Nutrition and the urban consumer

By Jennifer Christian and Abel Irena

The 'Pusha Love' campaign in Lesotho is about preventing HIV which uses positive dialogue about the future to talk about how to change the epidemic. About 20 'live' mannequins were deployed en masse in various parts of town. They would stand in random positions for 5-10 minutes and attracted lots of attention. Their mouths are taped and their t-shirts say, "It’s time we start talking" in Sesotho.

Jennifer Christian is Global Social Marketing Advisor with Population Services International (PSI) assisting with programme planning and marketing strategy for numerous health areas across the Southern Africa region. From September 2013, she is Global Marketing Manager for Marie Stopes International.

Abel Irena is currently the Nutrition and Neonatal Health Technical Advisor with PSI. Previous experiences include as technical advisor/researcher with Valid International for five years and as a nutritionist with Save the Children (US) in Ethiopia.

Do you know what a flash mob is or how it might be applied to a public health or nutrition message? Have a look at this short PSI youtube clip from Burundi to promote condom use in 18-24 year olds. Link at: http://youtu.be/RtSGJ2KcEEM

Funding for nutrition programmes has long focused on acute emergency situations and highly vulnerable, targeted populations, such as people living with HIV/AIDS. However, there is now growing recognition of the widespread nutrition gap in many communities living in chronic situations of need and affecting multiple population groups. This has brought a renewed focus on the need for general population-based campaigns, as well as easily accessible services and in some instances, nutrition products. In particular, there is recognition of the need to include the urban poor as a key population, often equally at risk of malnutrition to their rural counterparts due to poor diet choices, limited accessibility to fresh varied produce and poor living conditions. Innovative communication techniques common in the commercial sector for selling products, are increasingly used to help ‘sell’ health messages and associated services to populations. These look on the beneficiary as a ‘consumer’ of information, products and services. There are many lessons from the commercial sector and their successes in marketing and advertising commercial products (with the ultimate aim of profit), that we can apply to marketing and advertising services and products that have a public health goal.

This new approach is especially pertinent for the urban ‘consumer’. This adds an additional layer of complexity to the marketing strategy. How does today’s urban ‘consumer’ in developing countries differ from a rural audience? What is their significance in the adoption and uptake of new behaviours, products and services? To use marketing speak, how do we "sell" to them more effectively, even if we are talking about feeding behaviours or uptake of free products, such as micronutrient powders or bednets?

First, programmers need to begin treating developing markets as just that, developing, and very quickly. In addition to massive construction booms in many African and Asian countries, consumer choice, including health products, has also grown significantly. Twenty-five years ago, Chinese consumers were lucky to find a condom, and if they did it was an unattractive, government-distributed free option. Today there are over 1,000 brands in the country. Increased options make markets healthier by injecting competition that has a role to drive down prices and enables consumers find a product of their preference. Along with such options comes an increase in the overall level of advertising that people are exposed to. In urban slums, the chaos of daily life in densely populated areas, the plethora of independent vendors promoting a wide variety of goods, the new ways in which many companies are marketing to the ‘bottom of the pyramid’ (SMS, wall paintings, overbranded kiosks, branded vehicles, etc.) and the rapid increase in TV ownership and satellite TV, means that being seen by an urban consumer requires breaking through the clutter. Whether your campaign is for a product, service or behaviour, getting noticed and remembered in such an environment requires a different kind of marketing than the traditional, functionally-driven public health communication. It requires emotionally driven, relevant concepts and it requires ‘surround sound’ campaigns that incorporate new and innovative marketing techniques. This will be critical for uptake whether your product is freely distributed, socially marketed or commercial.

Commercial market research tells us that people react emotionally before they process rationally, even if they don’t always realize it. This means if communication does not resonate personally with a consumer, they will never take the time to process the actual message being delivered. Creating that personal connection requires two steps: gaining an in-depth understanding of your audience that goes beyond demographics, including their lifestyle, aspirations, fears and values, and creating an emotional benefit of the desired behaviour that is relevant, compelling and credible to your audience. This emotional connection is what can make an ad stand out on TV, be remembered and talked about; just as lack thereof can make it forgettable no matter how many times it is aired. Recent marketing research shows that while rationale might create a short-term shift in behaviour, an emotional approach can create a much larger, long-term change in profits (or in our case, behaviour!).

Even with a good concept, good execution of the campaign will still be the ultimate driver of success. This means complementing traditional media (TV, radio, outdoor, interpersonal communication, in-store) with newer media that are likely to reach an urban poor population (SMS, guerilla marketing like flash mobs¹, over-branding of people or of vehicles (e.g. taxis, buses), CCTVs in public transport) while ensuring it all ties together as a campaign. While traditional media can serve to increase awareness and knowledge, guerilla techniques can often create buzz and word-of-mouth around your campaign - helping to address attitudes or social norms. In Burundi, Population Services International (PSI) just organized the country’s first ever flash mob in the capital to promote their condom brand and then posted it on YouTube so that people could share it with friends (see link at beginning of this article). Even in densely populated areas, guerilla marketing such as flash mobs can create buzz in busy informal markets where entertainment options are otherwise limited. In Kenya, PSI is working with GAIN and the Kenyan Ministry of Health to use TV to create broad-scale awareness of a new umbrella brand that signifies food which has been fortified. Another communications campaign by PSI and the Government of Kenya addresses the issue of HIV and concurrent partnerships head-on² while a regional social marketing platform for condoms has unified a number of brand images to help increase uptake³. When it comes to creating broad brand connection and awareness, market research studies show that TV is still the most powerful medium.

However, internet and mobile phone usage is skyrocketing. Social media can be used to reward loyal fans with special offers (thus improving the chances of word-of-mouth recommendations) as well as serving as a platform for dialogue, experience sharing, questions or suggestions. In Zimbabwe, social media is being used to let men share their stories about why they chose to get circumcised and what their experience was like. SMS technologies can help with targeting and timely messages as well as product distribution, particularly among poor populations. In Papua New Guinea, subscribers to PSI’s ‘Haus Lain’ can receive weekly health messages on their phone. USAID and Johnson & Johnson have collaborated to create the Mobile Alliance for Maternal Action (MAMA), which targets pregnant women and new mothers with health information and advice via SMS which evolves in line with their exact stage of pregnancy. In Mozambique, PSI is piloting the Movercado programme where unique codes received via SMS serve as vouchers to be redeemed for free products in a nearby shop. This can, for example, allow pregnant women who go to the clinic to be sent a voucher for fortified food. By tracking their pregnancy, they can also be sent reminders about breastfeeding or complementary feeding advice. Vendors who honor the vouchers can potentially also be reimbursed for the product on their mobile phone, saving admin time and costs. Recently this has also been used to create access to water treatment products during a cholera epidemic, rewarding local businesses and avoiding the typical logistical difficulties of delivering emergency supplies. These newer media platforms for marketing campaigns can provide significant opportunities.

A flash mob in Roma, outside the national university in Lesotho. This marketing was done to create awareness as a "teaser" right before the launch of the campaign, 'Pusha Love'.

There are a large number of urban poor who are often malnourished due to the limited affordability and availability of fresh and nutritious food, increased availability of unhealthy, processed foods, and low awareness of appropriate infant and young child feeding practices. However, just as important is the role that the urban consumer plays in setting trends and disseminating new ideas, behavioural trends and products to rural areas. Rural consumers often aspire to what they see their urban relatives using, wearing, eating and drinking. In addition, urban consumers often bring goods back to their rural relatives during holiday periods. The urban population itself may include temporary rural residents, attracted/driven to the urban centre for work opportunities. In Namibia, PSI’s malaria programme made a point of encouraging people in urban areas to buy mosquito nets and bring them out to rural relatives during the holidays. In addition, uptake of something new may decline if rural consumers find out their city-dwelling relatives have never heard of it. Kenya’s fortified food brand awareness campaign has targeted urban consumers in its first phase for all of these reasons.

Urban markets are thus a critical one for building up awareness and changing behaviour that will improve nutritional outcomes amongst the entire population. However, it will require a change in mindset and a lot of learning from the private sector for organisations working in the field to make better nutrition into the latest trend.

For more information, contact: Abel Irena, PSI, email: airena@psi.org

¹A flash mob is a group of people who assemble suddenly in a public place, perform an unusual act for a brief time, then quickly disperse, often for the purposes of entertainment, satire, artistic expression or messaging.

²See video at: http://www.psi.org/multimedia/video/hiv-andconcurrent-partnerships

³See video at: http://www.psi.org/multimedia/video/psissouthern-africa-regional-platform-condom-social-marketing