis in radio forums is usually 'placed not only on creating knowledge of new idee,s, but also on putting them 0 into practice 1 Radio forums capitalize on the-notions that multi-channel communication is more effective than single-channel communication and that the effectiveness of a multi- r" media ipproaqh tends to increase with the degree of disparity between thechannels combined. Mass media, which enable ,one or several people to reach maty, lie at the end Of the communication 'scale opposite interpersonal charihels, .1". 1 .4 -10 - , n 1 a . which involve confrontation between individuals. Radio forums are said to combine the best aspects of these two extremes: Mass Media alone can reach a larger audience at the price of a less message impact, while interpersonal communication provides a greater message impact at the price of a smaller audience. This inverse set of relationships lies. at the heart of the particular advantage of radio forums $ (Beltran, 1969). , . India's Rural Forums' 0 The Indian experience with radio forums is the longest and best documented in the Third World' In 1956, UNESCO sponsored an experimental program designed to test the usefulness of a radio farm forum of the sort developed in Canada (Nicol, et al., 1954). The original project provided for one radio forum in each of144 villages. Following & detailed evaluation (Mathur and Neurath, 1959),*it Was recommended that the Indian government expand the pilot project. The expansion program began in 1959; by 1965, an estimated 12,000 groups.were meeting (Schramm, et al., 1967):' 14- , . .. . . Aboi 20 people composed a tyl2ical Indian radio rural forum. Members were chosen by village officials to represent various factions within the village. Middleabed people seemed to be favored, apparently'because they are more apt than the . .- young or the elderly to agree on issues (Bhatt and Kriihnamoorthy, 1965). Groups met two evenings a week, listening to half-hour broadcasts on assorted topics and discussing them afterward. Of those registered, 75 to 80 percent attended meetings, and 65 percent participated actively in the discussions (Mathur and Neurath, 1959). / &conscious, though perhaps dichotomous, effort was made to keep tne groups "non-political." As Bhatt and Krishnamoorthy (1965) point out, "In places where the president of the village andtligroup chairman arethe same person :oordination.is made easier, but,this is defective in that it brings village.politics into tne working of the,forum and spoils the non-political atmosphere." But surely, by nearly anyone's definition of politics, any group expecting to discuss common problems, make decisions, and implement those decisions will perforce act in a political atmosphere, two major evaluations have been done of the Indian experioce (Mathur and Neurath, 1959; Schramm, 1965). Together they raise several important points regarding the effectiveness and future usefulness of radio rural forums as educational tools: Integrating knowledge-transmission techniques into an overall program, the radio farm forum works far better than the simple, distribution of radios to villages in the vague hope that villagers will profit from their presence. Within the groups, both literates and illiterates participated approximately equally. . 'Useful surveys of the use of media in rural deveopment are Dodds 1972 and McAnany 1973. f / . 2 % 11 .: 4 4 TabIel r COMPARATIVE RESULTS OF THREE EDUCATIONAL APPROACHES-USED IN INDIA Forums . + .32 Apricalturallnowledge Agacultural adoption Wealth !mo,Medie Health ed000(1- Animation Literacy "- .31* + .53 + .30 + .48 + .42 +1.89 - .47 + .12 + .72 +1.10 - .04 SOURCE: Adapted from Roy. et al. (1969) le , Tests showed the knowledge gain of group members to be more,than double that of non-members. The group interaction drew out knowledge individual villagers had culled from experience and prompted them to share it. Despite conscious efforts.to keep group discussions and activities minpolitical,the forums seemed to engender a broader based, more firmly rooted villige democracy than elected councils could provide. These findings correlate with research findings by Rogers cand others on the effectiveness of various combinations of communication modes in increasing knowledge and encouraging constructive changd. Mixtures of mass media and interpersonal transfer work partly because positive pressure to attend and to participate are exerted by groups. Rogers bases his conclusions partly on research by Roy, et al. (1969) in which the effebtiveness of, radio forums, animation' training, and literacy classes were compared. The results of Roy's research in India are shown in Table 1. Rogers points out the financial implications,of this demonstration of the radio forum's superiority in stimulating change, a superiority that is all the more impressive when it is remembered that the total cost of the radio forum treatment amounts to about half that of the literacy treatment and about the same as that for the animation training 'treatment. In his analysis of the Indian forums, Schramm (1965) isolates several lessoris for . development planners. The' Inqian village forums tended to attract people least in need oUltem (narnely, the local elite). When initially high enthusiasm about the forums fell, average attendance decreased (corroborated by Ohliger, 1967). Prigrams should be localized as much as possible, wiih both planning and broadcasting decehtralized. ForUms can be effective, Sut not without extensive, continuous support a need often underestimated, 3 12 4 Ghana's Steps Toward Self-Help A pilot project in Ghana begun in 1965 and modeled on the Indian forums was inspir,ed by a report on broadcasting and adult education (UNESCO, 1964). Sixty experimental forums founded in forty Ghanaian villages made up the initial experiment, which was well documented by Coleman, Opeku, and Abell (1968). According to Coleman, et al., the forum pldn called for reading study guides, using visual aids, listening to broadcasts, disdussing all materials, and, finally, acting (the same pattern as was followed in the Indian forums). Program topics ranged from fertilizer loans to models forsooperative societies. Village lenders chosegroup mem,pers according to a fixed -quota system designed to reflect current age, education, and sex ratios in rural Ghana. The original groups comprised about 15 people each; by 1972, average forum membership had expanded to 25 (Dodds, 1972). . At the same time, the overall forum program also expanded steadily, and four hundred groups were operative by 1978. A critical feature characteristic of the Ghanaian forums is the practice of sponsoring communal activities (such as agricultural plots) that often earn workers income as they bring benefits to the community. Since the experimental phase showed the advantages of putting permanent printed materials in the hands of group memuers, later Ghanaian forums have been supplied with such materials. During the experimental phase, consisting of twenty meetings and broadcasts in all, attendance for the members of all groups averaged fifteen (out of the possible twenty) meetings. Twenty-six percent of all participants attended every,meeting, 51 percent attended between ten and nineteen sessions, and 23 percent showed up at fewer than ten. This attendance pattern may reflect recruitment priliciesmost people were simply asked to participate rather than accepted upon showing an interestas much as the quality of the program itself. Since the experimental phase, however, membership restrictions have been eased and the popularity of the forums seems to have increased. The forums in Ghana have been studied less systematically than have those in India Nevertheless, the experimental project exaluation (Coleman, et al., 1968) makes several points of interest to development planners: To keep the forums going, an efficient organizational infrastructure of .... supervisors, transportation, and communication was essential. . Villagers in radio forums appeared to learn between 10 and 27 percent more about and to act more frequently with respect to subjects featured in ' broadcasts than did villagers who studied outside of the forums. Unfortunately, no pre-tests were administered to either category of villagers, so this evidence laCks strength. More than 83 percent of participants said they, would like the forums to continue. A number of rural forums reported to the Rural Broadcasting Unit that they had undertaken major self-help prefects. Among these accomplishments were building and equipping medical ispensaries, constructing roads, establishing marketing channels, and introd cing new farming methods. 4 13 : o, MASS,CAltelPAIGNS THAT MOBILIZE LARGE POPULATIONS Unlike radio forums, which are aimed at relatively small numbers of listening groups over an extended period of time, mass campaigns are meant to mobilize large numbers of people for arelatively short Same. Radio forums hinge on group discussion and provide the opportunity for feedback to modify subsequent broadcasts.They depend on extensive organizational infrastructures to orchestrate the broadcast cornponents, the production and dissemination of support materials, and the network of %supervisors and teachers. During their long lives, radio forum projects may treat a broad, range 14f development topics. In contrast, campaigns tend to be more concentrated and to focus on a small number of related topics. Mass campaigns often rely on political mobilization as a base for stimulating widespread reflection and action on educational or health concerns. The communication strategy stresses mass media, including broadcast. print, billboards, and popular theater. The organizaticins that coordinate and bear these messages are temporary, but build upon the already existing personnel and resources of many permanent institutions. Cuba's Literacy Campaign In September of 1960. Fidel bastro declared to the UN General Assembly that Cuba planned "to launch an all-oUt offensive against illiteracy . . Within a few months, Cuba will be the first country in the Americas to be able to claim that it has not a single illiterate." The Cuban literacy campaign was officially launched on New Year's Eve of the same year and Castro called on the Army of Education to organize just as the National Militia had done. A number of thorough studies of the Cuban campaign from a variety of perspectives (Gillette, 197L, Fagan, 1964and 1969. Jolly, 1964, UNESCO. 1965, Comiston Nacional Cubana de la Unesco. 1962) all identify the twin goals of the campaign teaching literacy and building political awareness Intentionally, the political aspect was intertwined tightly with the educational effort. As a mass communications model, then, the Cuban literacy campaign must be viewed as a whole, with full recognition of its political nature. The conscious exercise enhanced the effectiveness of the literacy training, in which reading-and writing were taught to the quarter of the Cuban population denied such instruction,. under the pre-revolutionary regime. Reciprocally, the spread of literacy skills quickened people's responses to the call for political commitment. As a political institution, the literacy campaign resembled other Cuban programs in its emphasis upon citizen participation as a goal in itself. An editorial in GRANMA, a government newspaper, on the sixth anniversity of the Cuban Revolution said of the "new man" then emerging: This conception [of the new man] obliges the revolution to develop plans involving increased participation by the masses in the execution of diverse . the masses will daily have to increase their participation in societal tasks tasks, paying more and more atteljon to the management and direction of these activitids. 5 14 , r ....... The literacy campaign was clearly born of a spirit of development in which progress and change emerge when more and more people actin the collective, as opposed to individual, interest. These activities''wordlessly, but dramatically, teach the lessons of development and underkeyelopment" (Fagan, 1969). 4111r Accprding to UNESCO, ;'the campaign was not a miracle, but rather a difficult conquest made through work, technique and organization" (1965). The Cubans set up a National Literacy Commission including representatived of the Ministry of Education, the Ministry of the Armed Forces, and mass organizations of workers, teachers, students, and others. At the heart of the crusade to teach 979,000 illiterates were more than 270,000 literacy Workers from among at least four different groups: 1 People's Instructors-120,000 adult volunteers who taught largely in cities and towns: Conrado Benitez brigadista*-around 100,000 young volunteers, mostly students. who in April 1961 began living and teaching is rural areas; - Schoolteacher Brigadistas-37,772 regular schoolteachers who served primarily as specialists and supervisors during the campaign, working on it fulltime after April 1961: and "Patria o Muerte" Brigadistas-13,016 urban workers who _taught in rural areas while fellow workers filled in for them at their city jobs. ; Castro's assertion that "revolution and education are, the same ing" had perhaps never been better vindicated (Castro, 1961). By the end o 1961, the ... , illiteracy rate had plunged from 27.7 percent to 3.9 percent (UNESCO, 1965), the lowest rate in Latin America and one close to those of the world's developed nations. Although many commentators have disparaged the quality of literacy in Cuba, the standards that apply in most parts of the United Statesthe ability to sigone's name, read aparagraph from a national document, or bothare far less stringent than the exam used to measure literacy in Cuba. which requires a reading level of about grade 4. Although radio was not used to teach literacy in Cuba, it served well to "persuade the illiterate population to enroll, encourage widespread public support and.attract volunteers and support. and spread technical aspects of the campaign" (UNESCO, 1965) From the time the campaign was three months old, the National Radio began --efoadcasting about fifteen spot announcements a day in support of the campaign. People wrote songs, jingles, and at least one whole book of poetry to celebrate the literacy drive. The lessons of the Cuban experience reflect its dual goals The technical and organizational points are overshadowed by the fundamental message that every development project is above all a political project. The campaign emphasized teat development programs may be limited less by lack of human resources than by an inability to marshal Ore population. 'Named in the memory of a young literacy teacher killed by counter-revolutionaries 6 .. Mobilizing large numbers of people op a national basis is a complex pr ess in which the goals of increasing citizen participation and of imparting useful ills can be combined to great advantage. Development planners who restrict th selves to the narrow technical view, overlooking the broad political picture, cannot hope to. match the sort of success achieved in the Cuban literacy campaign. s --China's "MasS Line" for Health I Public health in the People's Republic of China has been a Popular topic in recent years, both with the Chinese and with foreigners working in Chinese health services (Wu, 1975; Horn, 1969; Ma, 1966; Fu, 1959) and with visitors and observers (Cherr1 1974; Rogers, 1974; Side! and Sigel, 1974; Jain, 1973; Wegmari, 1973; Faundes and Luulikainen, 1972). The accounts of both groups acknowledge the achievements of the Chinese in reducing the incidence of schistosomiasis (bilharzia),tuberculosis, and veneral disease (Horn, 1969) and in bringing down the annual population growth rate from about 2 percent in 1963 to about 1 percent by 1973 (Chen, 1973). ge. Of particular relevance to the present discussion is the series of mass preventive health campaigns the Chinese began in the early 1950s. For the most part, Chinese sources are cited in telling the story of these campaignsin part because these sources present the campaigns from a Chinese perspedtivelplacing them most precisely in their historical and political contexts) and an part because mczt commentaries by outsiders are merely fleshed-out explanations of Chinese primary sources. / Wu Chieh-ping begins a recent article in The Partisan Review op health and medical work with these words: "The mass line 'from the masses to the masses' is the fundamental fine guiding all the work of our party. So it is with the health work" (1975). Characterized.briefly, Chinese medical and health work gives priori prevention and rural health measures, promoting the full involvement of peasants and workers in their own health care. Wu continues: The principle of "putting prevention first" therefore can be put into practice only by launching mass movements to give scope to the masses' enthusiasm politically and ideologically, constantly, increasing their knowledge concerning science and hygiene and carrying out regular mass activities in health work. Firmly established as the primary leaderihip principle of the Chinese Comiknist Party, use of the mass line has promoted a participatory and egalitarian political style "emphasizing popular creativity and a dynamic process of interaction between leaders and led': (Seldon, 1972). In 1943, Mao Tse-tung articulated the main features of the mass line in his paper Some Questions Concerning Methods of Leadership: "Take the ideas of the masses (scattered and unsystematic ideas) anti concentrate them . . . then go to the masses and propagate and explain These ideas . . . translate them into action and test the correctness of thre ideas in such action." 7 16' t The Idea of integrating health work into the mass based organizations appearito have 'evolved out or experience in those regions that were. won before the final victory of.Communist forces int949. What have become periodic health campaigns 'date from the .Korean War. Many Chinese were shown films of American pilots confessing to the use bacteriological weapons in Korea, and the basics of germ theory werb quickly brought home to millions. American actions in Korea as well as Japanese attempts to spread plague during WorldWar II "aroused deep indignation in the Chinese-peopleeverywhere" and prompted the masses to epend aid to the e governmzd in anti::epidemic work and health work" (Fu,-1959). " The founding of the Patriotic Health Movement in 1952 reflected this new awareness of health matters. Eowsing on tasks that could be carried out by. i. . the ,Movement urged the people to individuals and -groups at home and r carriers of infectious diseases; to clear exterminate rats, flies, mosquitoes, and o garbage and litter; to improve the disposal and recycling of human excreta; and to 'upgrade the quality of water supplies. The Movement also led to inoculation and vaccination for over 25 percent of the Chinese people. The virtuel elimination of flies.,,,, has been one accomplishment noted repeatedly by Western visitors over the years. Another frequently cited success has been the prevention of parasitic a?rct' endemic diseases. In his lucid account pf health work in China, Joshua Horn (1969) describes in detail the anti-schistosomiasis campaign there. Particularly impressive is the story of Ren Tun village where at the time of liberation nearly everyone was infected with schistosomiasis. Not one child had been born in the village for the~ seven years preceding the liberation. Once the campaign to kill the snails that host the schistosomiasis blood fluke had been initiated, Ren Tun's poptilation increased from 461 to 671 within fifteen years, and new cases of schistosomiasis there are " rare. Save the Great eultural Revolution in 1967, h'ealth-care emphasis has shifted to rural, areas while progress in prevention contiriues. Possibly the best -known manifestation of the hew health policies was the creation of cadres of "barefoot doctors," rural medical auxiliaries who have made great strides in developing / effective rural services. Another feature of rural service has been the integration of all levels of health personnel. each local medical brigade comprises a barefoot doctor and a local committee of the Patriotic Health Campaign To back up the local brigades, hospitals regularly send mobile health teams to visit rural villages.-The teams' aim) include: 1 Providing preventive and curative services (especially preventive); Training lqcal people as auxiliary medical personnel; Promoting the Party's policy of planned parenthood; Improving existing local medical services; Cooperating.with the Patriotic Health Campaign; and Reaping from experience in the countryside a deeper understanding of the masses that can help team members better serve the task of building socialism . (Horn, 1969). Mass health movements sweep China several times a year, wilt most campaigns timed to precede national holidays. Movements may focus on indoor and outdoor 17 st . 'II sanitation, on..prevention and treatment of seasonal diseatee on improvement of working conditions, or. on popularization of hygienic habits and physical checkups The mass line as applied to health work has been described. by Ma Hai-teh, a member of a team that dramatically reduced the incidence of venereal disease in China, this way: "The mass line in medicine means that millions of people are getting an elementary understanding of what public work is all about and the irbportantpart every one of them plays in it" (1966). This approach to educating peoplesabou health clearly rests on belief in the intelligence, creativity, and strength of ordina' people. Creative involvement of every individual Is deemed essential if health care is to be successful. As Wu Chen -ping puts it,4Mass participation in medical and health work has proved that this work cannot possibly be done well without extensively mobilizing the masses and earnestly pooling their wisdom and drawing on their experience" (1975). . -. Demonitrating the high value they place on communication, II% liberated hinese began early to set up networks of local transmittergand public address and dspeaker systems throughout the country (Schutman, 1969). In 1965, the central overnment spelled out three broad goals .for the continuing expansion of rural broadcasting: . . . . 1. Each hs:en (county) was to have one broadcasting station to be financed tirely by the central government; 2. E h commune and production brigade was to be allowed to have its own bro dcasting station for which the commune or brigade could, according to its needs, receive partial subsidy from the central government; 3. Any household in the village was to be permitted to have a wdio-speaker for which an installment fee of four dollars was to be charged (Lee, 1972). . . besides relying on radio coverage, nearly all Chinese campaigns make wide use of discussion groups or forums. The groups receive from the government written materials ,relating to the campaign, and local Party cadres usually supply: the discussion leaders. Group sessions stimulate two-way information flow between cadre members and group participants. Films, slide shows, and opera are alto employed in campaign efforts. In addition, laige-character wall posters made by workers, students, and peasants are sometimes used to convey the messages of the campaigns. SYNTHESIS. The rural forums of India and Ghana focused chiefly on communication to hniques. (Since these forums were,developed under the auspices of the is, not surprising ) U ESCO Mass Communications Division, the technical mp multi-party system in India made for a range9Itheories about social change spanned from far left to far right policitally, Ad the forums there deliberately t were planned tcA'nonpolitical." In contrast/ Oianners of the massive campaigns in Cuba and China consciously mobilized tl)erpopulation to enact practical changes and at the same time to build political awareness and participation. Degrees of 9 '18 - C national commitment differed atarply between India and Ghana on the one hand and China and Cuba on the other. The Chinele and Cuban leaderships regarded direct improvement in the quality of life of the masses as a crucial nationr.!priority calling for a large-scale national effort. In India and Ghana, howev,errth7q. ural forumS were relegated to relatively minor roles in overall development strategies., 'Similarities'and differences among these campaign experiences yield lessons of use both' in evaluating the programs in Tanzania and in expanding general knowledge about how mass study-group campaigns operate:. least five important points seem to emerge from these experiences. . First, the narrower a program's theme, the greater its likely impact. The Indian and Ghanaian forums were umbrella-like projects that tried_ to cover a scattered multitude of rural concerns\ Brbadcast topics changed nearly. every week and ranged from adviceon immunization to the use of fertilizers to reasons for forming farming cooperatives. Conversely, the Cuban and Chinese campaigns concentrated on smaller number of ideas over a greater amount of time. Groups had ample chance to respond to the ideas presented and to acquire the facts necessary to discuss them in detail. Media coverage was naturally more thorough, and spending a relatively long period on a single subject seemecito allow interest to grow among individuals not initially involved. econd, an efficient Organizational infrastructure, is essential to keeping rural and campaigns going. Studies of experiences in all four countries stress that foru a tightly it network of supervision, transportation, and communication is vitalyet often under timated. NN. c / , d, forums ana.pampaigns can accommodate literates and illiterates Tike. Thi oint is of import to educators, especially to those concerned witli balancing rural development. (In the past, rural adult-education programs have tended to rely heavily on print as ,a means of communicating; of course, the benefits of the programs have fallen Mostly to those who have had some schooling. Literacy ,ias frequently been required for entrance into farmers' training centers, and adulteducation classes are often tracked according to years of schooling or levels of literacy.) In India and Ghana. people who could read got along fine together in media . forums with those who could not. . . . I Fourth, the force of a media forum' alone cannot'usually stir basic attitudes and instill change. Although the Indianforums bet with some success, results were far lam stunning° (see Table 1). Results in Ghana were similarly unimpressive. Practiced in political isolation as it was in India and Ghana, the forum method did not signifiqantly affect rural environments. inueed, comparing Indian and Chinese family planning experiences, Rogers deClares, "Communication alone can'do little , to change attitudes" (1974). Something more is needed. Finally, public participation and political support strengthen deve pment ed not programs. Media forums and other development-support strategies operate in a vacuum. Cuba (in literacy work) and China (in preventiv edicine), have managed to integrate development and political action. In China, for example, participation means group planning of births and consequent success in family 10 19 4 slob planning. Further, rural economic and political st ctures in China enable communes to provide each person with a nutritional die s well as a say in decision- making. In both Cuba and China, overtly political campaigns have called for the involvement of the masses, especially the rural masses. In both countries, development crusades are part of more far-reaching travels toward socialism. The mess edia and campaign experiences described briefly here offer still other es to planners. One is that linking media forums with an ongoing organ ational infrastructure is criticata point that this study's account of planning for the anzanian health campaign brings out. But the two most fundamental lessons a plain enough. The first is that.tha media.forum is a co unication approach that can lead to action. The second is that political support an popular :Thvolvement are the keys to truly effective programs. .a I. 11 20 2 EVOLUTION OF RADIO STUDY-GROUP CAMPAIGNS IN TANZANIA . Development means the development of people, not things. Julius K. Nyerere Development means liberation. Any action that, gives (the people) more control of their own affairs is an actiofflor development even if it does not offer them better health or more bread. Any action that reduces their say in, determining their own-affairsDr running their own lives is not development and retards them. . Tanganyikan African National Union The radio forums of India and Ghana were conceived and conducted in a relpively neutral political climate quite unlike that in which the Cuban and Chinese mass campaigns were carried out. Sic al neutrality is naturally foreign to Tanzanian nationalism, which is based rly articulated set of development policies that guides all plans and gauges -asure of every new idea. Indeed, the "Man is Health" campaign _was the Imination of extensive experimentation and evaluation by various Tanzanian agencies and ministries working to develop effegve educational strategies that serve well-defined nationatobjectives. Had not theft experiencesthe subject of this chapterpaved the way for Mtu ni Afya, the campaign would no doubt have been much leSs successful than it was. As its President Julius K. Nyerere has explained, Tanzania possesses four,, principal resources: land, leadership, ideology, and people (Nyerere, 1967). Independent development means relying as far aspossible on internal resources. Translating this idea into development strategy; Tanzania grants top priority to rural and agricultural concetris via socialist forms of organization. In initiating its transition to socialism and taking steps toward rural development, Tanzania has mounted several programs and policies that bear directly on the c development of mass education campaigns. , . ) . Decentralizatioq of government 'and official enco agement of popular participation. TANU, Tanzania's single political party*. and the Tanzanian Government see these policies as functionally reciprocal an politically essential. Decentralizing ministries /ram national to regional revels ha it is hoped,. made government more responsive to local needs and more support e of small-scale projects. In turn, it is hoped that people find these regional and distn overnment u its more accessible than big centralized bureaucracies. Localized development ... 111NLI stands for Tanganyikan African National Union. which was originated prior to the 1963 union of Tanganyika and Zanzibar. Ir 977. TANU was merged with Zanzibar's political party to form the Revolutionary Party (Chama Cha Mapinduzi, or CCM). 13 _ committees, ttke majorities of which are not civil-service employees, join with elected managkrnent committees from the cooperative (ujamaa) villages to plan programs and formulate policies. Planners also envisage the day when strong workers' councils will exist and when workers will direct the partially state-owned productive units (Green, 1974). Establishment of ujamaa villages. By the end of 1974, at least 7,500 cooperative villages had been set up to accommodate around three million people representing roughly 30 percent of the agriculturally self-employed (Green, 1974). In these villages called ujamaa, the Kiswahili word for the spirit of socialism, rural people who traditionally have been scattered in extended family dwellings gather together. FOcus of financial priority on ujamaa villages and rural programs. Since 1967, Tanzanian ministries and organizations have gradually turned their attention to rural services. The national libraries, for example, have put most of their money into rural library services; similarly, within the Ministry of National Health, emphasis has shifted from urban-oriented curative medicine to rural-centered medicine, both curative and preventive. Alteration of formal school stactures. Shortly after the Arusha Declaration was issued in February of 1967, Education for Self-Reliance, the major educational policy statement, outlined radical changes in the concept of the school. As part of this redirection in the national interest, a call was issued for village schools to become true community schools. Newly integrated into the social and economic life of the community, schools were to emphasize rural activities and other interests of the permanent majority, rather than those of people likely to leave the village after passing thejr examinations. Establishment and support of outreaching adc.:!-education programs Attempts to reach as many Tanzanians as possible with increased adult-education services are an integral part of strategies to increase participation in decision making and to reduce the gap between urban and rural incomes. Adult Education Year was proclaimed in 1 q70, and it brought the consolidation of adult education within the Education and the foundation of an adult-education network that now includes more than 2 000 officers.* Ministry of Nation Through these and other means, Tanzania is working toward a special sort of socialism, the goal of which is perhaps best expressed by Nyerere (1967): . The objective of socialism in Tanzania is to build a society in which all members have equal rights and equal opportunities; in which all can live in peace . . without suffering or imposing injustice, being exploited or exploiting; in which all have a gradually increasing level of material welfare before any individual lives in luxury. Committed to popular participation, Tanzania tips broken off sharply with policies in force during its colonial and early post-independenee periods. It has taken the 'For more information, see Tanzanian Ministry of National Education, 1974 14 22, na. view that new national consciousness ennot live except In the nation's ptgbple and. that education is a key to Making the transformation to socialism. The profess has . begun. TANZANIA'S FIRST RADIO STUDY GROUPS Radio-listening groups...arose independently in tanzgnia) in twoinstitutions at opposite sides of the country at about the same time. In poshi, a town near the northeast border, the Cooperative Education Centre (*GEC) was founpled in 1964 to , meet the educational needs of local cooperative societies. The CEC soon perceived that its purposes could not be achieved solely or even mainly by face-to-face education methods, and so began to experiment with simple correspondence study-letters. Since most Tanzanian villagers participating in the courses have had no formal schooling, printed materials can be truly useful only if literate members of cooperative groups read them aloud to their illiteratts colleagues. Accordingly, the CE sought to support and enliven these cooperative courses by using radio. 40" programs,to present essential ideas and information orally. The study groups themselves were modeled to a large extent on the study circles 1 common in Swedish labor and cooperative educational projects. The CEC's first radio/correspondence study-group program addressed the needs of cooperative societies and began in 1937. A series about the work of committees in general followed aleardaterdilySit end of 1968, more than 400 groups had registered in at least one of these courses. In Mbeya, a region in Tanzania's southern highlands, a similar experiment was launched by the Institute of Adult Education (IAE) of the University of Dar es Salaam (then called "University College"). Since 1964, the IAE had concerned itself increasingly with experimentation, research, and services related to adult education of all kinds and at all levels. Regional IAE offices, each one serving several regions, tried to fill increasing numbers of requests by villagers (by school-leavers in particular) to run classes in remote villages and towns where qualified teachers and tutors could not be found. Under mounting pressure, IAE planners in Mbeya soon saw the economic impossibility of answering all demands for education with traditional classroom instruction. They proposed an experiment using radio studygroups as a possible solution to this dilemma. Canada's farm and civic radio forums of the 1940s served as models, and each of the three subjectsEnglish, civics, and agriculturechosen for the experiment was expected to attract a different group of people. The IAE picked fifteen experimental groups from the members of the recently develo network of local adult-education associations. The radio programs, either imp ed or prepared locally by the IAE office, followed a simple format and were broa ast by the Adult Education Service of Radio Tanzania. The Mbeya project wa in more than one sense. \!t was plagued by numerous problems, some serious and some that should have been foreseen. Afew examples vtrij serve. The radio programs were broadcast `on the medium waveleng . Reception was frequently poor in the pilot areas, particularly vxhere bad weather prevailed. (The project overlapped with the rainy s asoniiii one of 15 23 . I Tanzania's wettest regions,)The English anti agricultural courses were broadcast in English, Experience in traditionalichobrsettings had suggested that the average. 4 member of the target audience e.g., primary school teachers, government and cooperative officials) knew enqiigh English to uhderstpiel the programs. But the disembodied voice alternately Crackling and fpding4ver the radipottinted a linguistic challenge more formidable than the mere comprehension of face- To -face series, recalls listening speech. Tony Dodds who recorded programs for the to a program with one 4f the study groups, As a raingorm raged, the program fa d completely away; finally, Dodds stood up and delivered (he rest of the progra in person, word for Word. Comprehension rose. instantly. Other aspects of the IAE's experience in Mbeya revealed ample room forimprovement in the radio programs, in the supporting printed materials, and in the general organization of the project. Yet all fifteen groups did last until the end of the project, which suggests that an economical combination of teaching methods such y 's that used is a viable-approach to adult education --7--ianzania:s second Five Year Development Planthe first plan to reflect the choice of a socials -road to development that had been voiced in the 1967 4rushi Declaration appeared in 1969. Economics and the economic option&operitO the people of Tanzania were the themes of political and educational develOpment prograrris held throughout the year. The Cooperative Education Centre and the Institute' of Adult Education _planned to expand the approaches to radio studygroup campaigns, and both institutions chose economics as their jopic: . At that time a popular version of the FiVe Year Development Plan, sche duled for publication in both English and Kiswahili, had already teen drafted by thfran non Government. and the IAE decided to plan its next campaign around the popular ed Plan. IAE developed a study guide designed to lead groups through the Plan, td e discussion questrons, and to suggest supplementaristudy activities It also devised an, accompanying tack) series intended to accent practical illustrations and individual interpretations of the rp'ain pulls of the Plan. At the same time,-IAB's northern and southern offices each held a trainingcourse for group leaders And 50 groups enrolled. more than half of them located in areas covered by the two, offices, including some villages near Mbeya that had been involved in the pilot project fun two years before. tx Communicatio ns problemsboat organizational and educationalplagued tl% Fiv Year Development Plan campaign from its outset. Neither the national headquarters nor, the local offices of key institutions were briefed about the project in its early stages, and so they did not endorse or participate in the campaign. Moreover, the study guides and printed information meant to help group leaders and members dislvs complex Issues of national economy were neither easy tc use nor attractive. Both radio programs and study guides failed to provide groups with local examples of the policies outlined in the Plan, even though such examples were essential in helping members see hgly the Plan's generalities could become . personal realities. Armed with these and other insights, the Institute planned its next campaign. 246 AN ft UCHAGUZI NI WAKO ("THE CHOICE IS YOURS") . , , Anticipating Tanzania's 1970 parliamentary and presidential elections. the IAE brought up the possibility of holding a national election study-canipaign. The first campaign with a national theme, Udhaguzi niWako ("The Choice-is Yours") wasp include radio Frgrams;a prinled study guide in Kiswehili, and organized listening groups guided by trained leaders. Joining the IAE on the planning committee were representatives from TANU, the Political Science Department at the University of Dams Sal4am, and the Electoral COmmission.The Institute also worked closely with the newly constitutecl'adult-education section of the Ministry of National Education. These involved Organizations nateonly helped to produce the campaign materials le but also to recruit and supervise the listening groups. _ T he, campaign had two *goals. The first was to' describe the machinery oft government how the Parliament and local councils work, what the President does,' how election campaigns are run, and how votes are cast. The second aim was to stimulate discussion among the people absiut the meaning of this machinery and about the duties and responsibilities of thef elected representatives. From campaign experiences in Tanzania and elsewhere, planners knew that the role of study-group leaders would be crucial to the success of Uchaguzi ni Wako and that the leaders would need some initial guidance, A seYies of short training Courses gave prospective group leaders a look at the materials as well as practice in various leadership techniques. The training courses also served as th ymajor medium of / publicity. This emphasis on training leaders proved well placed. Nearly every one of the \ sgventy groups that reported was guided by a formally trained leader. (That more than ninety additional known groups did not report reflects the difficulties agetting representative impressions and other feedback in written-form.) This campaign showedthat,success in establishing groups throughout a wide geographical area hinges on organization and on training of group leaders. These lessons were carried over to the next-campaign, which was to be national in scale as well as in theme. WAKATI WA FURAHA ("TIME FOR REJOICING') The Institute. of Adult Education centered its pilot study campaigns of 1969 and 1970 on major national events. In 1971. Tanzania's tenth anniversary of independence wat the natural choice of subject for the IAE's next and most ambitious radio study-group campaign. The new campaign combined education with celebration. One objective was to deepen Tanzanians' sense of nationhood. Tracing Tanzania's -history and highlighting national achievements since Independence would give the people reason to see December 9,1971.as truly a "Time for Rejoicing"Wakati wafuraha. 17 25 Another goal was to expand radio study=groupsampaign into a nationwide exercise. Planning and Organization In the study campaign on the election in 1969, study groupS were formed in every region of the country. thibugh most of the 1,600 groups giew up in clusters around the IAE off ices. In thcC1941 campaign, planners aimed for more nearly total national represe'ntationlenconipassing at least a thousand groups). As it had been in the previous campaes, the cooperation of numerGzis\ institutions was.,deemed essential. In particular, the Cooperative Education Centre,naci been planning its own 6 Independence celebration program, and it agreed to cotkdinate its plansfulfrwith . those Iff the IAE. The CEC's organational structure, along with its reported 1,200 study.groups (extensions of the 400 Moshi groups) became an integral part of the campaign. Planrkg began nearly ten months before the first tcheduleo broadcast, and a detailed schedule for intensive preparations was mapped out. With so many agencies (the University of Der es Salaam, the Ministries of National Education and .Rutal Development, TANU, and the .cooperatives) involved, balancing multiple inputs with production efficiency became a primary consideration. Study materials for group members were three: a seriel of radio programs, a Kiswahili textbook, and a study guide. The radio programs and the accompanying textbook chapters were coordinated only loosely; the text was designed4o serve as a permanent source of background and factual detail and was written to be read aloud, whereas the radio programs were meant to Stimulate discussion, to illustrate the campaign premises, and to authenticate the whole eftort. Each oteight half-hour radio shows began with fifteen minutes devoted to music, answers to questions sent in by groups, and announcements from the campaign organizers. During this "gathering time," groups had a chance to assemble, Settle down, and tune in. Production of these topical openers was done toward the end of. I planning period, after the study segmentsthe second haivep of the programswere complete. Besides the textbooks and study guides supplied to group members, a manual for study-group leaders covered general questions of leadership (how to conduct meetings, the duties of the leader, and soon) and provided practical hints (including references to the textbooks and the study guide) for running individual meetings. Evaluation and Results I Of all the items in the campaign evaluation, the measure of knowledge gain was j held most critical. Table 2 lists components of the planned project evaluation. A tenquestion test was designed to be administered by campaign organizers to a sample set of groups both before and after the campaign. Fifty groups in ten different areas were chosen for testing. Most groups included some illiterates, for whom the test 18 26 Table 2 CAMPAIGN EVALUATION PLAN. WAKATI WA FURAHA ) ' MEANS INFORMATION *LIGHT Cost per participant Description of groupleader training seminars Roactigns olvarticipants to training seminars Demographic data Attendance rates Geograptfcal distribution of groups Knowledge gained as a result of the campaign - Obstacles to organized group study - Campaign accounts Training reports. Group.leader trainee reaction forms Class registration forms Class registration forms . Group registration forms Pretests and post-tests administered to selected groups Evaluation seminars questionnaires completed by district education officers who supervised the groups was administered orally and. privately. Lijerate participants filled in the 'ansktth es themselves. ' . Convinced that we trained study-group leaders are indispensable, planners of Waken wa Furdha prOvided for the training of at least 1,000 leaders from all over Tanzania. Together,,,the IAE and the CEC developed a two-stage training program. The first step was to teach organizers of adult-education activities how to train study-group leaders. For this Die CEC, at the time more experienced than the IAE in running study groups, made good use of its eidsting structure. The second sfep in the group leader training scheme was carried out by the di6tric,t adult-education officers themselves (through the generosity of the Ministry of National Education) as they trained the study-groupaeMas and organized1 i c mpaiyi m theirareas7 First-stage seminars were held in six localeS to introduce the district adutt-. education officers to the ideas and.techniqueS of the study.group method Characteristics of the study-groups Group membership ranged from 3 to over 200 Rates of attendance, calculated on a group basis, were seen as indicators of general interest in the subject and methods of the campaign. Indeed, the only sure measure of the campaign's impact was the number of group members attending -meetings regularly. The average group attendance rate nationwide was'65 percent, nearly twice the norm for classes in adult-education centers (33 percent). In previous, smaller-scale campaigns, the main distribution of listening groups had been limited to two or three regions. In contrast, Wakati wa Furaha ran crosscountry. Groups filled out registration forms in 42 of Tanzania's 65 districts. The ratio of men to women in the groups varied widely from district todistrict For the campaign overall, the ratio was 62 percent men- to 38 percent women. Surprisingly, this ratio is almost the reverse of the attendance pattern for classes run by the Ministry of National Education, which are attended by about twice as many 19 27 .1 4 women as men. No single age group predominated among the participants; ages ranging from 1610 40 were represented about equally. Most of the participants, 68.4 percent. had no more than four years of schooling, and only 13.6 percent had completed more than seven years. hence, the campaign seems to have reached the intended audience. Figures on the occupations of the grOup members confirm this assumption: 72 percent were farmers, 13 percent were civil servantsor clerks, an d 7 percentwpre teachers. (All other occupations totaled 8 percent.) A major strength of the radio 'study-group method is its ability to use talents of thdse who are neither highly educated nor highly experienced. Group leaders need not be teachers, but simply literate citizens trained in group leadership techniques. Of those whobecame group leaders, 92 percent were men and 8 percent women. The mean age of the leaders was 30 years, with the highest percentage of ages falling in the 21- to415-year-old range. Teachers were the largest occupational grobp among the leaders at 47 percent, with farmers following closely at 40 percent. Such other occupational categories as TANU officials, office workers, artisans, and civil Servants-made upthe remaining 13 percent. The large proportion of farmer- leaders particularly surprised campaign organizers, who had expected a much heavier representation of primary-school teachers and voluntary literacy teachers. As for education background, 28 percent of the group leaders had four or fewer years of schooling, 55 percent had from five to eight years, and a remarkably small proportiononly 17 percenthad more than eight years. Thus, leaders were not significantly better educated than group members, 13.6 percent of whom had completed more than seven years of school. The lack of a larger educational gap between the leaders and the group Members led in the context of such a successful projeCt supports the notion that leaders of radio study7groups can be solicited at large from the population to be served: Reiults of the knowledge-gain test Of all the phases of the campaign evaluation, gauging knowledge gain proved the . most difficult. Initially. 50 groups j5 from each of ten districts) were selected for testing; in the end, only 17 groups, together comprising 97 members, had submitted results of both the pre-test and the post-test. try' 'These 17 groups scored frorri20 to DLO percent on'the pre-test, with 72 percent the mean. Post-tett scores ranged from 50 to 100 percent, with a mean of 83 percent. The difference between the means. 11 percent. rates 4.62 on a "t" statistical test, and is significant at better than the .01 level. From this it can be safely con- cluded tht the increase in scores between tests cannot be attributed strictly to chance.,fn terms of individoal progress, 49 people did better on the post-test of knowledge gain, 38 made the same score, and 10 fared worse on the post-test than on the. pre-test. Although not spectacular, the 11-percent overall improvement in )3erformance is incontrvertibly positive. Considering the average group had 65 percent attendance and met for six out of ten 60-minute sessions, the level of improveTent seems respectable. Unfortunately. no control gro'Cip was forfried fog purposes 20 28 of comparing campaign methods with the traditional classroom approach to learning. Campaign Costs The evaluation of the cost of the campaign was intended to determine both the total cost and the distribution of costs across a number of categories. In this sort of .campaigp, many of the expenses are absorbed by participating agencies, and estimates must suffice in lieu of icnore precise figures.' The Institute of Adult Educatio was the principal organizing agency and as such incurred the bulk of the expenses. The Cooperative Education Centre helped distribute materials and set up seminars. he district adult-education.officers conducted most of the second-stage group-lead r training, distributed a great deal of material, reproduced the report forms, and s rvised study groups in their areas. Many of these duties fall within the normal_ range of responsibilities for adult-education officers in Tanzania, and se, expenses ior s me seNices were not included in the cost evaluation. Estimated cam iaign expenses are listed in Table 3. Notincluded are the salaries of the IAE staff me bers involved (who would hive been paid whether they worked on the campaign or ot). Nevertheless, planners of future campaigns take note: the staff commitment to e campaign was considerable and essential. The work of planning, production, di tribution, supervision, and evaluation for Wakahwa Furaha adds up to roughly 40 person-months. At any given time during the ten months, two to eight staff members were working full-time on the campaign. The costliest item in the campaign was publicity. The cost of printing the posters, an expense carried by the Ministry of Agriculture,ty itself represented nearly 40 percent of the total budgeta particularly hefty share in view of the fact that the impact of the posters turned out to be negligible since most of them were still f Table 3 ESTIMATED CAMPAIGN EXPENSES WAKATI WA FURAHA EXPENSE CATEGORY- Production of study materials Publicity Training ot group leaders Stage I Stage II Evaluation TOTAL CAMPAIGN EXPENSES Per capita costs (for 20,000 people) Leader frame. Stage I Leader trainee. Stage it Study group member Tz shillings US dolla;s 5,91975 .34.168.75 829 10 4.785 54 8,61800 1,20700 31,272 90 1,65475 4,379 96 231.76 81,634.15 11.433 36 11600 0.12 0.12 0.50 ty7 00 408 '140 US. dollar equaled 7.14 Tz shillings at the We'd the campaign. 21 29 ; stacked in agricultural extension offices when the campaign ended. Distribution of the textbooks and study guides also proved to be problematic and expensive. The campaign textbook was designed and edited by IAE and printed by the East African Literature BureauThe estimated unit cost of the books was 4.25 Tz shillings (about U.S $0 60), and a total of 2,000 copies was run. This cost could probably be reduced to about one shilling a copy in future campaigns by simplifying the format, cutting the number of pictures, and printing the books on cheaper paper. - Conclusions Wakati wa Furaha had-mniweak points. Delays in the distribution of to is and study guides definitely damped the campaign's impact. over half the district adult- education offibers reported that they had not received their copies before the opening:bf the campaign, and a few never did receive materials. In contrast, few cases were, reported of groups hampered by lack of radio sets. Radios seem to be well distributed in rural Tanzania, and volunteers who own radios can probably be depended upon to share them in future campaigns. It also became clear that groups would have to be better organized and more closely supervised in later campaigns. Despite these difficulties, the Wakati wa Furaha campaign achieved an impressive measure of success. Interest was aroused on a national scale, study groups were established all over the country to encompass about 20,000 members, and letters are still received from citizens on the subiectof the campaign. In addition, the audience reached was the audience the campaign's planners had in mind rural people whose need for education was greatest. The training of group leaders also went well. Never before had a two-stage training program been tried in Tanzania, and organizers naturally worried about the distortion of information betweerrthe first and second stages of trairilrig, Indications of the success of training efforts were the high rate of return of registration forrfis and the accuracy with which most of tne somewhat complicated attendance fornis were filled in These and other signs indicated that training messages came through loud and clear to the second-stage trainees, the individual group leaders. Finally, tslAkatt wa Furaha was a triumph for the radio study-group campaign as a learning method. The evaluation turned up positive evidence that peopte do learn from such campaigns. The statistically significant improvement in test scores strongly implies that at least some aspects of Tanzania's progress in the ten years. since it became independent are now well understood by the people. It also provides an index for measuring the success of future campaigns. a N, 22 30 3 t 'MTU NE AFYA ("MAN IS HEALTH "): ORGANIZATIQN, AND TRAINING The enthusiasm remaining among rural people in the wake of Wakati wa Furaha was convincing evidence that the radio study-group campaign as an apprgach4o \ education warranted still greater efforts. Nearly 20,000 people had taken part in the trne for Rejoicing," learning about and discussing their country's goals and progT,ss in the decade since Independence. Never before in Tanzania had so many been ieachedat so small a cost, , Since Wakati wa Furaha had expanded the campaign method to a national scale, the next step was to launch a mass campaign that would test the limits of the mass .media link-up with study groups. The new campaign was to be a step forwed in another sense; it wasto represent a movefrom abstract learning to action that would directly affect the quality of life in rural Tanzaitp. Following considerable discussion among ministria, organizations, and individuals, a new theme was chosen: community health, with an emphasis on preventive medicine. Several considerations figured importantly in the decision. First, planners wereaware that three-quarters arnainlandTanzania's two million people lived more than 10 kilometers from the nearest hospital (a two-hour walk for a healthy person), and that a fifth of the population lived still farther from any hospital, rural health-center, or dispensary (Thomas and Mas renhas, 1973). Since curative health services were far friarn adequate, efforts by th people themseLves to prevent disease could thus make a dramatic difference. Second, numerous diseases ss dreaded and debilitating but far more widespread than leprosy and sma ox were seen as major impediments to velopment in rural Tanzania. Of these, happiness acid to social and economic tuberculosis, malaria, schistosomiasis (bilh ia), hookworm, dysentery, and other water-borne diseases were chiefly respons le for keeping in !notion the vicious cycle illustrated below (Tanzanian Institute of Adult Education, 1972). Li -REDUCED INSUFFICIENT NUTRITION ABILITY TO WORK 23 ar4 ' What these diseases have in common, the Ministry of National Health pointed out, is a susceptibility to preventive measures that include various practicable environmental changes. Third, increased movement of people from scattered dwellings to ujamaa villages was afoot. These confluences of people from various isolated Iodations created fertile environments not only for the spread of disease, but also for organized healtheducation on a large scale. By the end of 1971 according to the Ministry of Rural Development, some 4,000 ujamaa villages housed an estimated 750,000 adults. These ujamaa residents were already familiar with functional literacy classes and other adult education activities. Finally, the the.me of health education seemed to jibe nicely with the intended emphasis on action. A preventive-medicine campaign could truly put knowledge into praCtice. And many of the recommended environmental alternatives the campaign would focus uponLbuilding latrines, for instancewould be ideally suited to group 'action. The Ministry Of National Health had good reason for choosing to treat in the campaign the specific diseases listed above. All were widespread geographically, and their incidence within the total population was high. Malaria, for example, accouoted for 10 pe,rcent of all hospital admissions and for 7 percent of all deaths. As for tuberculosis;an estimated 150,000 cases in 1973 were expected to give rise to 30,000 new cases a year (Gish, 1973). Collectively, infectious and parasitic illnesses plagued one-third of all. hospital patients and ,caused one-third of all hospital deaths each year. . PLANNING AND ORGANIZATION CampaigmAims Otte new campaign, named Mtii n; Afya ("Man is Health"), had three aims: 1. To increase peoples awareness of how they can make their lives healthier and to encourage both groups and individuals to take appropriate action; 2. To provide clear and simple information about the symptoms of specific diseases and their prevention; and 3. To encourage those who had participated in the national literacy campaign to maintain their skills by reading campaign materials designed especially for the newly literate. 11. As mentioned earlier, breadth of scale and emphasis on action distinguished Mu ni Afya from the campaigns preceding.it. In identifying the campaign's prospective participants, planners first accounted for the -heedeof the_750,000 adults living in ujamaa villages, where communicable diseases constitute a much greater threat than in more scattered corhmunities. Added to this main group were some 250,000 adults living in the six Tanzanian districts in which the national literacy campaign 24 32 . Zap 0 was spearheaded in 1971. This overall target done million people amounted to fifty a times the number reached in the immediately preceding campaign. In Mtu ni Afjia, action was to take the form of intensive efforts by groups and individuals to make physical changes to foster better community health. Promotion of communal action was to bee fundamental ingredient of the radio programs, the printed materials,.and the training. The integration of,Mtu ni Nye with national literacy efforts was its third departure from previous campaigns,The Ministry of National Education's iiteraoy, campaign, begun in six districts in 1971, had within two years become the major activity of the national adult-education network Thousands of people were becoming literate, but they had little to read. The texts for Mtu niAtya,were therefore geared, in terms of both format and vocabulary, to the newly literate. Campaign Timetable An informal follow-up meeting held by the IAA staff in mid-January of 1972 to discuss Wakati wa Furaha marked the beginning of planning for the national health campaign. At subsequent major meetings, representatives of the health, agriculture, and education ministries, as well as members of TANU and the Cooperative Union of Tanzania, planned together. By late April, the Ministry of National Health had first drafts of the campaign textbooks ready. / Despite this swift initial action, the planning process was lengthy. As shown in figure 1 (which begins with the sixth month of planning), sixteen months of intensive planning, production, diitribution, and training took place between the campaign's initiation and the first radio broadckStin May of 1973.' , .. The previous Campaign had taught planners to allow ample time to prepare anu distribute all printed materials prio,r to the opening of the group-leader training seminars. Distribution of texts, study guithis,.and leaders' manuals was to be-done through the training seminars. The twice-weekly broadcasts of the twelve radio programs, the first on May 14 of 1973 and the last on August 5, were carefully timed as well. Planners strove to avoid major_planting and harvesting times and to complete the sequence of shows before Ramadan, when many of the substantial portion of the nation's population who are Muslim fast during the day and -cut -down on activities outside the home. Other early preparationi for the campaign included drafting final project proposals that were submitted for approval to the University of Dar es Salaam, the Ministry of National Education, the Ministry of National Health, and the Treasury in May of 1972. In addition, a request for 1,450,000 Tz shillings (U.S. $210,000) was submitted in late June to the Swedish International Development Authority, and the title for the campaign, Mtu ni Alya, was approved at the first formal meeting of the National Coordinating Committee in mid-August. 25 Figure 1 CAMPAIGN TIMETABLE , ' 1972 JAN Study Guides . '1972 JUL 1973 AUG NOV OCT SEP JAN DEC I 1 I I Recording Radro Programs Script writing Group Lean' Manual I 4 1 r I Writing --- ------ Typese ling.-- Printing - Distribution I Training Stage Ill Publicity Supervision ' , ,. _.----"" I I . r 1 Seminars Seminar Planning I I I Circulars and Letters ---- Meetings ---- AWN) Announcements Preparation I ' * . Seminars t . . . . ti .t. Operation I I I .. Post., Pre-Test Preparation I_ SEP I 1 Seminars Siminar Pinning I Evaluation I I .1 Seminar Planning Training Stage I AUG Transmission --- -- Proaration --------;--Technical Production -Distribution TrainingMatenal Training Stage II I JUL Dist ibutign Planning Editing - Typesetting -- Printing --- Binding I JUN MAY APR MAR FEB I I I . Test National Coordination I 4. , 0 , A campaign of the scale of Mtu ni Ma would have been impossible without interministerial cooperation and coordination. To be sure, mass campaigns depend heavily on field organization, and no single ministry is equipped to carry out all phases of a mass campaign. In an exercise of foresight that proved critical to the success of the campaign, the IAE-and cooperating ministries placed responsibility for continual coordination and direction of the campaign in the hands of the newly created National Cooklinating Committee. Chaired by the'director of the IAE, this Committee decided at its.first meeting, on August 8,1972, that its primary duty was "to keep all parts of the scheme under constant review, to anticipate problems, to propose solutions and to ensure , i the smooth working of the whole scheme." The Coordinating Committee also/made some tactical degisions at its first meeting It determined, for example, that thoseCommittee members concerned with producing 'extbooks and radio programs would meet once a Month early in the campaign and more frequently when the training seminars were being organized or when other activities demanded additional sessions. The use of large wall charts marking principal campaign deadlines (one f ofthe campaign overall and other more detailed charts for the various phases) kept staff members 4 to date and averted 'several potential crises (Barrett, 1976). Me ' Allocation of Responsibility . 'Responsibilities among the cooperating agencies shifted somewhat durihg the course of the campaign. The allocation of duties as itstood at the campaign's end is outlined in Figure 2. I Mobilization and Publicity .. I \ . . . The buildup of theMturnAlya campaign entailed both advertising and grassroots organizing of the sort that characterized the miss campaigns conducted in Cuba and China. Campaign planners saw mobilization and publicity proceeding in three t overlapping phases: informing governmental and political leaders about- the campaign and the role they could playirrit; mobilizing:Tanzanians on a mass basis to get potential group members and group leaders into the act; and keeping up momentum through well-timed bursts of publicity throughout the campaign. 4 Caphiring the interest and support of senior political and govprnmental leaders was considered fundamental in the Tanzacnian context and was thus begun earliest. The.National Coordinating Committee arranged meetings in various divisions of the participating ministries and of TANU; at the meetings, full details of the campaign were discussed and various departments were asked for their individual support. Busy civil servants with stacks of unread reports already heaped atop their desks received succinct, one-page information sheets the) stressed the scope and the .. It. r 27 c 35 . ti ' Figure:2 ALLOCATION OF RESPONSIBILITY . National,Ministry of Health. Health Education Unit Content of textbooks and radio programs Production of radio programs Assistance from health-education personnel in reayting training. distribution. and supeanston Radio Tanzania Assistance :n editing radio krograms Provision of free air time J. Tanganyikan African National Union (TANU) Overall mob/salon and recruitment of group mem- Ministry of National Education. Adult Education Directorate Overall prganizatton of recruitment ol group.mem- bers and leaders ng Assistance in bers and leaders. distribution of materials to groups, training of group leaders. supervision In Aisistance in editing to . Prime Minister'sOff - RuralDevelopmentDivision lot regional and district deAdmihistratde s veloprne nt directors (senior administrative officers -of the decentralized government) Provision of training facilities (rural training centers) Assistance in training ducation (IAE) A e of A. Day-16-day :ampaign coordination Edging and production of textbooks Drafting echting and production of group-leadoff manual Development of training methods and Materials Coordination of publicity-) Production of posters Evaluation practical nature of the campaign. In addition, each Member of Parliament (M.P.) received a gift set of the campaign textbooks during Parliament's official session in Dar es Salaam. This tactic paid off, at least in the town of a dkoba in northwest Tanzania. There, the local M.P. held a series of meetings with theiolloWing agenda: , "Man is Health Campaign" and -"any other business"! Tanzartian/Officials and othpr personnel at all levels get much of their new and information frofn circulars issued by senior ministry officials at Dar es Salaam and at various regional headquarteig. Thanks to the Cgordinatiog Committee, official letters stressing the consistency of Mu ni Afya with national objectives, pointing out its integration with previous mass campaigns and adult-education work, and urging staff at all levels to support the campaign Were sent out.tly the principal secretaries, by senior civil servants of the Prime Minister's Office and of the education and health ministries, and by the head of TANU's political education department. (Goverriment personnel were not assigne4d specific duties until later in the campaign preparation period.) A combination of political party support and active recruitment of adult-education coordinators at the-ward level was used to mobilize the general population. Thee training seminars for group leaders held at district, division, and ward levels ,stimulated interest, especially when officials and other influential individuals participated. Some people become group leaders by responding to publicity appeals (via newspapers .and other media) for organizers. TANU offici3ls were actively.asSisting in the.recruitment process as early as October 1972, sigmonths before the first broadcasts. Recruitment and popular support were given a lastminute boost when the Prime Minister, Rashidi Kawawa, Went on the radio to encourage thelieople to participate in the campaign. 28. In-the-field mobilization efforts were backed up by intensive and sustained pubkity. Media of all kinds were used to introduce the campaign and to keep it in Tanzanians' minds. The symbol of the campaign, like a logo in conventional advertising, identified the campaign at a glance. Giving the campaign a name, an established practice in Tanzania, provided an audible symbol as well. The title "Man is Health" soon became part of the everyday vocabuletik and captured the imaginations of many. Oh one crowded bus, friendly. passengers were heard to shout, "Open the windows! MW ni atyal We don't want to suffocate!" Press releasesheralded each new phase of the campaign', and newspapers and magazines were used to the fullest. Articles arkf features appear,ed both in Uhurti ("Independence"), the Kiswahili daily with a readership of 200,000, and,in the Daily News, the English-language paper read mostly by civil servants and officials. More significant for rural areas were the stories carried in Kwetu ("Ours"), the Ministry of Information's monthly magazine with a circulation of about 50,000;in Urusi Leo ("Russia Today"), a widely distributed information newspaper, andin Ukulima wa Kisasa ("Modern Farming"), a rural newspaper distributed by agricultural field staff and read by more than 100,000 rural people. Radio spots. were aired over both the national (larably educational) and (he commercial services. Matsushita Radio and Battery Company responded to requests from campaign organizers with free commercial air time (two-minute spots) on their popular thrice-weekly evening programs. On ne such spot, it was pointed out that "if the textbooks [study guides] were piled on on top of another they would be higher thanXilimaniaro" (Barrett,1976 a also offeredlhe use of advertising space reserved for them in newspa rs and on the back cover of Film Tanzania (This entertainment magazine, especially popular in urban areas, features photographic action stories in comic-strip sequence.) Additional radio slots were made available, on the weekly educational program of the health and rural development departments. . One campaign publicity device was truly,unique. textile patterns were designed to incorporate the symbol of the campaign and various aspects of its messages. This farm bf publicity worked well because designs of Khanga and Menge (cloth sold by th) that Tanzanian yeomen traditionally wear change often, and women eagerly wait new patterns. Uraliki Textiles initially agreed to print at least one special esign, but ended up releasing five separate patterns in the course of the campaim. As the campaign's spirit heightened, publicity extended beyond what had been planned Many spontaneous responses cropped up, some in forms that fed back into the mobilization protess. f he r Volcanoes, a pop singing group, recorded a song about Mtu nr Alp that wa played on the radio, and other songs were written and sung by schoolchildren a school open-days and at local seminars. At least twenty campaign-inspired poe s were printed in newspapersbr read on the radio. . Production and Distribution of Materials Previous campaigns tAci proven the fundamental importance of the media 29 f . Table 4 USE AND QUANTITY OF CAMPAIGN MATERIALS. . DESCRIPTION Wtkly radio progritrns. 20 minutes each Weekly"gathering.tilme"programs,10 minutes each Mock raft programs (cassettes), 20.minutes each Study gueee-sets of two 48.page volumes USE "1": Group listening Group listening 7 Leader training Group study and leader 'QUANTITY 12 12 400 1,004000 training, Leading of groups and leader training Leader training Group discussion- Group leaders' manuals Flipcharts, sets of sixteen Health educatio) posters, sets a set 1 75.000 400 10.000 materialsradio programs and printed matterto the success of the study-group method. The materials produced for Mtu ni Alya are listed in Table 4. Radio programs The radi)foo grams were multi-functional. First, they provided a framework for the meeting of study groups. They gave participants a sense of movement and accomplishment that is critical to the success of any mass campaign, and they -; compelled groups to progress. Because they were important and because the ."Teltil000ks and the group leaders' manual were based on them, the programs had to be ready early. Thus, drafting of the radio-program scripts was the first item on the production schedule. Second, the ratio programs helped group members identify with the materials they were studying and discussing. On the radio snows, real people talked about real problems:As much as possible, the radio programs included recordings of villagers made in the fields about their own experiences, with the subject Under discussion. Oramar tions of important problems 'by actors and commentary by health experts rounded out the shows. Third, the radio programs reinforced messages broadcast via other media. The programs were designed to cover the same material as the textbooks did but in a somewhat different way. Campaign planners knew that many groups would have to make do with poor radio reception, that some would have no radio at all, and that in some places a radio would be available one week but not the next. Therefore, provision had to be made for groups that would lack text or radio, as well as for 4 groups that would have both. 1 Each half-hour show opened with the catchy signature tune that marked the beginning of the 10-minute "gathering -time." These- introductory segments combined advice to groups, news.about the progress of Other groups, and songs or poems-based on the campaign or related themes. Then came the 20-minute study programs. Each show ended with a summary of the information that had been 30 38 Table 5 RADIO PROGRAMMING SCHEDULE a Malaria, Malana Malaria I 2 3 6 7 8 9 10 11 12 Dates Broadcast (1973) Topic Week Na 4 16 May 21.23 4-May 28.30 June A 6 June 11. 13 Water-borne diseases Water-borne diseases Dysentery Dysentery Hookworm Hookworm Schistosormasii Tuberculosis Tuberculosis June 18. 20 June 25.27 July 2. 4 'July 9. 11 July-16. 18 July 23.25 July 30. August 1 presented; this summary was given by a health officer who echoed the textbooks and the group leaders' manuals by stressing the next stepaction. Table 5 shoWs the six topics assigned to the radio programs and corresponding textbook sections over the twelve weeks of the campaign. Each program was Woadcast twice, on Monday and Wednesday, to give study groups a choice of ineeting times. Study guides The study guides consisted of two volumes of 48 pages each.The books were the same size as the literacy primers, and, like them, were printed on the Goss presses used for the daily newspaper Uhuru. Reels of 52-gram newsprint were used for the text, covers were printed on cardboard, and staples were used to bind the books. The originals of the text pages were typed and then enlarged-PhotographicAlly,7: The final print size was 120-pica with oile-and-a-half spaces between words, attype face geared to new literates. For ease in reading, line length was 40- at 32 characters. Although the original plan specified that each participant would receive a set of books, some people had to, share sets as the campaign's popularity grew. Both photographs and line drawings were used to illustrate the texts. Cartipaign organizers were aware of research indicating that photographs with the backgrounds blocked out, rather than line drawings, are most easily understbod by n'on,- literate adults. But because drawings are easier to reproducNon newsprint, they were used for many of the illustrations. Page space was,divided between text and illustrations in a ratio of about 60 percent to 40percent The study guides and the preliminary scripts for the radio programs were drafted by the Health Education Unit of the Ministry of National Health. The Community 31 39 A Medicine Department of the University of Dar es Salaam suggested certain alterations: for example, some material about how flies transmit diseases was cut to make room for a second section on tuberculosis. Writers from these ministries presented each weelh topic according to a uniform three-part format: (1) disease symptoms, (2) dangers and complications, and(3) prevention. They educed the texts substantially to fit them on the limited number of pages available. Each final text contained about 1.1.000 words. (The average Kiswahili word is one or two characters longer than its English equivalent.) Next, the study guides were edited for style and vocabulary. In terms of 'difficulty, the books were meant to pick up where literacy primers left off. Exceptions had to be made for medical and other technical terms essential to the discussion of diseases, but such exceptions were kept to a minimum and care was taken to give all synonyn for a single disease. In some pads of Tanzania, people mistakenly believe that Homa ya mbu, an illness that'strikes adults, and Dege-dege, a severe fever children get, are two different diseases. Although adults respond to classical measures against malaria, the children's sickness is commonly thought to be unrelated to mosquitoes ind unresponsive to western-style medicine. Both, of course, are malaria and can be prevented and treated with chloroquine or some similar medication. Interspersed throughout the study-guide sections are questions intended to stimulate group discussion and action. The questions (translated) below followed a narrative on hookworm: 1. Look at the members of your family. Do you see any hookworm symptoms among them? 2. What are some reasons why people in youi village would not use latrines? . Discuss how such taboos can be broken. 3. Discuss your village and find places where a public lavatory is necessary. How could a latrine-construction scheme be started in your village? Group leaders' manual The group leaders' manual, a 16-page newsprint booklet, contained two kinds of information. For purposes of training and reference, the manual listed duties of a study-group leader, methods of recruiting members, and ways of running study meetings smoothly, In addition, the booklet gave group leaders detailed guidelines for each meetirig.as well as the complete schedule of radio broadcasts related to the campaign. Each of the 75,000 stwily-group leaders received a manual. The translated sample section of the manual shown in Figure 3 outlines the campaign's sixth-week meeting agenda. The group leaders' manuals also contained the group registration form, a key source of information for the campaign evaluation. The form, along with instructions for filling it in, was stapled into the center of the manual. At the end of the campaign, the form, were to be torn out and sent to Dar es Salaam for analysis. 32 40 Figure 3 TRANSLATED EXCERPT FROM GROUP LEADERS' MANUAL MEETINGtF THE SIXTH WEEK. LESSON: DYSENTERY. Purposek The aim alas lesson is to show group members why it is essential fa those suffering from dysentery to go to a hospital for treatment, and to show them-how this disease spreads. It is also important that the group ?waltzers make sure that they implement effectively all their resolutions ' Section fa this weekfrom the pprik ' Dysentery. part 1. pp. 36-14. Important points* The meaning 01 dysentery The cause of dysentery SymptomS (31 oysehtery How it spreads F1'esolutions and actions of The Planning 1. In theMeeting Read the minutes of the last meeting at 4'pm o Listen to the radio broadcast PI the day that the group has chosen. Those without radios can read the )t ( ,4 ` . books Recommendations, question's and what to be done should be read Decide among yourselves on the questions and agenda, and decide on the implementation. Allocate work logroupmembersaciordinglothedecision reached by the group fa instance. reading some pans of the book in preparation log the following meeting preparing the place for the next, ... meeting. preparing materials (eg radios, batteries. etc.). , , , M4ke a roll call otali group members' Make sure that every group member arrives at the meeting 15 minutes before the radio broadcast in order to listen to the minutes and discuss questions and actions lot implementation., . . 2. Preparation for the next meeting We shall read at home about dysentery. second part, pp 44.4a We need pick axes. hoes, etc. for d gging pits. afya bora," Hookworm, Bitharzia. T B . New books: Mtu nr Alva Make arrangements to get e guest speaker if it is necessary to invite one. Materials needed. . Radio and batteries Books for group members Blackboard and chalk d there is' a guest speaker Exercise book and pencil (optional) -to Where to get help: District Education Officer (Agricultural Extension) Adult Education Co-ordinator Head Teacher Doctors or Rural Medical Aid Community Development Officers Field Officers 11 (vale( Devekpment Olker IP* 0 O 33 411 ' Distributior3 of materials Distributing the printed materials 'was a prodigious task. The district adult- 4 education officers 'Were asked for estimates of the number of groups they expected would be formed in their respective areas. Then,the numbers of ujamaa villages in individual districts were counted. Armed with this information, organizers decided -how many books to send ch area. (They presumed that the average Study group would contain lift n people.) Accessibility and distance delermined priorities in the distribution process. The Institute of Adult Education in Dar es Salaam directed distribution from the printer to the district centers. The district adult-education officers then took the books from district centers to outlying villages. At first, planners figured that the basic unit package should contain material for one group (that is, fifteen sets of study guides and one copy of the group leaders' manual). But as things gpt rushed, packers resorted to using cardboard boxes that held about 120 sets of the study guides and manuals. These boxes were not too heavy for one man to handle, and were sturdy enough to withstand transport. Most of the textbooks traveled from district witer to study group in the hands of newly trained group leaders. Although distributIng materials through the training teininars for group leaders seemed a practical idea, many tie-ups developed. Some trainees had to:traverse long distances to attend the seminars, without adequate transportation, they found taking boxes of books back home with them troublesome. /l In contrast, distributing training materials proved relatively easy. The flipcharts, /..._cassettes, and seminar timetables went (by bus, foot, Landrover, and plane) straight to the district centers with few hitches. The posters, however, were produced late and had to be distributed separately. The few posters printed were sent to district health officers with instructions to forward them primarily to ujamaa villages. TRAINING OF STUDY-GROUP LEADERS The Wakab wa Furaha campaign had shown that trained group leaders are crucial to the establighment and continued functioning of study groups. With a target audience fifteen times that of the previous campaign, Ailtu m Alp called for 75,000 trained leaders. Since the effectivenesS of training seemed to hinge on having the campaign materials available at the training sessions, training could not begin until the textbooks, leaders' manuals, apd flipcharts had been prepared and distributed. As Figure 1 shows, the first training seminar began in January of 1973. To train 75,000 leaders by May 14, the date of the first radio broadcast, organizers devised a phasic training system. Training, proceeded in three, sometimes four, stages. In the, fiat stage, teams totaling about 240 regional officers from various ministries were divided among seven zonal seminar groups to learn about study-group methods and about how the campaign related to national objectives. At these seminars, which tasted about three 34 42 40. days, regional teams 'were trained to organize and conduct the next leVelof seminars. Each zonal meeting brought together teams from several of Tanzania's (then) eighteen regions. Fourteen tutors from the Institute of Adult Education and the Department of Health Education'in the Ministry of Health were grouped into three teams so that several zonal seminars could rulrsimultaneously.In February and March, the regional teams scattered thrOUghout Tanzania to set inars. At,tbe district seminars, participants including up about seventy district district adult-education officers, r I development officers, TANU officials4strict health and medical officers, agricultural extension agents, and representativ'esot__ voluntary agencies were taught how to train the front ranks of study-group leaders. The district seminars also served as distribution points for tote campaign textbooks. Finally, 75,000 trainees gathered at around 2,000 two-day division and ward seminars to learn how to recruit study-group members and how to conduct individual Maly groups.At this terminal stageln the training procesp, study materials were further dispersed. Rect:uitment Flexibility characterized the recruitment of study-group leaders. How a particular leader was selected depended large? on local customs and on local adulteducation procedures. Most leaders were chosen by one of four methods. The first method was to allow members of a prospective study group to-choose one from among their number to attend the training seminar. Although perhaps ideal, this method was not the most prevalent. The main problem it posed was logistical: frequently, the training seminars were what initially aroused local interest, and the seminars would be over by the time people decided to form groups. Another recruitment approach was simply to make the tenkbouse cell leaders study-group leaders. This method was relatively easy to adopt since TANU's well organized network of local leaders, one for every ten-household cell, runs throughout most of Tanzania On the island of Mafia, in tht ujamaa villages of Dodoma, and in other places where MN ni Alva was enthusiastically supported by local TANU officials, cell leaders extended their roles to become campaign activists. Std other Tanzanians became leaders by responding to radio and other media publicity Campaign publicity encouraged individuals who felt they could organize groups ()'ten to fifteen people to contact district adult-education officials. Some 5 to 10 percent b the eventual leaders answered this challenge. The fourth, anb,prgpably most common, practice was for grassroots adulteducation organizeralo select leader trainees. The head teacher of each Tanzanian primary school also serves as the local adult-education coordinator and knows the community well, and the ,teachers' calling upon local participants in adult- education activities to function,ass group leaders often boosted local participation and identified natural leaders. , 35 43 Seminar Content a'nd,Training Methods The training seminars were the focus of several critical campaign activities. and content was provided to rotivate Information about campaign on pedple to participate, and oup leaders were trained through direct use of campaign materials. In-ad ition, potential problems in running study groups were identifieland possible sciiiitions discussed, local campaign planning was initiated, and campaign materials were distributed. , Most seminars ran from two to three days, generally thredays for zonal and district meetings and two days for division- and ward-level training sessions. Since the div' Tonal and ward seminars did not have to cover publicity planning nor some ore t of the subjeCts covered during aspects of leadership, they were st1orter. Table 6 lists th the two-day and three-day sewers. The training process was uided by the principle that seminars conducted at every level should conform as closely as possible to the format the study groups would later follow. In that spirit, full discussion and participation by all seminar participants was encouraged. The similarity of the seminars to the study-group meetings was underscored through Use of campaign materials for the training Table 6 TOPICS COVERED IN GROUPLEADER TRAINING Recommended Inime spent Topic I Mlu ni Atya and adult education in Tanzania Mtu ni Atya compagn.ongins Campaign aim improving health Recruiting study-group leaders and members, publicizing campaignthroughdJferent orgamzattons Campaign materials. study guides, radio programs, group leaders' manuals, hpcharts . a Distributing campaign materials Le.ading Mtu ni Atya study groups: preparing materials for meetings, preparing (minutes)* - 30 60 60 60 60 60. fa action 60, MOCK MEETING I (second week of camnvgn) importance of preparing the study group meetings Des L ding Mtu ni Atya study groups. how study groups and classes differ, respon- 60 60 7 ibises of leadership a MOCK MEETING II third week of campaign) Discussion: responsibilities of members and leaders Importance of and methods for obtaining feedback from the groups for research and evaluation Counseling and visiting study groups" y Conducting study-group leaders* seminars" 'is/Discussion' problems arising out of the campaign limes based on threeday zonal and district seminars. "Covered in 2...081 and district seminars only. -44 36 60 60. 60 60 60 126 60 sessions; each-trainee could see the textbooks and listento radio-program samples recorded on cassettes. In the same vein, role-playing in the mock study-group meetings gave leaders experience with discussion in small groups. Indeed, planners felt that the experience of participatinig in a well organized grouplearning situation would do more than words to impress on leaders the differences between a study group and-a traditional class. For most leaders and group members, educational experiences had been dominated by the formal teacher-student relationship. The notion that the teacher is an expert and that the student is an empty vessel was consciously and scrupulously undercut from the beginning of the campaign: training emphasized that members of a MN niAfya study group were to be equals working together to understand the complexities of local health problems. The campaign organizers and workers made it clear frorg the start that the group leader's job was to stimulate and focus discussion and to encourage appropriate action. It was suggested at the training seminars that each group strive to leave behind one "monument," one physical structure or change that would stand in testimony to the group's participation in Mtu niAfya. As it turned out, many groups had too much enthusiasm and creativity to confine their efforts to the construction of a single ... monument. O Table 4 listed the materials used in even7traininNrninarstudy guides, group leaders' manuals, sample radio programs, and flipcharts that noted key points on the study-group method and the campaign topics. It was hoped that consistent used these training aids would help minimize distortion as the training "message" passed rom zonal seminar to district seminar and finally to group leaders at the division and and levels. Sets of notes duplicating the flipcharts were planned originally as an a ditional aid to trainers, but this aid never materialized because unforeseen tasks onopolized organizers'. time. One such task involveZ1 hours down at the docks leering tons of newsprint through customs,.plus additional hours finding storage space for the paper. .. . The 400 radio-program cassettes were recorded by the Institute of Adult Education in Dar es Salaam, five at a time on five Philips portable recorders connected in series., No facilities for more efficient reproduction were available in the capital (although it was recently learned that duplicating facilities did exist 300 miles away in Dodoma at the time of the campaign). District adult-education Officers had been given batter Irun cassette recorders for other purposes, and these ordigary Philips portable worked well in the training seminars. ... ,Training Evaluation' Campaign organizers wanted to track what happened to the training "message" as it passed through the stages of the seminar system. Accordingly, a simple set of observational guidelines was developed, and one man followed the message in its journey from the national to the ward level. This experiment indicated that 'some distortion did occur. Quite commonly, for example, the third-stage seminars would stray from the suggested schedule. Many of the division and ward !raine 'rs were 37 Ae 45 primary-school-teachers with litt es9.! no experience in managing groups of adults, and th: had keeping convey ationS focused on one topic at a time. In p session purpWedly devoted to the diffe ces between study groups and classes. for instance, discussion may have gotten si attacked to recruiting or radio batteries. Generally, however:the distortion of the contentof the training sessions was limited. The training system's most serious flaw showed up in the last stage of training. Reports from several regions indicated that, although the content of the seminars was satisfactory, group leaders could not be adequately trained in two days. A. number of circurrittincaliipport this criticism. At the zone and dittOct levels, most of those in training were experienced educators, or at least had in seminars previously and knew how to get the most out of a brief e ounter. Furthermore, facilities where the first-stage seminars were held often includedgight *ding, solfiat the participants, most of them experienced readers, could read in the evenings. Most of the group-leader trainees, on the other hand, lacked experience with books, seminars, and education in general For them, the usual two days was Snot enough time to comprehend fully all the material presented. It was important that each of the elements of the campaign be kept in perspective and that no one get carried away by the idea that people can be manipulated mechanistically by means of radios, group leaders, and so forth. Henry Bid, who was involved in the training, expressed this awareness (1974): In the campaign we id not only rely on the training, the radio programmes and the other materials roduced but also on the people themselves and their common sense. M ny of us were convinced that given the basic,information needed by means of books and radio programmes and supported by their study group leaders, thg Mtu ni Afya participants would act in a sensible way. And so they did ,-/ad we not trusted in the people there would never have been any campaign to talk about. Campaigns become mass campaigns by the masses not their leaders. The leaders may initiate, be the spark, but the masses are "ie powder. (Emphasis added) 46 38 4 MTU NI AFYA ("MAN IS HEALTH'S: STUDY GROUPS IN ACTION . During the week beginning on May 14, 1973,people all over Tanzania turned on their radios for thefirst of twelve Mtu ni Alya broadcasts. By the engi of the sixteenth month of intensive preparation, some 75,000 study-group leaders had completed their training and were ready to lead the twelve weekly study meetings that would bring Mtu ni Nye home to untold numbers of rural Tanzanians and put the massmedia campaign approach to a rigorous test.' The health-campaign study groups were designed to progress logically from learning foiction.Assemb/ing during the prescribed gatheri,ng time, group members heard ten minutes of political songs, poems, and short announcements relating to the campaign. Then the twenty-minutetore program came on the air, and members settleddown- tesome serious listening. Next, the group-leader nother literate person in the group introduced the printed material on that weeys topic by reading aloud from the appropriate section of theilludyjpidereisrCussin9,both the radio shows and the written materials, the group related the topic to its own particularaga----.and circumstances. If the information presented seemed relevant, members set about resolving how to prevent the disease or eliminate the health hazard in question. Before the next meeting or perhaps later, the group began acting on their resolutions, either individually withifi their homes ocollectively in the community. In practide, probably no two groups operated alike. About half the time, groups would have to make do without the radio programs. The radio reception in some parts of Tanzania was poor, some groups never had radios available, and those _radios that were distributed occasionally broke down. When listening to the campaign programs was impossible, group leaders usually presented the pertinent textbook material orally. Another variation in the meeting format derived from misinterpretation of the study-grotip method. Although they had been trained to act as peer racilitators, some leaders assumed traditional teaching roles and gave health lectures after the radio shows were over, often talking so long that group members had no opportunity to discuss the material among themselves, and sometimes irritating the group members Where groups were too large, discussion s stifled too. After trying to handle a study group of 75 or 80 people, five times the id !number, some leaders explained that, "Although only a few actually participate in the discUssion, everyone participated in theimplementation of the resolutions." Yet, the success of the study, 'The following account of the study groups in action is based on three primary sources. Intenm evaluation reports drawn from short evaluation tours carried out in July 1973, more detailed supervision reports filed by local supervisors after visits to2,131 groups, and demographic and attendance data supplied by the secretaries of nearly 20,000 study groups. 39 7 group method, organizers felt, depended on active discussion among all group members about how the content of the campaign related to their environment and to their daily'lives. - . . - , ,, I HOW WERE THE STUDY GROUPS SET UP? _ Roles Within the Groiips 'Three administrative functions had to be fulfilled for each group. Sometimes the study-group leader Would perform all threejpreparing for the meeting, chairing the meeting, and recording the attendance, Minutes, and resolutions, In a typical group, the chairpersbn was a mature man, perhaps a traditional tribal leader or another locally respected individual. To be the secretary, a man or woman had to be literate and otherwise able to keep an accurate record of the proceedings. (The leader was usiialtrhe only group member especially trained for the campaign.) Functions were ly literate freely switched around, depending upon local predilections. Where th person acted as the go9p leader, he or she would have to keep th ecords as well as guide the diicussions. - `In other groupi, confusion between the roles of the leader and the chairperson , created subtle problems. The Kiswahili title given the leaders, kiongozi, wa kikundi, carries an authoritarian connotation. A kiongozi is traditionally 'someone who gives instructions and strong suggestions (that are usually followed). Of course, this unfortunate chOice of nomenclature clashed with the leadership philosophy consciously propounded in the training seminars. In subsequent campaigns in Tanzania, a title that means "advisor," mshauri wa kilundb has been used to a7ld role conflicts and hurt feelings. . 1 . .,- . Group Memberships Some groups contained two members, others two hundred. Many of the bigger groups broke up'into small sections for discussion. The average group numbered 18. However, this figure conceals as much as it reveals; the great majorityof groups had 25 to 30 members, up to twice the ideal if 15 suggested during the training seminars. Larger groups were rribre common for two reasons: in some areas, the campaign proved more effective than expected in mobilizing people to participate in the groups; as has been seen, actual audiences °amounted to twice the precampaign audience estimate. The 75,000 trained study-group leaders could not ,cope with some V° million participants an still maintain ideal conditions. . The second reason for large group size i related tothe conversion of already organized literacy classes by adult education coordinators at the ward level. Many such classes (accounting for roughly 60 percent of all the groups) customarily met on Monday, Wednesday, and Friday, so that allotting either Monday or Wednesday to the health-education campaign was simple. The resulting Mtu ni Afya groups were hence the same size as the literacy classes, around 30 members. This cumber, while perhaps manageable where standard methods of teaching literacy ale used, 40 48 0 ' was not conducive to discussiorf and other desirable study-group activities. Where peopkiAoynd the &nu ni Afya material more interesting than the usual literacy topics, already crowded classes of from 30 to 35 people suddenly mushroomed to 50 or even 100. Since one campaign aim was to involve as many people as possible, most orOanizers welcomed additional members in spite of the impossibility of holding effective discussions in large groups. . , Meeting Times Grouek could meet at either of two radio-broadcast times, Monday or Wednesday afternoon at 4:15. Those without radios or unable to gather at one of these times net whenever they liked. The programming was planned to conform with the afternoon scheduling traditional for other adult-education activities. Of course, no one time or even one, of two timescould be convenient for everyone in so diverse a nation as Tanzania. The attendance registers of some 20,000 groups show a strong preference for Mondays, when almost three-fourths of the groups (73 percent) met; 18 percent met on Wednesdays, and 9 percent convened on other days: WHO PARTICIPATED IN MTU NI AFYA Characteristics of Group Members By the end of the campaign, background data had been received on about ese 300,000 of the estimated two million participants (slightly less than a sixt d male-todata show an attendance ratio of 51 men to 49 women. This bat female ratio compares with 62:38 for Mimi/ wa Furaha and . :57 for the adulteducation classes sponsored by the Ministry of National Education. The Mtu ni A fya ratios varied from area to area;-in some regions, women and men met separately. Even in the predominantly Muslim coastal areas, however, some women attended adult-education classes and some groups included both sexes. Although some Tanzanians still cling to traditional concepts of sex roles, women are becoming more and more active in adult education generally. That women made up nearly half the " study groups is eviderice of this trend. Certainly, membership of the " n is such pervasive efforts disease prevention depend upon the attention and participation of both men and women. (Early in the campaign, organizers fearedthat the subject of health edOcation would appeal more to women than to men, but their worries were dispelled as'the study groups began forming.), As had been the case ta,Miakati wa Furaha, the ag$s of study -group members ranged fairly evenly from 16 years to 40. Peopktbetweeh 20 and 40 years old (those th to change their practices, to establish most likely to be open to new ideas new homes, and so on) accounted for 5Mrcent of all participants, with 18 percent youngeand 29 percent older. 4t 49 )In terms of schooling, a statistically representative group of 20 p rticipants in Mtu ni Afya would divide up as follows., seven who had no formal education, seyen who had taken part in literacy classes, five who had finished one to four, ears of primary school, one who had completed between fivs and eight years Of primary school, and no one with any secondary education. Fully 82 percent of the Stealthcampaign rticipants had no more than four years of schooling. Overall. only 68.4 participants in Wakati wa Furaha fell in this same educational catepercent o gory. I eaching the target audience, unschooled rural people, M?u ni Nye clearly , anced the campaign preceding it.. out . . 1;----Having people of different educational levels working together in the study groups was advantageous for everyone. Each of the particirants, regardless of schooling, could talk 'about his or her experience with illness. Participants with different backgrounds made different contributions, and literates and illiterates worked together..Experience and thwillingness to share itnot formal knowledgewere the essential ingrecjients of active participation. Out of the 20 representative group members, 93 percent, or about 19, were farmerS. This increase over the previous campaign, in which only 72 percent of participants were farmers, is proof that Mtu ni Nye was on target in terns of occupation as well as educational level. Progress since the earliest Tanzanian campaigns, in which 25 percent of those enrolled were teachers, is plain t6 see; the restricted learning circle had given way to the mass campaign. d Attendance Rates and Patterns The attendance rates given in 1'1;0 Zior study groups in individual regions and for the campaigr)overall provide a basis for comparing the Mtu ni Nye campaign with other kinds of adult education. In Figure 4, attendance patterns are traced for the campaign overall (a) and for comparison by meeting day (b), by sex (c), and by status within the group (d). As the table and.figure show, the average attendance rate for all regions compined wa,.. 63 percent. This figure is not strictly comparable to Table 7 STUDYGROUP ATTENDANCE RATES BY REGION Attendarp rate Region (percnnt, Region 67 66 66 65 65 65 62 Sninyanoa Kgorna West Lake Tanga Ruvuma Coast Arusha Mtwara Irga LIrdi Mbeya M01090to K. " Singrda ,Mara ATTENDANCERATE OVE0 ALL REGIONS (lot which data ore avaibble) 42 50 Attendance rate (percent) 61 , 59 59 58 55 51 36 63 OP Figure 4 STUDV-dROUP ATTENDANCE PATTERNS OVER ALL REGIONS 100 100 80 8p 11 . x.60 60 Members only. Av. 63 131 a. 40 , -,, moor "..1.1.414111111111111111110r."=""111"11\00"Oso sootrO,_ 40 I masime,Monoay. Av. 64 (7396 0! groups) 20 _me Wednesday. Av. 62 (18% 01 groups) othsy days. Av. 55 ( 996 ogroups) I 0 2 4 6 Week 8 2 10 (a) General L.1 1 4 1 1 6 Week i 8 1 I 1 10 12 10 12 (b) By meeting day a 100 100 Group leaders. Av. 84 80 Males. A1(64 g e co s e 60 a) t.) a Females. Av 60 . f a 40 1 a. 6° Group members. Av. 63 40 20 2 6 4 8 10 2 12 4 Week (c) By Sex , 6 8 Week (d) By status 1 1 the 65-percent rate for the Wakati wa Furaha campaign, however, singe the relative audience sizes of the two campaigns were different: the national election-related campaign attracted a good many people, about 20,000, whereas the later national health campaign, based on what may have been a more popular topic, drew nearly 2.000,000. Despite the larger scale, Mtu ni Ma almost matched Wakati wa Furaha in hot dtr) g power. Compared with the average attendance rate for ordinary Rdulteducati classes in Tanzania, about 33 percent, 63 percent is excellent ---Pirt (a) of Figure 4 traces the overall attendance of study-group members for the twelve weeks of the campaign. Starting out at about 77 percAnt of the eventual total audience (some people did not join until several weeks into the campaign)., attendance-suffered its steepest decline between ,the first and second weeks.'. Presumably, quite a few people degided after the first meeting not to take part in the 43 51 t s. remaining group discussions. From the second week to the tenth, however, attendance fell only about 10 percent in all, a very steady pattern for an adulteducation class. ) But the graph in Figure 4 doesn't tell the whole story. Nearly a quarter cf the people who enrollegin study groups never turned up at all, as the first-day figure of 77 percent attests. For those who did attend the first meeting, subsequent attendance averaged 86 percent, a much higher indicator of participants' interest than the national average of 63 percent. Part (b) of Figure 4 shows how generalattendance divided up according to meeting dayMonday, Wednesday, of some other time. Over 90 percent of Mtu niAfya study groups met on Monday or Wednesday when the radio programs were played, and attendance patterns were virtually identical for the two days. But for the groups . meeting on other days and hence without benefit of radio support, attendance began lower, remained relatively erratic during the campaign, and fell more sharply at the end. The average attendance figure for groups without- radio support was 55 percent.'The averages for groups- that met on Monday or Wednesday were 64 percent and 62 percent, respectively. Regions known tot have the poorest radio receptionKigoma, Mara, and Ruvumaall appear at the low end of the attendance list in.Tfible '7. Evidently, radio support, though not indispensable, probably lends stability and hence improves attendance and (it is hoped) enhandes learning. ! Did attendance patterns differ between the sexes? Part (c) of Figure 4 shows twin ,att dance curves that average out at 64 percent for male participants and 4 perc ntage points lower for females. For the average-size Mtu ni Alya study group, eigh en people, this difference is too small to be significant. Finally, part (d) of the figure combines the attendance pattern for group members already seen in part (a) with the corresponding plot for group leaders. Predictably and fortuitously, leaders attended meetings more regularly than did members, at the respective average rates of 84 percent and 63 percent. The dual graph shows an interesting trend. The group leaders had fairly even attendance until the ninth week, where the lice drops sharply. The attendance of group members fell (forthe second time) the following week. That the two drops were related seems likely: members simply followed the leaders and dropped out. Once again, the role of the trained leaders is shown to be crucial. I Participation in Discussion s iscussion is People came to the campaign meetings, but did they participa the catalyst in the study-group learning process, and a major duty th leaders was active par*, to stimulate as many of their group members as possible to take Local supervisors who observed grotp sessions were asked to record the ns number of people who contributed to the discussions during their visits. Pe making at least one comment were counted. Visit reports came in for2,131 gro s in 52 44 %, nine out of Tanzania's eighteen regions in 1973.-In these groups, an average 58 percent of theRmbers participated in discussion. How should this figure be interpreted? In most of Tanzania's adult-education classes, participation consists of recitation and repetition of words and sentences. But these passive activities, appropriate for literacy instruction, were not the sort of participation that campaign planners had in mind. Instead. leadets were trained to model their-study-groyp sessions after ujamaa village meetings, where all kinds of contributions to discussions on any issue are expected and accepted. As we have seen, however, most of the study gm Jps were oversized, and nearly all were larger than the recommended fifteen members. In view of that disadvantage, along with the fact that the educational experience was new to most participants, 58 percent seems respectable. p HOW DID THE STUDY GROUPS TURN LEARNING INTO ACTION? 0 , Tanzania had seen several study campaigns before 1973, but the "Man is Health" campaign was the first to focus on action. This time. each group was to build some ;sort of health montiment, some physical evidence of environmental change !resulting directly from the campaign. The group leaders' manual 'contained Suggestions for projects that groups could undertake to' help prevent the various ,dIseases and health hazards discussed during the campaign. Many groups, after' analyzing their particular situations, cunt up with original and effective projects of their own (In a Jaterpart of this report. the.campaign's effects on the-households of eight villages that were the focus of a special before-and-after study are examined.) Many study groups did take up tasks suggested in the campaign materials. The most common Of these activities are listed in Table 8. with percentages of groups participating in each based on reports from the 2.131 study groups. The supervisors' report form included space to indicate what resolutions groups made and whether or not those resolutions were transformed in act lat ote that most supervisory visits took place during the firs Jew weeks paign, so that only activities relating to the campaign topics presented earls. ere reported.) Malaria was the4ubject for the first two weeks, and more than 1.200 of the group actions reported related to its prevention. The lessons first established that the mosquito cares malaria Although thit relationship had been known in medical circles for many yeari. most villagers in Tanzania were as unaware of it as the fellow who said. ever knew that malaria was,caused by this mosquito." (As mentioned earkaT, eople in different localitiescallednialana by different names and treated it differently as well ) Once the mosquito was iiritified as the culprit, the next step was to destroy its breeding places. M Table 8 s ows. musquitoeradication practices included clearing away large-leafed plants that grew near houses; destroying broken pots. old tins, and other cqntainers that held stagnant water; and even draining' ponds and larger bodies of water. 45 53 "Tibia 8 STUDY-GROUP PARTICIPATION IN CAMPAIGN:RELATED ACTIVITIES Participation by groups' (percent) Activity 28 20 Clealling arenaround houses and clearing away nearby vegetation Bah:ling rebuilding or repairing latrines Destroying containers holding stagnant water Boding or biterer :-..-vf.--- or both Cleaning areas aftnd water sources 19 12 I Draining bodies of vagnant water Using mitecticdes or malariapreventing medication, or both Dgging rubbish lilts . Th9fling *OS Making racks or stands to hold eating utensils Av 0 id i n g km* use of drinking containers and cgaredes.` Airing bedding in the sun 'Covering food Collecting materials for construction t 11 5 5 4 3 3 3 2 2 1 Some groups pursued more than one activity. The building of latrines was the next most common activity. About one-fifth of the groups visited had built or repaired latrines. In one district, Dodoma, latrine building took On truly monumental proportionseach house had its own latrine. There, TANU officials had called for a latrine for every house, along with other development projects, in a resolution proclaimed soon after the campaign began. A few irritated villagers in Dodoma complained about neighbors who tried to sneak into neajby latrines rather than build their own. One villager thwarted such trespassing by putting a padlock on his latrine door; an offender got the message and promptly built his own. In I ri nga, people felt alatrine for every house was not enough, and were concerned about travelers waiting along the roadside for buses; accordingly, they agreed to build a latrine at each major bus stop in the area. \ Hundreds of thousands of latrines were constructed in Tanzania as a result of th Mtu nj Afya campaign. This trend, if it continues, cannot help but reduce the incidence of diseasessuch 'as hookworm and schistosomiasisthat are transmitted through human waste. Most specialists in preventive medicine feel that latrined and a pure, plentiful water supply are two of rural people's best defenses against the spread of most diseases. Accordingly, water also received considerable attention fromthe study groups. In some parts of Tanzania, the same spirit of cooperation that prompted people to build latrines moved them to dig wells. Members in 253 groupt of the 2,131 surveyed both. (The figure of 12 reported that they had begun to boil drinking water, filter it percent carrying out this activity may be high, but checking its reliability would be difficult.) Certainly, awareness of the direct correspondence between safe water and good health rose; an independent study of self-help water schemes confirms 46 S. 54 the trend (Tchannerl, 1974). Yet the concept of safe water is not an easy one to get across; Many rural people persist in thinkingthat all piped water is safe. The national hea ?th campaign stressed that "clean" water is not necessarily "safe" water, even though the two may appear identical to the naked eye. ' Tuberculosis (TB). was alpe covered early in the campaign. -The .campaign literature and, radio programs rebommended a number of measures aimed at preventing TB, including enlarging windows to allow more light and ventilation, boiling cow's milk, avoiding spitting in public areas, and getting vaccinations for everyone, especially children. In area after area, study-group discussions on how the disease spreads via the saliva of an infected person inspired original resolutions and actions beyond what had Leen suggested. People in most parts of,Tanzania drink locally-made alcoholic brews out of a common container. As health campaign participants started to realize that they could be passing TB around with the beer, many local bars begun to offer customers individual drinking vessels. In some places the similar practice of sharing cigarettes was also labeled ,a dangerous habit, and at least partially eliminated Once people understood how they could fight TB, they actedeven against the grain of custom.- . One afternoon in the Mwanza region, for example, a Mtu nt Afya study group gathered around the local schoolteacher's radio to listen to atroadcast about tuberculosis After the show, group members studied the material in the textbooks and began to discuss TB symptoms As they talked, they realized that one of their own group showed those very symptoms. Group members determined that their friend's affliction could affect the health of everyone in the area. Together they decided that they all had some responsibility for the health of the community, and they took up a collection to pay for sending their colleague to a hospital for diagnosis and treatment. In the spirit of Mtu ni Afya, activities were limited only by the imaginations of the participants Some groups collected money to buy mosquito nets or malaria tablets. One town in Morogoro now dotes its marketplace twice a week for cleaning by volunteers In a town on Mafia Island, citizens occasionally stop what they are doing to help pick up rubbish and clean up COMMON PROBLEMS Clearly, the groUps did not always function ;smoothly. Apart from the major problemthe unmanageable size of many groupsvariOuS other shortages and shortcomings beset many study groups Although group leaders managed to find room for Iwice the anticipated number of participants, they had no way to ;nultiply the study materials. Only one million sets of the textbooks were printed In addition, distribution of both. participants and books was unevenin some places books became dog-eared while in others they lay unopened In the West Lake region, for instance, more than four times the number 0'1 people expected enrolled in the campaign Following pre-campaign estimates by local adult-education officials, organizers sent 50,405 sets of books to West Lake, 'I 47 ot- 55 yet, study-group members numbered 235,000 there. A few groups had only one book each. On the other hand, one or two districts had too many books. tilfortunately the reporting. system was too slow to allow redistseution of these excess texts un I well into the campaign. Existing communication networks in Tanzania linked all stricts -directly wit) their regional headquarters. Districts adjacent geographi lly but belopging to different regions communicate only rarely, andShen only wit ifficulty. Take the cap of Arusha's Mbulu district and Dodoma's Kondoa strict. The headquarters of the two districts are only 120 to 130 kilometers part. Before the campaign, Mbulu received a large surplus of books; meanwhile in Kondoa, the textbook shortage was severe. Poor communications kept these neighboring districts from making the simple exchange needed. Many groups were unequipped for action, though rural development field-Staff members and people at Local depots of Communication and Works (the ministry rks) all helped. Such activities as digging latrines, draining responsible for publi r pipes, and drilling wells require the use of spades, picks, and ponds, buryin other impte ents; and necessary tools, were frequently in short supply Local extension officers received numerous requests for equipment, which pointed up the necessity of cooperation between various ministries. Proof soon accumulated that rural health should not be the sole concern of health personnel or of adult-education office", thus, inter-ministerial cooperation became a major by-product of the Mtu ni Afya campaign. so, That 80 to 90 percent of Tanzanians understand common language, Kiswahili, is an important national asset. But scratchy words heard over a malfunctioning radio set are harder to comprehend than the same words spoken by a next-door neighbor. Mordover,"most radio programs were recorded in the coastal areas where people speak relatively fast, and many complaints about the pace of speech on the campaign's radio shows appeared in interim reports. Language problems also arose in connection with the group-leaders' manual The study guides were scrupulously edited for vocabulary level, but the leaders' manuals were put together less carefully. Consequently, at least a few of theleaders never even glanced at their manuals once the training seminars ended d The figure for average part ipation by members in study-group discussions, 58 percent, failed to fulfill the opes of some campaign organizers Yet, in light of general experience with aduq education and health practices in Tanzania, this result . reflects well on the health campaign and on the study-g up method. In moving groups from discussion to action, however, the campaign was an unequivocal success. As reports began to come in on the kinds of activities that were carried out in the various regions and districts, it became clear that the 48 56 b \ message that discussiOn alone should not constitute the entire ac ity of the group had been accepted. The new kind of learning that went on during the Mtu ni Alya campaign reached many people in a way traditional approaches used in othecadulteducation programs never had. The proof was in the efforts people made to improve their health. . The total number of person-hours that went into activities inspired by the "Man is Health" campaign cannot be counted. Consider latrine-building alone. If the average-latrine took 50 hours to construct, the estimated 750,000 latrines (based on district reports) built in Tanzania represent 37.5 million person-hours. If the Ministry of Communication and Works had paid workers one Tz shilling an hour to do the same, the cost would have been 37,50qopo Tz shillings. The campaign itself cost only 1,942,000 Tz shillings.* The gains from a single activity among the many pursued by Mtu ni Atya participants are staggering. P This figure represents "externally financed" campaign costs that is, those not absorbed by the participating ministries and agencies) The Appendix of this study outlines how the external funds were spent. / \. --, .49 57 MEASURES OF OAMPAIGN.IMPACT a Chapter 4 answered a number of questions bearing on the impact of MN niAfya. But campaign planners did not intend to rely solely on routine datatotal enrollment,__ regional distribution of study groups, and attendance rates and patternsto evaluate the campaign's effectiveness. They wanted to see how well specific health messages got across to Tanzanians, and so provided for two more measurements, how much knowledge was gained by study-group participants, and how many) villagers adoptad certain health practices as a result of the campaign. KNOWLEDGE-GAIN TEST To gauge the redo study-group method's effectiveness in conveying information, campaign organizers arranged to test members of study:grotlps located in four representative regions Those partiCipants, including both ujamaa andnon-ujamaa villagers, answered a single set of multiple-choice questions twice, once just as the campaign began, and again after the campaign. ' Selecting Study Groups for Testing The study groups chosen for testing were located in four different regions. Coast, I ringa. Mtwara, and Mwanza Within each region, groups from both ujamaa and nonujamaa villages were to be.aelected Control groups, which were not to take part 4n Mtp ni A fya but were to Continue their programs of literacy and political education during the campaign period, were also tested. Campaign organizers were particularly eager to compare the progress of ujamaa and non-ujamaa villages Some adult-education and community-education workers in Tanzania feel ujamaa (or cooperative) villages make better learning environments than dog traditional villages As the argument goes, ujamaa villagers, who make a voluntary change &life-style when they join a cooperative community, probably possess a relatively high degree of political motivation that could be expected to carry over into health studies and Other activities. At the least. the social discipline and the emphasis on collective milk that characterize life in ujamaa villages would seem to augur well for good attendance and full participation. Unfortunately (if only for evaluators), the notion of a control group conflicts with the aims of an intensive campaign When the idea it to mobilize every person possible, finding someone (much less an -entire group) who will not take part is difficult indeed On Mafia Island, an especially politically active part .of the Coast region, there were no control groups since TANA felt that in such a national campaign all people were entitled to participate. In Mtwara, a similar situation developed at the control group, swept up by the excitement of the campaign, participated as fully as any of the officially sanctioned study groups. That control 51 58 Y groups were not also divided between ujamaa and non-ulamaa villages was a major . flaw in the experimental design. Developing the Test a In Apri) 1973, the Institute of Adult Education drafted 25 multiple-choice questions based'oft the health lessons contained in.the radio programs andin the textbooks. The test was edited for vocabulary level and then tried out on about seventy-five adults living in both urban and -aural areas. The results of this trial helped the evaluation team to weedkout ambiguous or otherwise weak questions. The final test was reduced to 13 questions and was administered orally to individual stud, -group members by their leaders under the supervision of district adult-educationZfficers. The pre-test was given during the week between the first Arid second study-group meetings; the post-test followed the final ,meeting. TO-St-Results The mean scores of the study groups tested in each of the four regions are shown in Table 9. Campaign evaluators studied these results for answers to three \ questions. . First, did Yhe pre-test and post-test scores of the experimental groups (those participating in the campaign) differ significantly? In other words, does the radio study-group method work? Apparently, participants did learn something about health and disease in the brief period of the campaign. On the average, Mtu ni Afya study groups showed a rise in score from 43 percent to 63percent, fora percentage improvement of nearly 47, significant at the .01 level. d, did the experimental groups learn significantly more than the control Se grow s2 As mentioned before, abiding by the goals of the campaign made rigorous isolation of the control groups impossible. Most members of the control group not only knelk of the campaign, but also participated in it actively. Thus, results showing knowledge gains of experimental control groups could be spurious and should be evaluated accordingly. As the table shows, the experimental groups, comprising a total of 185 members, gained an average of 20 percentage - points from pre-test to post-test, improving their collective score by almost 47 percent:The control groups gained only 9 points for an improvement of 19 percent. The difference between the two scores-28 percentis statistically;significant at the c).05 level. Third, did the ulamaa village group-members tend to learn more than the other participants? Table 10 divides up the test re§ults for experimental group members according to village type. There is a difference of 7 percent in the test-score gains of cilamaa village participants over others (gains that represent improvements in test scores.of 56 percent and 35 percent, respectively). This better performance on the part of uiamaa village groups is significant at the 0.05 level. In this case, these results must be viewed with skepticism and serve only to highlight what is an interesting 52 Tauter 9 KNOWLEDGE-GAIN TEST RESULTS F? Number of study-grilup members ion °group , C 'G . Percentage improvement' Mean score on post-test Mean Score on pre-lest - . '..) .--7..........(percent)._ T" i 5 roue 2 IRINGA Group 1 80 63 39 13 .56 27 44 86 58 63 43 23 70 56 19 114 64 I 31 18 60 47 37 47 15 25 12 16 22 15 41 39 47 54 69 15 39 66 23 24 Group 2"" Group 3 Group 4 MTWARA Group 1 Group 2 Group 3 Group 4 Group 5 1 M WANZA . 33 56 . 68 69 4t Group 1 "' 11 Group 2 18 . _Group 3 11 41 Group 4 8 63 AVERAGE SCORES FOR EXPERIMENTAL GROUPS (185 members) AVERAGE SCORES FOR CONTROL GROUPS (35 members) 47 66 15 61 82 49 30 43 63 47 49 58 19 .A1 61 . .. 8 Percentage improvement calculated.as follows (using scores for first group listed and rounding olf). (80-63)/63 x 100 - 27 "Mafia Island only "'Control group' , V4, Table 10 KNOWLEDGE-GAIN TEST RESULTS UJAMAA AND NOUJAMAA STUDY-GROUP MEMBERS village Number of sluaygroup members Mean score on pre-test Mean score on post-test Percentage improvement' (percent) ' Ujamaa 89, 41 64 56 NonUjamaa 96 45 61 35 ' 'Percentage improvement calculated as in Table 9. 53 60 , question for further research. (Strictly controlled experiments that more selectively eliminate sources of score bias would need to be made.) HEALTH-PRACTICES SURVEY Improving health was what Mtu ni Afya.was all about. Recording the health practices each of the roughly two million participants adopted would have been impossible; yet,Zenpaign evaluators wanted to know in what ways the campaign had changed most villagers' lives. Limitations of funds and personnel compelled planners to.select with care both the focus and the content of their health-practices survey. Choosing Target Areas Campaign organizers felt sure that those villagers participating directly in study groups would be affected by the campaign and that the effects needed only to be measured. But'what about the participants' neighbors? Since the campaign was aimed at promoting change that would benefit the overall village, evaluators chose to focus on health practices at this level. Financial restrictions limitedlhe number of villages surveyed to eight. Since eight villages cannot be called representative of the nation as a whole, each survey is actually a case study of what changes Mtu ni Afya inspired in a particular area. In light of numerous observations of group actions all over Tanzania, however, the eight villageg surveyed appear in no way remarkable in terms of enthusiasm or participation Care was taken to ensure that residents of the villages surveyed remained unaware that they were under special scrutiny. I The main criterion for selecting a target village was that at least one "Mn is Health" study group would operate there. Differences in culture, climate, and political activism were also taken into account. Four villages in each of two regions were finally chosen, as follows:* , DODOMA Region Bahi Sokoni (ujamaa) Buigiri Mission (ujamaa) Hombolo Bwawani (ujamaa) Mvumi Ikulu (ujamaa) COAST Region Kaloleni Kerege (ujamaa) Kihimbwa Kikcingo ( ujamaa) The four villages in Dodoma are all ujamaa villages formed as a result of TANU's Operation Dodoma in 1971. Each of the sites had been only a small settlement before the Operation, but the new villages are large, each comprising from 350 to 600 houses. In contrast, the Coast villages (which became ujamaa villages in the 1960s) are all long-established settlements containing between 30 and 120 houses each. For brief descriptions of the villages, see Hall and Zikambona. 1974 54 61 0 Developing the Health-Practices Checklist The survey'wes-based on a st of visible health practices. One suggestion made to the study groups, for exortile, was that ,yetfelation immediately surrounding houses be cleared to eliminate likely breeding place3 for malaria-carrying mosquitos. Whether or not this suggestion was implemented could be easily seen. (Direct observations were considered important because answers to verbal questions on health practices were sometimes evasive.) Whether people really were boiling water was hard to tell, but a new latrine was concrete proOf of a change in health habits. . / An initial health-practices chpcklist was developed by the National Coordinating Committee and tested by Tanzanian medical students who were doing field work in Morogoro a few months before the campaign. A final version was developed on the basis of the pre-testing, and a complete set of instructions was developed for the survey-takers. The final health-practices checklist appears in Figure 5. A number of the individual items are explained in more detail below. Item 1Health education officials decided that vegetatiOn must be absent within ..., fifteen feet of the house. Item 3This question had to be answered verbally, since entering people's . bedrooms was not thought proper. , Item 4That is, did all windows have mosquito netting? t i c Item 5In the pre-campaign sur7ey, observers counted only latrines with solid floors, four walls, and roofs In the post-campaign survey, however, question 5 had to be modified tisp read, "Has a latrine of any kind been built or rebuilt as a result of Mtuni Alya'," The standards called for in the campaign textbooks end radio programs turned out to be unrealistic Not only was the standard latrine to have a floor, tour walls, and a roof, it was also to be placed over a pit twelve feet deep. (The kinds of latrines actually built are described in the next section.) figure 5 HEALTH PRACTICES CHECKLIST Is Mete vegetation glowing neat the house, Are Mere depressions, holes or leceplaCes of any kind near the house that could hold stagnant wale'', 3 Is Mete mosquito netting over the bed(s) in the Ledioom(s)9K--4 Is Mete mosquito netting on the windows') 5 Is Mete a latnne that meets Mtu rif Afya standards' 6 Does the latiine have a covet') 7 Is the latrine being used' 8 Is the courtyard around the house free of rubbish) 9 Are Mete any animal feces near the house') 10 Ale them any 'wi' other vermin, or other pestS visible in Of around the house; 11 Does the houatrhave any windows') 12 Are there a lot of flies in or around the house') 1 2 55 62 $ Item 7Survey-takers were told to inspect the paths between latrines afid houses. An untrampled, grassy path was a sure sign that the latrine was not in use. Item 9The animals in question were mostly cows, goats, and dogs. Item 10When observers asked villagers about vermin land other pests, people generally seemed willing to discuss the problem and to accept practical advice. Item 11In keeping yith the recommendations given in the course of the campaign, a window was defined as a covered aperture at least two feet square th'it could be opened to admit fresh air and light. Item 12This question provoked a lot of .controversy. CImpaign m6e.kials emphasized heavily the threats flies pose to good health, and urged general cleanliness as well as the exterminetion of flies. But survey-takers could hardly be expected to count flies one-by-one. Organizers thus finally decided that since all observers would have similar educational levels and backgrounds, their ideas Of what constituted "a lot" of flies would be fairly consistent, but this problem was never satisfactorily resolved. Evaluators the oet lice survey to two uses. Fol each village, the checklist was usedio measure o erall action to improve health. Households were awarded one point for each h alth practice followed, so total scores ranged from 0 to 12 points. The scores of all h useholds in a village were then averaged to produce the village health,-practices i dex. The difference between the pre-campaigrl index and the post-campaign i ex was used as a measure of health improvements for .the village as a whole. The survey results were also examined from the standpoints of the individual health practices. Which practices were most prevalent. which seldom seen? Surve; Results Table 11 lists the health-practices indexes both before and aft r the campaign for the eight villages surveyed. Note again that every house in each village was checked, not just the homes of study-group members. All eight villages showed an increase in positive health-related activities, as indicated in the right-hand-column of the table. A strdng seasonal factor must be taken into account in interpreting the scores for the Dodoma region. A major item making up the health-practices index was the clearing of vegetation away from houses. During the pre-campaign survey in March, the rnpize crop in Dodoma was at its highest, obscuring village houses almost completely from view. When the post-campaign survey was carried out in September, however, the crop had been harvested. Of course, the rises in the Dodoma health-practices indexes must be laid at least partially to this exaggerated improveMent'in the first item on the checklist. 56 63 A s1 Table 11 HEALTH- PRACTICES SURVEY RESULTS, BY VILLAGE Region and village Number of houses Mean post-campaign health practices index Mean pre-campaign health practices index . DODOMA. Bahi . &riga . 335 365' 528 493 . Hombolo Mvum, Regional Averages 1,720 43, 2.1 Percentage 105 46 54 48 80 2.2 32 (26) . (4 4) 45 (61) 31 30 4- 'COAST Kaloleni Kerege 120 38 88 Kihinema Kikongo Regional Averages 34 122 364 69 2.7 49 (46) 66 (66) 96 35 (42) .2.084 36 55 60 OVERALL AVERAGES . 6.4 a2 53 4:1 imixovement . 68 19 Percsmage improvement calculated as in Table 5.1. Collectively, the eight villages (comprising 2,084 houses) showed a rise in health- practices score from 3.6 before the campaign to 5.5 afterwards, a 60 percent improvement. (Correct results, however, Mvu distortion caused by seasonal changes in the Dodom small improvement becomes negligible.) Initially, the table shows, the Coast villages boasted health-practices SC.Qi s considerably higher than those for Dodoma. Coast's average pre-campaign inde 4.6 is' nearly double Dodoma's 2.6. Kerege's outstandingly piW,,pre-campaign score of 6.9 reflects the village's special nature. Beginning in Wady 1960s, the Tanzanian government invested a good-deal of money and effort in this ujamaa village, making it almost a mddel of its kind. That the investment paid off is evident in the condition of the houses and in the health habits of the people in Kerege. Table 12 breaks down the survey results by practice. Neither the health-practices categories nor the numbers irlthe table represent all the changes inspired byMtu ni Afya; they merely indicate that improvement did occur in the course of the campaign. The creativity of study-group participants both in modifying the health practices listed and in thinking up new ones in response to their own situations is only hinted at in these figures. The discussion below amplifies the results shown in Table 12. Progress related to the first health practice listed, the clearing of vegetation, has already been discussed. The second health practice was met by filling in small holes and discarding broken pots and other useless receptacles. Overall, the 2,084 houses'increased their observance of this practice by about 54 percent, with'some 57 64 4 a Table 12 HEALTH-PRACTICES SURVEY RESULTS, BY PRACTICE. FOR 2.084 HOUSES IN THE EIGHT VILLAGES SURVEYEb 0 Number of houses, pre-campaign Health r:ractice 1. 2. 3. 4. 5. 6. 7. Elimination of vegetation growing near hosuse Elimination of stagnant water near house Mosquito netting in bectoom(s) Mosquito netting on windows Latrine meeting Mtu ni Atya standard Cover on latrine Latrine in use a Elimination.? rubbish around house 9 \ Number of houses. postcampaign Percentage change* 286 357 136 84 494 328 1.916 +570 548 + 54 147 +, 8 421, 421 _939 + 32 335 685 - 32" 1,248 1.223 1.399' Ehitunation of animal feces near house 111 +109 +123 +182 - 13 la Absence of rats or other vermin in or around house Windows in house (2. Absence ()I "a lot" of flies in and around house 11. '''' 503 . 245 818 . 773 375 1,572 + 46 + 53 + 92 11 Percentage change calculated as for percentage improvement in fable 5-? "Because the criteria lot latrines were relaxed at the time of the post -survey. some latrines counted in the presurvey were, apparently. later not thought to be of standard quality. villages showing no change and others registering improvements of over 144 percent. Since the Coast villages he within Tanzania's coastal rain belt, this practice was more applicable-there than in Dodoma, which is dry most of the year. With respect to the third and fourth practices, putting up mosquito nets meantr. buying them first, and lack of money, proved to be a limiting factor. Bahi Sokoni, with the most severe mosquito problem of the four Dodoma villages, added the most mosquito nets; by the end of the campaign, twenty peop)a-therd had equipped their bedrooms with nets. Adoption of this practice irias muctispottier in the Coast region, where only, Ahree or four houses in each village put up new mosquito nets. Coast region's Kerege ujamaa village again stood out as the only village of the eight where netting was added to windows (item 4). Ker,gge's pre-campaign health- practices score was high, despite the fact that not one house there had window netting before the campaign. Afterwards, however, 14 percent of the windows of Kerege's houses sported mosquito nets. - On a national basis, the digging of pit latrines proved the most successful single activity of Mtu ni Alya. For the eight villages surveyed, however, as Table 12 shows, the number of latrines meeting the study-guide standards ,(see item 5) actually declined during the campaign period. As explained earlier, these standards'were beyond the reach of most rural Tanzanians. But people built many latrines of their own design, and all kinds of latrines were counted in the post-campaign survey. Table 13 lists the results of that survey. 58 65 .) 4 Table 13 N...., ( . LATRINES 8 <JILT OR REBUILT DURING CAMPAIGN IN THE EIGHT VILLAGES SURVEYED ii Region and Wage DODOMA Bahl 841 Hombo to' Mvu Mr Rego nal Average COAST Kaloleni Kerege Kihimbwa KOcongo Number of new or rebuilt latrines Number of houses ,.. 335 364 528 493 , 1,720 108 25 38 43 22 558 32 138 227 .A 88 22 49 . 34 15 120 57 122 Regional Average OVERALL AVERAGE latrines 85 . Percentage of houses with new or rebuilt 2.081 18 56 44 47 143 39 701 :34 'Only latrines that met campaign standards were counted, The table shows that a total of 701 latrines were built or rebuilt in the eight villages during'the campaign period, accounting for roughly 34 percent of the 2,084 houses' `in all villages combined. The figures for Dodoma are conservative since the post- campaign survey was done in late September 1973, when Dodoma's latrineconstruction activities were just getting into full swing. As later reports show, nearly every house in Dodoma had a new latrine by December. Many of Dodoma's new latrines werewalled with maize stalks or similar plant materials and were roofless. Many of the villagers said they planned to add roofs to x- their latrines as soon as they had reinforced thp walls.with, mud. By the end of the campaign, several people had demonstralddthe feasibility of this plan by completing their latrines this way. Most Dodoma families allowed room for a bath in building latrines, so that some were nearly as large as houses. Returning to Table 12, we see that the number of latrines with covers (item 6) more than doubled during the campaign period. The overall positive change rate of 109 percent reflects individual village improvements ranging from 21 to 700 percent. In general, the Coast villages implemented this practice to a greater extent than did the villages in Dodoma. The success of efforts to get latrines covered grew as the seventh health practiceusing latrinesgained popularity. The average rate of latrine use increased 123 percent in the eight villages, including a steep 370 percent climb in Kaloleni. That latrines were built did not always mean that they were used, and latrines serving merely as pristine symbols of status or progressiveness were not the . 59 sort of "monumeris"Mtu niAlya planners had in mind. For many Tanzanians, using latrines meant breiaking powerful taboos. The custom in some places is that thq feces of fathers and children, particularly those of fathers-and daughters, are not mixed. More generally, people" find the expanse, of the God-given bush a more ratDral setting than a small house for eliminating bodily wastes. In view of these and other traditional beliefs, the marked increase in the use of latrines by Tanzanians was one of the campaign's greatest Accomplishments. A In many people's minds, Mtu ni Alya meant cleanlipess. The village environment, houses, and even the people themselves appeared cleaner when the postcampaign survey-takers come around. The increase in the number of tiouses and codityards free of rubbish (iterrVit in Table 112).-r18? percent more after the campaign than beforewas the biggest improvement in the campaign, except for the removal of vigetation, which nature took care of through the harvest, Falling also Within the category of general cleanliness was the question of animal feces, the ninth item in Table 12. Study-group members learned that the wastes of domesticated animals (including cows, goats, and dogs) often contain the eggs of worms and other parasites harmful to people, and that feces also attract diseasecarrying flies. Yet the campaign made no detectable dent in the habit of leaving feces around houses in the villages surveyed; in fact, such animal refuse surrounded 13 percent more houses after the campaign than before. In Dodoma, pabple customarily keep cattle in the immediate courtyards of houses to prevent theft of the animals. Consequently, large piles_ of manure lie near the houses. Efforts are being made to encourage people to keep cattle farther away from houses. The tenth health practice in the table, concerning the presence or absence o f rats and other pests, is another aspect of general cleanliness. The cami,aign materials urged people to make their homes unattractive to such pests by storing food carefully and by eliminating places where small creatures like to live. Within the modest overall Improvement of 46 percent, success was mixed Bahl in Dodoma region and Kikongo in Coast region both showed iargedecreases in the number of houses where pests were found, in the case of Bahl, this &crease corresponded with general imprOvements in cleanliness. Like building the latrines, implementing the eleventh health practice, creating or enlarging windows to meet Mun/dye specifications, required special efforts by the villagers. To improve lighting and ventilation in houses (partly as a defense against tuberculosis), the use of windows two feet square or larger was stipulated in the campaign materials, only such windows were counted in the surveys. The overall improvement in this category was small, 53 percent. but change was much greater in some villages than in others. Kerege. ;ong established through substantial government support as an comae village, already had large windows in 62 percent of its houses before the campaign. Kikongo started out as a sisal estate, and about 40 percent of all houses there had large "Western-style" windows. No more than 14 percent of the houses in the other six villages had even one good-sized wihdow before the campaign. Two people in Mvumi eagerly pointed out to,the survey team how they had enlarged previously existing windows in their houses" mud walls, according to them a fairly simple task. 60 67 ' . Thyie h and final observation, the troublesome one of the numbers of flies around houses, was included in the survey despite measurement problems because the study guides and radio programs had so heavily emphasized flies' evils. As fieldwork since has suggested, however, the number of flies in a given area at a given time depends only partly on general cleanliness, absence of animal feces, and so on. Seasonal variations may influence fly populations. In the Dodoma villages, where the cattle are kept near the houses and where animal wastes were even more apparent after the before, the numberzf houses free from "a lot" of flies was up by nearly 50 at the campaign's end. In some Coast villages, on the other hand, a virtual one-to-one correspondence between the two practices seemed to prevail: a house free of animal feces was a house with few flies. Interpretation of these divergent findings is difficult; seasonal variations and flies' breeding times are poorly understood factors that call forfurther attention. At the time of the follow-up survey, Dodoma had been without rain for seven months; perhaps this severe shortage of water reduced the numbet ol flies. CAMPAIGN FOLLOW-UP AND INTEGRATION WITH NATIONAL HEALTH SERVICES A A lengthy discussion of the need for planned follow-up activities began in the early stages of the planning of the campaign. It fed to the decision to vary follow-up activities according to regional health, problems and priorities. most groups would continue to implement the agreed-upon activity, but systematic follow-up of some kind would be necessary. Two provisions were discussed in this regard. regional campaigns on local health problems and a second-phase, large-scale national campaign on.nutrition to begin in 1975. .1Iv The handling of the question of regional campaigns was perhaps one of the major weaknesses of this program. As the campaign was beginning in April 1973, each region was asked by the Regional Development Directors to identify typical or chrotp regional health problems. The National Coordinating Committee agreed to help develop educational materials for such regional efforts. In at least one case, this .. , pattern worked very well. Shortly after the campaign began in the Arusha region, in the Meese' district m organizers and villagers began saying that the subject pf the campaign as planned nationally was of no relevanCe to. their region. They suggested that a ampaign on venereal diseases was needed more Officials in theslistrict explained that the incidence of venereal, diseaSe is usually high in the Menai district because of generally late marriages and a general freedom of sexual relations among males and females of the same age. As the age -pets' are pan-Maasai and there is much travel from place to place with the cattle, venereal disease has spread rapidly. The idea of a VD campaign was actively supported by Arusha's regional medical officer, and educational materials were prepared for the region. The VD campaign was a Manned . Age -sets' reflect the custom whereby tribal members morfrom bne role in society to another as they grow older Until they are married. most young Maasai assbme the somewhat nomadic life of cattleherders 61 68 , combined identification, treatment, and education effort and proved very popular. In fact, the materials prepa. ed for Arusha have since been used in several other areas, including Dar es Salaam, on a smaller scale. Other proposed topics for regional campaigns included trachoma (conjunctivitis) in Dodoma region and malaria in Mtwara. In Bukoba, plans were made and printed materials prepared for a local nutrition campaign. Unfortunately, only the Arusha regional campaign ever took place lack of time and money, and a feeling on the part of many officials that these kindS of efforts weremot interesting, promising, or effective were the constraining factors. In addition, there was general agreement. among the organizers of the campaign that the question of follow-up had been left until too late and that this lack of immediate systematic follow-up represented one of the most serious flaws of the program. Yet another weakness in the campaign overall was its lack of adequate integration into the health infrastructure. linkages with the curative services in the. field were weak at best. To a large extent, the b'_ me for this failure lay not with the campaign organizers themselves but with the nature of the services offered by the Ministry of National Health Nevertheless, because of the success of the "Man is Health" campaign, much stronger links were formed between the health ministry -anclihe ''Food is Life" campaign that would begin in June 1975: On a more positive note, the network of study-group leaders was not allowed to crumble this time as it had been during the preceding political education campaign, the names of all study-group leaders were maintained at divisional offices, and these leaders formed the core for the nutrition and food-production phases of the mass "Food is Life" campaign At the time of the campaign.the Ministry of National Health was beginning to make policy pronouncements of sppport for preventive medicine, but funds for prevention were not yet. matching the rhetoric. So while the Department of Health Education gave 100 perent of its time and staff to the campaign, this action' carried little weight with most doctors, who continued to see health care in terms of Western curative practices (Gish, 1975) While early in the campaign many persons within the Ministry of National Health doubted the usefulness of a campaign ut this nature or the wisdom of having the Institute of Adult Education guide such an effort, the commitment of the health-education unit and the health-education field staff was active and full Campaign organizers came to feel that the strong continuing impact of a campaign such as Man is Health depends on combining permanent. active village-health committees linked to expanded primary health care with periodic mass campaigns e29 k .24 \TANZANIA'S MASS CAMPAIGN: EFFECTS AND IM. PLICATIONS FOR.DEVELOPMENT PLANNERS Tt!e party guidelines of the Tanganyikan African National Union (1974) clearly and forcefully state what "deveropmenr"means in the context of the Mtu ni Afya 'carnp'aign: r For people who have been slaws or have been oppressed, exploited and disregarded by coloqialismor Capitalism, development means liberation. . . . If development is to benefit the people, the people must participate in contiderifig," plaliningsand implementing their development plans. The duty of the party is not to urge the people to implement plans which have been decided upon by a few experts or leaders. The duty of the party is to ensure that the leaders and eperts implement the plans that have been agreed upon by the people themselves. When.the people's decision requires infortpation which is only available to the leaders and the experts, it will be the duty of the leaders to make such inforthation available to the people:-But it is Aot correct for leaders and experts to usurp the People's nght to decide on an issue rust . . because they have the expertise. For Tanzania, Mtu ni Afya pioneered,toward these goals of informing the people and of promoting their primary role in planning for their own futures and in implementing those plans For those concerned with development in general and with rural development in particular. Tanzania's Man is Health campaign warrants careful consideration Zs. 1,0 EFFECTS OF THE CAMPAIGN Of all participants in the health study-groups. 90 to 95 percent were farmers. Educational planners have shown in study after study that the balance of urban and rural educational opportunities continues to be weighted heavily against rural peo-01e, especially the rural poor In Tanzania. it was precisely this neglected group of rural and unschooled adults that benefited most from the campaign approach Rural people never before called upon to think creatively need help Betting' 'started Villagers_may have grown accustomed to leavig major decisions about the most fundamental economic relationships within theircommunity to others, be they agricultural extension agents in the neighborhood or poll yrs in the capital Thus, colonial habits of decision-making may linger long.after e end e encrs An `experience in one Tanzanian - village illustrates this point.. ormer employees of a sisal estate were made its owners and managers Unable to believe their good fodune. they allowed production to fall sharply to their own direct detriment. 1 3 6. 70 . Today: when many nations' deVelopment policies stress increased involvement of the poor in their futures, change is slow. It takes time ior people to rediscover that they have power and creativity, and that they can initiate positive alternatives to their present options or lack of options. While coming to grips with one's newly discovered power does require time, education can helpif the right methods are used. Agricultural "extension" methods that merely pass on knowledge of crop improvementt from research station to farmer are not adequate. Neither are community-education efforts modeled on schoolroom setups in which teachers are experts and dependence on books is absolute. Where these and other methods have failed, however, group discussion can succeed. The radio campaign approach emphasizes the complete and equal participation of all stu -group members in ver exploring the lout implications and applicability of information the radio and in print. This communal exploration may turn up relevant ways-to use general knowledge and can help all involved overcome the inertia of passivity. MW niAlya created a communal atmosphere that fostered learning and action by rural Tanzanians concerning their own health. Bef ore the carngaign, most rural villagers saw illness as beyond their control. Where the possithity of help had been recognized, it was seen too much in terms of modern medicine, the provision of which is still hopelessly inadequate in rural Tanzania. The "Man is Health" campaign used radio and other media to raise people's awareness that they can conti of many of their shared health problems and that groups of people working together can eliminate many unhealthy aspects of village environments. This new habit of joint discussion and decisiorvmaking mil, rt is hoped, influence how people deal with future problems of all sorts. Villagers getheriffg today to discuss a communalfeeding program for their children gain experience and skills that they can apply tomorrow when flood control becomes the issue. In particular, the "Man is Health" campaign had the indirect political impact of strengthening the TANU ten-house cell-system. At the time of the campaign, the cells in many villages had lapsed into inactivity except when called upon by branch or ward-party offices to do something. That the ten-house Cell leaders in several districts, such as Mbeya, Dodoma, and Mafia, where the campaign Was enthusiastically supported, acted as study-group leaders reinforced the structureof the ten-house cell system as a means of stimulating discussion concerning development questions. For many ten-house cells, such discussion can help initiate the difficult task of working out priorities for further development The collective action that mass-campaigns foster has far-reaching implications As to what makes people act or why they decide to replace previous habits, there are several schools of thought. The rationalists, social scientists along them, say that Ihformatton leads to reflection, reflection to change in attitude, and change in attitude to cange in behavior. Hence, they emphasize the importance of identifying and modifyttig attitudes. Yet, as..experience. w)th mass campaigns indicates, behavioral change need not wait until attitude (that elusive something) alters Everyone need not, for example, understand germ theory in order to perceive a need for latrines and to help build them. In fact, even an academic understanding would not necessarily lead to the construction of latrines, rather. social pressure may be used to prompt latrine buildirfg, while logic and convenience promote use of the finished product. \ 71 64 1 1 This positive use of social prey -dure brought dramatic results when aAplied lb health in rural Tanzania. Isolated individuals have little ability to corol the overall village environment as it affects their health., Although each perspn or family may make certain changes f%the better, such as boiling water or eating more nutritious meals: larger and more complex environmental and economic questions can only be dealt with on a collective basis. Groups and whole villages working together can quickly and efficiently bring about major environmental changes that indiruals cannot hope to achieve , Once mobilized, people need information about the roots ottheir problems and about ways to solve them. The "Man is Health" campaign used radios, existing group networks: and i:opular media to open access to specific information about health problems in rural villages. No single institution could pave reaShed more than a fraction of the rural poptilation, neither the Schools nor the extension networks coda havd carved specific information to as large a portion of the population as the campaign brought into active involvement This expanded 'outreactr enabled Tanzanians who had never before taken part in any organized teaming activity to develop awareness and skills that could tie put to immediate use in their daily lives .47 In the Mtu nt Afya study groups, complete and equal participation b9 all.group Paulo Frefre; and othe;s have poihted out the memberS vas the ralptvan shortcomings of traditional student-teacher relatibnships. Adults who intend to' direct their own development are not best served by aneducational system wherein one persoses expert. teacher. possessor of knowledge while the other participants are simply feciptents of that knowledge,. RaQier.iointexploration such as that which characterized the Tanzani i health campaign stimulates hyely involvement and becomes a strong motivate element for improving community life 4 1. Another effect f mass campaigns apparent following Mtu, nt Afya is the , strengthening of gra ssroots political structures ana !trice the building of a mass political base. As poi nted out earlier. TANU party cell-leaders became study-group Leaders in some plat es. and the Carnpaig.ri fortified the newly emerged political structures of such villages by calling upon them to take specific actions The accomplishments of the hea.ljh campagn are particularly impressive against the backdrop of cost. Through use of the'existing network of extension officers and primary schools in combination with that of radio programs and mass-produced _printed materials. campaign planners held down,expenses toonly,s fraction of what literacy instruction or evening adult-education classes cost in'Tanzania Thus the is. under, certain concAtions. more economical by far than other forms of nonformal education mass campaign study-group approach . c. IMPLICA77ONS FOR DEVELOPMENT' PLANNERS - The ulhtpate question regarding th e Tanzanian experience is this What are the chances that Tanzania s success can be duplicated elsewhere? The answer is not ' A , 6 72 Originally, this study was intended as a handbook for campaign planners,-,but as the'study progressed and the analysii deepened, it became clear that a single set of guidelines could not beextracted.,There are no 'models. Neither China, nor tuba, nor Tanzania provides us with a model that Gan be applied directly"elSewhere. Indeed, one of the stteeest points to emerge from the Cuban analysis e its own highly successful, literacy campaign was that the campaign was not carefully planned. Beginning 18 ronths before the first radio broadcaSt, on to other hand, planning for the "Man is Health" campaign was thotough. Table 14 provides a comparison of the Tanzanian campaign with those previews media experiences discutsed in Chapter 1. Massmobilization does not.spring spontaneously or magicallffiom agood idea. Discussed beloW are several key contributors to the success of Mtu ni Afya as well --. as of.the other Tanzanian campaigns. ,. - An active adult-education field staff. Bedguse groups required SUpervisiontnd organization and because supplies had to be coordinated, some sort of dependable infrastructure was needed. In this case, the field staff of the adult-education division orthe Ministry of National Educaton supplied the necessary structure; in a different context, another agency or organization coulb perform the same f uhction. Strong national political support. At the time of the' Man is Health" campaign, he Tanzanian adult-education netWork consisted of full-time personnel at each administrative level from ward (slightly larger thane village) to region. This network ' grew from 62 di§trict adult-education officers in 1970 to_nearly 2,300 full-and part-. time staff in 1973. The duties of the administrative and supervisory staff include assisting in opening and maintaining classrooms andin class activities, in recrJiting teachers, inallocating resources, it training leachers, in publicizing; in providing community guidance. and in communicating with TANU, the government, and other organizations. . The full commitment of political parties and governments was undeniably crucial to all of the successful campaigns that have been,exaMined in the course of this study. For the future, however, regional or local action may be feasible where national support cannot be expected. Inter-ministerial cooperatiop.it doesn't matter to a villag er which mirotry provides the village with a clean-water supply. Unfortunately, the Ministries themselVes are only too concerned about who gets credit. institutional rivalries and burpaucratic conflictsharsh realitiesare not apt to disappear simply because they have been condemned by participants in international seminars and others. Yet, Mtu ni Afya wanroof that strong triter:ministerial cooperation can actually flourish within the context of specific, intensive, action-oriented programs. The National Coorainating Committee successfully brought the interests and capabilities of those agencies involved together in an effort that at least three ministries (Education, Health, and Rural Development) were only too pleased to claim in their annual reports. Often, ministries unwilling to make any permanent personnel shifts are quite willing to commit their field staff for relatively short periods. The fact that mass campaigns are short and intensive increases grealh the likelihood of inter-ministerial collaboration. 66 73 c ... . \ c. A - Countries. India and Kind of program f Group discussion Table 14 , COMPARISON OP MEDIA EXPERIENCES National political support Two-way communicatioh Range of topics Scale , Rural Forum Yes No Yes Extensive Primarily radio, textbooks Selective Literacy Campaign Yes Yes No Limited Textbooks, some racho, posters Mass Yes Yes No Limited Radio prior to. Mass Ghana ` Cuba China Media : Preventive . . Heal* 1958, print Campaign / Tanzania "Man is Heallh" -Campaign Yes . Limited Yes Limited RactIO..lexttzOsga_______Mass posters, printed cloth 41A, 0 74 t i . .., Integrated or horizontal approach to rural develop nt. Ideally, inter-ministerial coope,ation yields integrated development. Bringi g better health-to any, village iricludes.et the very least, matters of water supply atrine construction, food'supply, and education. Change in any one of these ctors alone cannot eliminate or significantly reduce the incidence of disease rom the ministerial point of view, this _ means that water development, rural cons ruction, agricultural, and 'educational skills must be coordinated, at every level. . . Limited scope of campaign subject matter. One of the crucial weaknesses in community-education campaigns has been the Counterproductive attempt to accomplish too much in one campaign. As indibated in Table 14, such was the case for the farm forums in India and Ghana. The early Tanzanian campaigns were also unmanageably broad in scope, devoting" one week to school, another to farm cooperatives, and yet another to,health. Since community pressure, increased -consciousness, and .subsequent action build slowly, narrowing the focus of campaigns is essential if an educational program is to inspire action. Campaign focus relevant to all of intended audience. Information presented in a campaign must appeal to the needs and situations of all those taking part. The number of subjects as universally, applicable as hgalth would seem to be limited. (Even for the "Mart is Health" campaign, as discussed in the latter part of Chapter 5, some ,regions and villages found certain topics irrelevant.) If a nation wants a response from us people, it must speak to their local concerns. Surely there isito, ..,.._. reasCh-Whylhe radio study-group approach could not be used for regional or even strictly local campaigns:. Use of all available forms of communication. Radios are not magic! They will not work miracles and are useful only as a part of the overall campaign approach But radios are ubiquitous, and it is that fact, rather than the medium's intrinsic qualities, that makes radios important for campaigns. Use,of all available media made for maximum impact in Tanzania. Messages printed on cloth, local dramatizations of issues, political meetings, notices posted in railroadcars, newspapers, dance, and word of mouth all played parts in Tanzania's campaigns and in those of China and Cuba as well. Tanzania has institutional resources that many countries can't match, on the other hand, other countries have transportation and communication infrastructures 4 superior to Tanzania's. Certainly the most important ingredient in the "Man is Health" campaign was commitmentcommifment by the institutions involved to (10 all they could to promote learning and action to improve health in rural areas. Appropriately modified, the methods used in Tanzania could work anyplace and on any scale. With strong commitment backing them up, radio .and the study group. approach canibe powerful tools for development. 0 t 75. 68 .fr D ON RECEALT DEVELOPMENTS IN TANZANIA A lot has happened in Taha tr R he 1973 health - education campaign . described in this study took place. I km, -1 he country saw the culminationdf a fiveyear literacy campaign that raised to .44 cy rate from roughly 25 percent in 1970' to 75-80 perCent in 1975. ThiS gain r s oneof the most stunning educational achievements in Africa and an achi t has taken place in a nation that is listed as one of the 25 poorest count e d. 1975 also saw the mounting of another mass campaigp on food production and nutrition, the "Food is Life" campaign. (An excellent description of this campaign was written by the Director of the Institute of Adult Education, Fr. Daniel Mbunda, an is available in the first issue of the Tanzanian Adult Educafion Journal.)The "Food is Life" campaign was in many ways more complex than the campaign described herein, since food habits and growing patterns vary from location to location. As with this campaign, there was a strong emphasis on pwctical achievement. Pre-school community feeding programs, workers' canteens, and widespread development of w re-some-of the-results-of-the campaign. In November 1977, the Ministry of Education announced the achievement of universal primary education . . . a place for every boy and girl to attend school. The method used to accomplish this goal was to take the lessons from the mass campaigns for health, literacy, and other aspects of political education and to apply them to the task of primary education. The communities built the schools themselves with their own skills and, largely, with their own funds. The teachers have been and are still being trained through a combination of correspondence education, face-to-face instructiori, and radio lessonsmethods first developed to reach the broad adult population. What about more mass campaigns? The situation is not completely clear. There are some in Tanzania who feel that large-scale campaigns divert resources and energies for programs that produce short-term gains. But there are others who counter by saying that campaigns have demonstrated a capacity for doing what cannot be done in any other way and what is needed is the better linking of the such large-scale efforts with ongoing programs. Two topics for further campaigns, the role of women in development and the use of appropiiate technology, are being discussed in 1978. Whatever the decision, the programs that are adopted will be carried out with considerable boldness. The campaigns and the successes of adult-education programs, along with other accomplishments in Tanzania, are announced with a combination of fanfare and humility. But they should not be seen as models to be picked up and used. There is much room. for improvement, much need for criticism, and great cause for a continuing struggle. Nor should this paper be used as a blueprint. It should, instead, be seen.as the presentation of materials for discussion and reflection. 69 76 APPENDIN Table 15 TANZANIA'S HEALTH CAMPAIGN: EXTERNALLY FINANCED COSTS Tz Shillings Expense Category Muffing of study-group leaders Tut-vet and other expenses for training teams that attended zonal, district, divisional, and ward training serinars Setting up and running district and divisional seminars Purchasing and recording cassettes used in training U S Dollars 61,600 8,627 1463,000 64,846 11.000 Production of study guides. and group-leader manuals 3,000 420 440,000 61,625 Typing-Ad-giber general services, manuscript stage . , Paper (220 metric fbns of newsprint) I. 1,000 140 Printing 745,000 104,342 Distribution Other materials and photography 196,000 27,535 Production of radio programs 3,000 420 Publicity (including filming of study groups and filming of shows used to promote study activities) 1,500 210 , Research (excluding that covered under the "training" category) 14,000 1,961 2,500 350 Post-campaign publications (reports and other follow-up) 1,942,200 TOTAL COSTS 'Does not add exactly due to rounding rp 77 71 272.017' BIBLIOGRAPHY. 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