Generating demand in public sector nutrition programmes: A way forward

Increasing consumer demand for safe and nutritious food is key to improving global nutrition. The private sector uses sophisticated techniques and tactics to promote products that appeal to customers’ perceptions, values, and emotions. Since lower product prices equate to smaller profits, private sector actors have little incentive to promote healthy foods among low-income populations. On the other hand, the public sector has great incentive to generate demand for the purchase and consumption of healthy foods - but it lacks the effective marketing techniques to do so.

To understand how social marketing might be applied to generate demand for healthy foods, we conducted a two-part inquiry into how the Brand and Marketing (BAM) Best Practices Framework (Mann Global Health, n.d.) might be adapted for public sector nutrition programmes.

The BAM Framework was developed to consistently assess public and private sector marketing programmes according to five best practices: audience focus, brand strategy, campaign strategy, measurement, and governance. These best practices can be useful for global health and development programmes as they encourage shared understanding of definitions and standards of excellence for demand generation techniques. This enables more productive dialogue between donors and implementers, among implementing teams, and between implementers and creative agency partners.

The two-part mixed methods study consisted of an online survey and in-depth interviews complemented by a document review to test the appropriateness of the BAM Framework in the public sector nutrition context.

Online survey

The online survey aimed to ascertain widely accepted understandings and current practices related to social marketing and demand generation in nutrition-sensitive agriculture and market-based programmes. Survey data were collected in English and French to represent experiences of nutrition programmes in low- and middle-income countries (LMICs). Information was requested on the nature of the respondent’s programme, including the geographic region (urban, peri-urban, or rural), the primary audience and the objective of their demand generation efforts, the primary nutrition outcomes, the principal collaborators (market vendors, producers, the government, distributors, etc.), and the types of interventions used. We also asked whether the respondent would be interested in participating in a semi-structured in-depth interview to further explore their programme’s demand generation efforts. Descriptive analyses were used to synthesise the findings and draw early conclusions.

In-depth interviews and document review

Based on interest expressed in the survey, in-depth interviews were conducted to explore how programmes generate demand for healthy diets and how their practices align with the BAM Framework best practices.

The in-depth interview guide was structured around three main sections: (1) background information on the programme’s demand generation efforts, how these fit into their larger programmatic goals, and what team members were involved in their planning and implementation (e.g., nutrition experts, SBC experts, monitoring and evaluation experts, creative agencies); (2) information on the programme team’s efforts to understand their audience, including whether they had identified a clear behaviour to promote and a clear audience, and the extent to which they researched their audience and what they did with their findings; and (3) information on the programme’s experience with branding, including whether they developed a brand or used a brand that already existed, whether the brand had a specific vision, and whether they experienced any branding challenges.

First-hand accounts from the in-depth interviews were complemented by a review of supporting programme documents, which included information on SBC strategies, creative briefs, formative research findings, marketing content, and other programmatic resources. Thematic coding was used to synthesise and analyse the data.

Online survey

The survey received responses covering 33 activities implemented in 17 countries. Representatives from 22 implementing organisations shared experiences of their efforts to market healthy diets. Reported activities formed part of a variety of nutrition-related interventions, including scaling up and improving the quality of care groups, agricultural extension and diversification actions, and strategies to increase the access of caregivers to a continuum of care for young children.

The survey yielded five primary findings consistent across the respondents.

The host country’s government played a critical role in demand generation activities. 95% of respondents listed the government as key collaborators, and 15 programmes were implemented in response to a government mandate. Other important stakeholders and collaborators included community agents and market actors (e.g., producers and vendors).

Respondents used a wide variety of interventions, but commonly reported community events such as peer groups and community dialogues as most relevant.

Consumer and market research and human-centred design were the most used marketing techniques. Only a few respondents used more sophisticated marketing techniques like branding (30%) and advanced audience segmentation (27%).

Terminology mattered, with inconsistent language often used to describe this work. Common language included terms such as SBC, market systems work, and demand creation.

Programmes often focused on improving dietary diversity rather than on specific foods or food products.

In-depth interviews and document review

In-depth interviews were conducted with respondents from four public sector nutrition programmes implemented in low-income, rural communities in Bangladesh, Guatemala, Rwanda, and Kenya. A total of 60 supporting documents were reviewed. The programmes aimed to strengthen value chains for animal-source foods (ASF), increase demand for ASF, reduce barriers to the adoption of priority health behaviours, increase adoption of water, sanitation, and hygiene behaviours, and determine the effectiveness of multi-tiered marketing campaigns to promote specific foods. Across the programmes, several demand generation strategies were used and evaluated according to the BAM Framework best practices.

Audience focus

In all four programmes, a focal audience was identified. Typically, programmes started with a broad target audience (e.g., caregivers) linked directly to the key goals and outcomes. Formative research was then used to further specify target audience members (e.g., caregivers of children under two in households that raise animals), who were typically those needing to practice the desired behaviour(s). Most programmes also targeted a secondary audience (e.g., influencers or supporting actors) for behaviour change. In alignment with the BAM Framework, the establishment of behaviours was a critical first step and considered a central component of all programmes. However, most programmes focused on 10 or more behaviours per actor, with no indication that the behaviours were staggered over time to avoid overwhelming programme participants.

Interview respondents recognised the importance of understanding the audience and could elaborate about their process for doing so. All programmes began with a literature review, followed by formative research to fill identified gaps. Programmes aimed to better understand the audience and the factors—i.e., barriers and motivators—that impact their ability to practice the promoted behaviours. Common themes that emerged from formative research focused on how audience members thought foods were expensive, valued the taste of food, could not access the foods being promoted, preferred imported over local foods, and associated certain foods with a certain gender or financial status. Few respondents reported learning information about their audiences’ deeper motivations for food purchasing and consumption, with most learning focused on their sociodemographic characteristics or their perceptions about foods and food-related responsibilities.

Campaign strategy

Respondents recognised the importance and power of communicating a benefit to the audience during the campaign. Despite this, some articulated the benefit as the programme objective and/or promoted behaviour itself. For example, it was common to use "eat [programme-promoted food] to improve nutrition and health outcomes" as a benefit statement even though it also encompassed the objective and promoted behaviour of the programme. According to the BAM Framework, a benefit statement should articulate why or how eating promoted foods can contribute to improved nutrition and/or health, or what other benefits the audience would reap from this; however, this was not well understood. In some cases, failure to layer or sequence benefit statements risked overloading the audience with potentially conflicting benefits.

While programmes could articulate the importance of, and made efforts to conduct, formative research, the findings were not always reflected in the development of campaigns. For example, in cases where taste played a key role in food consumption, campaigns focused on communicating the nutritional value of the food they promoted, not on ways to improve the taste.

All four programmes used a variety of approaches—informed by the formative research—to market healthy foods. While these approaches were useful and contextually appropriate, they often lacked innovation and included traditional SBC interventions such as home visits from community health workers, community meetings, parenting sessions at early childhood development centres, cooking demonstrations, cooking competitions, text messages, menu planning games, reminder calendars, taste tests/new product showcases, mobile sales agents, religious leader sensitisation, school clubs, and radio dramas. Thus, opportunities remain to make approaches more resonant, salient, and memorable by prioritising consistent messaging, inspiring audience engagement, selecting intentional placements, and making emotional connections with the audience. There was moderate alignment with the BAM Framework, but clear opportunities for strengthening the marketing approaches.

Brand strategy

The BAM best practices related to branding were not reflected in the programmes reviewed and the use of branding was misunderstood by respondents. The term ‘brand’ did not resonate with respondents and most were unable to answer the question of whether their marketing work had a brand. Respondents were more receptive to the use of alternative terms like ‘logo,’ ‘slogan,’ or ‘look/feel’, but were still unable to provide details beyond acknowledging a donor’s branding requirements and organisational logos.

"Programmes should carefully consider and assess how the audience might perceive the demand generation work based on their previous experience with specific donors and organisations." - Interview respondent

"Because literacy rates are low, branding is not needed." - Interview respondent

"Often, donor-funded programme names offer a natural branding opportunity, but these are not always capitalised on." - Interview respondent

Two respondents shared their programme’s branding, which reflected the brand vision. However, we were unable to determine whether branding was consistently and clearly executed because implementation had just begun.

Measurement

All respondents had plans to test message effectiveness, although some were less formal or structured than others. A common approach was concept testing (through focus group discussions) in which members of the target audience looked at an image, product, or message and answered questions based on their understanding of it.

Because the programmes assessed were in the early stages of implementation, they are yet to be evaluated. We were therefore unable to determine alignment with BAM principles.

Governance

All respondents had an organisational structure that they felt would allow them to successfully carry out their programme objectives. They confirmed that there was collaboration with donors, stakeholders, and influencers (like local governments), although some parties did not always support the design and execution of the strategy. All respondents followed a similar process that included a literature review, formative research, organising information and data from research, developing a strategy, implementing, and evaluating. Their plans, however, did not consider accountability for, or maintenance of, the brand. Furthermore, none of the programmes had explicit incentives in place to reward the adoption of desired behaviours and achievement of outcomes. While respondents described broad rewards of their programmes such as ‘decreased mortality’ and ‘increased education,’ there was no discussion of rewards being developed specifically for the programmes or their stakeholders.

Findings from the survey and in-depth interviews showed that respondents were familiar with the BAM best practice concepts. Apart from branding, all interview respondents were applying, or planning to apply, the principles in their programmes to some extent. The ways in which some applied these principles leaves room for a deeper understanding of the best practices and for improving the quality of their implementation.

Do less to achieve more. Many implementers aim to change too many behaviours at once, overloading their audiences - often without the needed time, staff, or budget. Prioritising behaviours would allow programmers to streamline efforts, maximise resources, and maintain focus on the behaviours that have the highest potential to influence nutrition outcomes.

Identify whether the target audience would truly be persuaded by only receiving information. The target audience’s lack of knowledge is rarely the main problem. Reemphasising the importance of a healthy diet and sharing nutritional benefits is often the default approach (instead of more comprehensive demand generation approaches), but may not resonate with the audience or compel them to act. Even when people know what they should do, other structural, social, or internal factors such as cost, community norms, or personal preferences may play a bigger role. Without addressing the more pervasive factors, sharing information or promoting knowledge is insufficient to generate and sustain demand.

Prioritise and allocate sufficient time and resources to developing campaigns that are creative and innovative. This could mean hiring or engaging more internal staff with diverse backgrounds (e.g., marketing, anthropology, psychology, technology, etc.) or contracting external firms (e.g., creative agencies) that inspire and help develop more salient and effective marketing campaigns.

Consider developing a brand when needed. Branding is underutilised in public sector nutrition marketing. However, its pivotal role in the private sector suggests opportunities for using branding to influence behaviour change. When developing a brand, its sustainability beyond the current programme should be considered, including the potential to partner with local public and private sector actors.