Development Media International

Our Recommendation

Development Media International (DMI) is a top-tier, rigorously evaluated behavior-change organization that meets and often exceeds our bar on intermediate and ultimate outcome evidence. It ran the first cluster randomized controlled trial to set all-cause child mortality as the primary outcome of a mass media campaign, ran it for 35 months across 14 clusters in rural Burkina Faso, and when the answer came back that there was no detectable effect on child mortality, published that in The Lancet Global Health.

Putting a central claim to a test that can fail is rare. Publishing the failure is rarer. What the same trial did find, against randomized controls, was a 56 percent increase in malaria diagnoses, higher antenatal attendance, more facility deliveries, and more under-five consultations. A second randomized trial, independently evaluated by the Abdul Latif Jameel Poverty Action Lab and Innovations for Poverty Action across 16 radio areas and 7,500 women, found contraceptive use up 5.9 percentage points, births 10 percent lower, and women’s self-assessed health and wellbeing 0.258 standard deviations higher.

DMI's Fierce Certification score is 100/100 points based on our criteria:
✔ Has Ultimate Outcome Goals (20 pts)
✔ Measures Intermediate Outcomes (15 pts)
✔ Measures Ultimate Outcomes (20 pts)
✔ Measures Intermediate and/or Ultimate Counterfactual (20 pts)
✔ Shows Continual Learning & Adaptation (25 pts)

The Social Problem

Children in rural Burkina Faso die of malaria, pneumonia, and diarrhea. In 2010, when the organization’s flagship trial was designed, the country ranked 161 of 169 on the United Nations Development Program’s Human Development Index, with 44 percent of the population below the poverty line, 77 percent rural, and an under-five mortality rate of roughly 114 deaths per 1,000 live births.

The distinctive feature of this problem, and the one the organization is built around, is that the treatments already exist and are often free at the point of use. A child with malaria can be tested and treated. A woman can deliver at a facility. A newborn can be breastfed within an hour of birth. What fails is the sequence of decisions that gets a family from the onset of symptoms to the clinic door.

On the family planning side the failure is similar in shape. Around 25 percent of married women of reproductive age in sub-Saharan Africa want to stop or delay childbearing and are not using any method of contraception. In the same region, only 23 percent use family planning at all. In Burkina Faso in 2014, only 16 percent of women of childbearing age used a modern method, and the average woman gave birth to six children. Focus group work by the organization found the binding constraints were not supply. They were lack of information, fear of side effects including infertility, deep-seated attitudes toward family size, and women’s lack of decision-making power.

The consequences follow: children dying of the three most treatable conditions, deaths around birth that skilled attendance would prevent, pregnancies that were not chosen, and the diminished lives of women without reproductive control.

The Solution

The organization buys enough radio airtime to saturate a listening area and broadcasts the right messages relentlessly enough to change what families do.

Create, Test, Scale. That is the organization’s stated method, in that order. Campaigns are developed with local scriptwriters and informed by qualitative research in the target communities. They are tested with the most rigorous methods feasible. If they prove high-impact, they go to scale across many millions of people.

The Saturation Plus approach. Formative research identifies the specific barriers, scriptwriters in-country produce large volumes of short spots, and those spots run at high frequency across community radio stations with limited transmission range. For the family planning campaign, focus group discussions with hundreds of participants produced 59 motivational radio spots and 29 informational spots. Burkina Faso was chosen for the child survival trial partly because its media landscape, community FM stations with limited range, allowed clean cluster separation.

Focus areas span family planning, child survival, early childhood development, nutrition, water, sanitation and hygiene, and emerging, infectious and neglected diseases. Current campaigns run in nine sub-Saharan African countries: Uganda, Madagascar, Malawi, Zambia, Mozambique, Burundi, the Democratic Republic of the Congo, Ghana, and Mauritania, covering themes from tuberculosis and mental health to menstrual health and labour rights. Campaigns have also been delivered in Latin America and Asia. Burkina Faso, where both randomized trials ran, is not among the current operating countries.

The testing infrastructure is the differentiator. Trial clusters were selected for high radio listenership, above 60 percent of women listening in the past week, and minimum distances between stations to exclude population-level contamination. An organization that lets the requirements of a clean experiment shape where it works is unusual.

Mapped against a Theory of Change, the chain runs: saturate the airwaves, caregivers learn and change behavior, care-seeking rises, treatment happens, children survive. Links one through three are proven with randomized controls. Link four is proven on the family planning side, where contraceptive uptake produced 10 percent fewer births and measurably higher reported wellbeing. Link four on the child survival side was tested and could not be demonstrated, which the organization published.

Key Outputs

• 78 million people reached across 9 countries
• Two completed randomized controlled trials plus a third underway in Côte d’Ivoire on early childhood development
• Child survival trial: 35 months, 14 clusters, 7 intervention and 7 control, averaging 29 to 34 villages per cluster, campaign running March 2012 to January 2015, with household surveys at baseline, midline after 20 months, and endline after 32 months
• Family planning trial: a two-level design testing both media access and message quality. 16 radio areas covering 5.1 million people, 8 of 16 stations receiving the campaign, 1,500 women receiving radios, 7,500 women surveyed in 252 villages, 461 clinics, plus monthly administrative contraceptive distribution data
• Family planning scale-up: 39 radio stations across Burkina Faso, reaching 16.3 million people, roughly 80 percent of the country’s population, with an estimated 225,000 additional women using modern contraception. Adapted into seven countries in southern and eastern Africa
• $7.70 per couple-year of protection for the family planning campaign
• Published in The Lancet Global Health, BMJ Global Health, Global Health: Science and Practice, and The Lancet
• Funding partners include the Global Innovation Fund ($2 million for the family planning trial), the United States Agency for International Development Development Innovation Ventures initiative ($400,000), and the Wellcome Trust
• Endorsed by The Life You Can Save and Founders Pledge

Key Intermediate Outcomes

From the child survival cluster randomized trial, measured against seven control clusters over 35 months:

• Malaria diagnoses increased 56 percent
• Primary care consultations for children under five increased
• Antenatal care attendance increased
• Health facility deliveries increased
• Seventeen targeted family behaviors were measured through mothers’ reports, with midline results published separately after 20 months

What moved and what did not. An independent editorial in the same journal that published the midline results concluded that despite innovative approaches and high reported listenership, only modest behavior change was found, concentrated in care seeking rather than habitual behaviors such as hand washing. The campaign changed what families did when a child became ill. It did not change what they did every day.

From the family planning randomized trial, independently evaluated across 16 randomly assigned areas:

• Modern contraceptive use rose 5.9 percentage points, a 20 percent increase in the modern contraceptive prevalence rate, statistically significant at p = 0.046
• Births fell 10 percent in campaign areas relative to non-campaign areas
• Misperceptions about contraception fell, and the researchers identified this as the mechanism driving uptake. The knowledge index rose 0.29 standard deviations
• Cost-effectiveness estimated at $7.70 per couple-year of protection

A published null worth naming. The same trial found fertility preferences remained unchanged. The campaign moved behavior without moving what women said they wanted, which says something specific about how mass media works.

Historical non-experimental results are presented on the Impact page with the design labeled: contraceptive and antenatal behavior gains in Cambodia and India, hand-washing gains in Ethiopia and Nepal, a leprosy hotline going from 6 to 477 calls a day in Brazil, and a 26 percent rise in national tuberculosis diagnostic tests in Brazil in the three months after a campaign. The organization states plainly that scale-up campaigns use non-experimental designs.

Key Ultimate Outcomes

Child mortality was measured against a randomized control, and the effect could not be detected.

The Lancet Global Health paper (Sarrassat et al., 2018) set all-cause post-neonatal under-five child mortality as its primary outcome. Post-neonatal under-five mortality fell from 93.3 to 58.5 deaths per 1,000 live births in control clusters and from 125.1 to 85.1 in intervention clusters. The authors’ conclusion is unambiguous: a comprehensive radio campaign had no detectable effect on child mortality.

Two features of those numbers matter for interpretation. The arms were not balanced at baseline. Intervention clusters began 34 percent higher than control clusters, 125.1 against 93.3, so the comparison is between two very different starting points. And mortality fell steeply in both arms during the trial period, which reduced statistical power. The authors also note large heterogeneity between clusters, with mortality ranging from 56 to 156 per 1,000.

One ultimate outcome was measured with a comparison group and did show an effect. From the family planning trial, women’s self-assessed health and wellbeing rose 0.258 standard deviations, p = 0.008. The authors describe this as consistent with the program being welfare improving. Births falling 10 percent is reported above as an intermediate outcome, since a reduction in an event is not itself a condition of life.

The lives-saved figures are modeled and are excluded from this evaluation. A companion paper in BMJ Global Health (Murray, Head, Sarrassat et al., 2018) applied the Lives Saved Tool to the measured facility utilization increases and estimated a 7.1 percent average annual reduction in under-five mortality, which produces the 3,000 lives figure for Burkina Faso and underwrites the 22,000 figure for 2020 to 2025. That is a legitimate and transparent method, published in a peer-reviewed journal, and it is modeling rather than measurement. A donor should understand which is which, and the website does not consistently make that distinction.

Historical disease-burden results are non-experimental: trachoma prevalence in Ethiopia falling from 70 to 52 percent in areas receiving no antibiotics, and households in Nepal reporting eye problems falling from 64 to 29 percent.

Continual Learning & Adaptation

It built its operating model around being testable. Trial clusters were selected for radio listenership above 60 percent and minimum distance between stations specifically to exclude contamination between arms.

It published a null on its own central claim. The child survival trial is the defining fact about this organization, and the way it was handled says as much about its culture. The result went into The Lancet Global Health, the cost-effectiveness paper states openly that the trial was unable to detect a mortality effect, and the modeling paper opens by acknowledging the same before explaining what it does instead. Nothing was buried.

It published the intermediate steps too. Midline behavior change results appeared in Global Health: Science and Practice after 20 months, and a separate paper documented the Saturation Plus design and implementation in detail so others could replicate or critique it. The same journal issue carried an independent editorial assessing the trial, quoted above, which found the behavior change modest.

It handed the second trial to independent evaluators. The family planning trial was evaluated by the Abdul Latif Jameel Poverty Action Lab and Innovations for Poverty Action rather than by the organization itself, with survey work, clinic records, and administrative distribution data triangulated.

It used qualitative research to redesign the intervention. Focus groups with hundreds of rural Burkinabè participants identified fear of infertility, attitudes toward family size, and women’s lack of decision-making power as the binding constraints, and 59 motivational and 29 informational radio spots were written from those insights. The trial then found that misperceptions were the operating mechanism, validating the diagnostic work.

It disseminated results locally. In 2019 the organization hosted an event in Ouagadougou to share the family planning results with Burkinabè stakeholders including government representatives. In 2021 it co-hosted a webinar with the United States Agency for International Development, the Global Innovation Fund, the Abdul Latif Jameel Poverty Action Lab, and Innovations for Poverty Action.

It scaled what worked and kept testing new areas. The family planning campaign went from a 16-station trial to 39 stations covering 80 percent of Burkina Faso and adaptation in seven countries, while a new randomized trial on early childhood development runs in Côte d’Ivoire.

Further Reading

Organization Sources

• Development Media International homepage, source of the Create Test Scale framing, the 56 percent malaria diagnosis figure, the 3,000 and 22,000 lives estimates, and the endorser list. developmentmedia.net
• Development Media International, Impact, source of the historical non-experimental results across Cambodia, India, Ethiopia, Nepal, and Brazil, and the 78 million people across 9 countries figure. developmentmedia.net/impact
• Development Media International, Projects, including the Child Survival Randomised Controlled Trial, Family Planning Randomised Controlled Trial, Early Childhood Development Randomised Controlled Trial, and Women’s Integrated Sexual Health. developmentmedia.net/projects
• Development Media International, What We Do, How We Work, and Focus Areas. developmentmedia.net/what-we-do
• Development Media International, Annual Report 2024-2025 and Resources library. developmentmedia.net/resources

Peer-Reviewed Trial Evidence

• Sarrassat, S., Meda, N., Badolo, H., Ouedraogo, M., Some, H., Bambara, R., Murray, J., Remes, P., Lavoie, M., Head, R., and Cousens, S. (2018). “Effect of a mass radio campaign on family behaviours and child survival in Burkina Faso: a repeated cross-sectional, cluster-randomised trial.” The Lancet Global Health 6(3): e330-e341. DOI 10.1016/S2214-109X(18)30004-4. The primary outcome paper, source of the child mortality null, the baseline mortality figures, and the care-seeking effects. thelancet.com
• Murray, J., Head, R., Sarrassat, S., Hollowell, J., Remes, P., Lavoie, M., Borghi, J., Meda, N., Ouedraogo, M., and Cousens, S. (2018). “Modelling the effect of a mass radio campaign on child mortality using facility utilisation data and the Lives Saved Tool: findings from a cluster randomised trial in Burkina Faso.” BMJ Global Health 3(4): e000808. Source of the 7.1 percent modeled annual mortality reduction underlying the lives-saved claims. bmjglobalhealth.bmj.com
• Kasteng, F., Murray, J., Cousens, S., Sarrassat, S., Steel, J., Meda, N., Ouedraogo, M., Head, R., and Borghi, J. (2018). “Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso.” BMJ Global Health 3(4): e000809. PDF
• Sarrassat, S., Meda, N., Ouedraogo, M., Some, H., Bambara, R., Head, R., Murray, J., Remes, P., and Cousens, S. (2015). “Behavior Change After 20 Months of a Radio Campaign Addressing Key Lifesaving Family Behaviors for Child Survival: Midline Results From a Cluster Randomized Trial in Rural Burkina Faso.” Global Health: Science and Practice 3(4): 557-576. DOI 10.9745/GHSP-D-15-00153. ghspjournal.org
• Murray, J., Remes, P., Ilboudo, R., Belem, M., Salouka, S., Snell, W., Wood, C., Lavoie, M., Deboise, L., and Head, R. (2015). “The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso.” Global Health: Science and Practice 3(4): 544-556. DOI 10.9745/GHSP-D-15-00049. ghspjournal.org
• Head, R., Murray, J., Sarrassat, S., et al. (2015). “Can mass media interventions reduce child mortality?” The Lancet 386: 97-100.
• Glennerster, R., Murray, J., and Pouliquen, V. (2026). “Mass Media and Contraception Use: An Experimental Test of Modernization Theory in Burkina Faso.” National Bureau of Economic Research Working Paper 34829; also Becker Friedman Institute Working Paper 2026-32. Source of the 5.9 percentage point contraceptive effect, the 10 percent birth reduction, the 0.258 standard deviation wellbeing effect, the 0.29 standard deviation knowledge effect, and the unchanged fertility preferences. Earlier version issued as Centre for the Study of African Economies Working Paper 2021-04 under the title “The Media or the Message?” Working paper PDF

Independent Assessment

• “Behavior Change Fast and Slow: Changing Multiple Key Behaviors a Long-Term Proposition?” Global Health: Science and Practice (2015) 3(4): 521-524. DOI 10.9745/GHSP-D-15-00331. An independent editorial on the midline results, concluding that only modest behavior change was found, mainly in care seeking rather than habitual behaviors. ghspjournal.org
• Abdul Latif Jameel Poverty Action Lab, “Lowering barriers to contraception use through mass media,” updated March 2025. Source of the 16.3 million reach and 225,000 additional users figures. povertyactionlab.org
• Innovations for Poverty Action, family planning trial study summary. poverty-action.org
• Global Innovation Fund, Development Media International investment overview and 2024 completion assessment. globalinnovation.fund
• Rethink Priorities, assessment of mass media family planning cost-effectiveness referencing the Development Media International trial. rethinkpriorities.org
• Family Planning 2030, “Accelerating Family Planning Progress in West Africa Through Mass Media.” fp2030.org
• Population Reference Bureau, “Reproductive Health in Sub-Saharan Africa.” Source of the 25 percent unmet need figure and the 23 percent contraceptive use figure among married women. prb.org

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