Medical Aid Films (MAF) is a young charity which wants to reduce childbirth-related mortality in the developing world by creating and distributing health education films. Taking in account the scale of the problem, interventions in this area have the potential to make a big difference. Is MAF a good opportunity for giving?
MAF was born out of the experience of midwife Fiona Laird while working for Medecins sans Frontieres in a refugee camp in Darfur. Witnessing newborns and mothers die due to basic mistakes in hygiene, delivery, and care-as basic as cutting umbilical cords with dirty knives-she decided to set up training in the camp. This was tremendously well attended, showing that women were thirsty for education with the potential to save their lives.
The problem Fiona witnessed affects a large portion of the population of the developing world. It is estimated that, every year, over 350 thousand women die as a result of pregnancy and childbirth, and that almost three million newborns die a year - 44 per cent of all under-five deaths. This has been recognized to be a priority: two of the Millenium Development Goals are reducing child mortality and improving maternal health. However, progress has been somewhat disappointing. The aim to reduce child and maternal mortality by two thirds between 1990 and 2015 is still far from being met: as of 2012, these had only dropped 47 per cent, remaining very high in Sub-Saharan Africa and Southern Asia. A staggering 80 per cent of these deaths are considered to be easily preventable by basic medical care and education. It seems, then, that by improving childbirth provision and newborn care, it would be possible to have an extraordinary impact.
A big part of the problem is that in regions where there is a shortage of skilled medical workers, health education is usually unavailable. Medical Aid Films aims to address that lack. Their films teach practices which can increase maternal and newborn health, and being made in collaboration with local production companies, they are adapted for different cultures. Most importantly, a single film can be widely distributed and left in different health and community centres, where it can be watched and re-watched by both health care providers and local women. Other important advantages are that films can overcome lack of literacy and allow for clearer, and possibly easier-to-remember, explanations of the relevant practices.
Since Fiona's trip to Darfur in 2006, Medical Aid Films has produced films on 26 child and female health topics (and translated them into several different languages) and distributed more than 17 thousand copies of these to over 850 partners in 60 different countries. They have made changes to their methods according to the ongoing feedback they receive from the field. Small case studies seem to indicate that the approach has had positive effects.
The most detailed study of the effectiveness of their work conducted so far was an external evaluation by Anthrologica on the Chitambo Film Education Project. This project ran for 12 months in rural Zambia, centred at the Chitambo hospital, which has a catchment area of over 100 000 people over a 90 km radius, and has only one doctor. Maternal and newborn mortality rates are high in the district and only three in ten women deliver their babies in the hospital.
MAF provided films on five different topics and support to staff. The films were screened on portable projectors bi-weekly at the antenatal care clinics at the hospital and during outreach sessions held once a month at 14 rural healthposts. Between March and August, over 2000 people attended screenings (non-unique individuals). Though there was no change in hospital attendance, audiences reported high levels of engagement with the films and changes in individual behaviour of mothers, and health workers claimed that the films had improved the content and quality of health education. Further, hospital staff noted that, without the films, no education would have been provided at the sessions.
In 2009, GiveWell looked at different interventions in maternal mortality. Despite the high number of maternal deaths considered avoidable (i.e. which could be prevented by the use of existing technologies) by the World Health Organization, they concluded that there was only good evidence for effectiveness for government-level interventions. This has been attributed to providing broad, free access to health services, professionalizing midwives, using data to guide policy-making, and targeting vulnerable groups.
As for specific interventions, no good evidence for effectiveness was found, though some of the programmes studied had positive effects. Give Well investigated training traditional birth-attendants, providing skilled birth attendants, antenatal care, community mobilization, and clean delivery kits.
Of the ones relevant to MAF's work, training traditional birth-attendants was found to have an effect in reducing child mortality and increasing knowledge, but not in reducing maternal mortality. This may be due to lack of medical services to which to refer women with major complications, barriers to learning, and insufficient training to give skills to perform life-saving interventions. Community mobilization was found to be the intervention with the most potential. The study cited attributed a statistically significant reduction of maternal and newborn mortality to setting up facilitator-led groups, though the estimated cost per infant life saved was still higher than for the most effective charities.
These results suggest that tackling the problem may require a broader intervention in the health systems of the affected countries. But they also indicate that MAF is a promising intervention. The fact that films can reach far and stay with the communities allows for a sustainable provision of education, in many cases where there was none before. The films may improve education of un-skilled midwives by transcending language barriers, and they may facilitate community mobilization. MAF also seems committed to improving standards based on feedback, and they are aware of the need to collect more quantitative data before and after their interventions.
The Chitambo Film Education Project: Summary of External Evaluation (pdf)