Indonesia’s performance on the health Millennium Development Goals (MDGs) still remains poor. On MDG 4, which explores the mortality rate of children 0-5, Indonesia has made some progress, moving from 97 per 100,000 live births in 1990 to 44 per 100,000 by 2010. However, the rate of progress has declined, and it remains unclear whether the MDG will be met.
One of the key drivers of the progress for child mortality is the rate of complete immunization of children under 5 against a range of childhood diseases, including measles, diphtheria, whooping cough (pertussis), tetanus, tuberculosis, polio and Hepatitis B. Despite their importance, complete immunization coverage against these diseases is quite low in Indonesia – for instance, only 27% of children are fully immunized against polio, and more than 21% of children have not been fully immunized against measles.
The Government of Indonesia has made significant efforts to increase the supply of health services to improve these outcomes. By 2011, only 6% of rural children lacked access to a primary health care center, and almost no urban children lacked access. Only 8% of rural children were born in a village without a midwife, compared with only 2% of urban children. Despite important progress on the supply side, low rates of care-seeking persist and outcomes remain poor.
The Government is seeking to investigate whether electronic media -- social media such as Twitter, as well as conventional text messaging to cell phones -- can help increase vaccinations. In Indonesia, use of Twitter and other social applications – especially those accessible via mobile – has skyrocketed. Indonesia holds the world’s fifth largest number of Twitter accounts, though recent growth has outpaced three of the four nations with larger user bases: Brazil, Japan, and the United Kingdom. On a daily basis, we observe between 400 and 500 million tweets, of which about 75% are original tweets and the remainders are retweets. The Government thus believes that Twitter has an important potential role in spreading social information, such as immunization campaigns.
In addition to the policy interest, there is also a separate set of academic questions about the diffusion of information over networks: how we communicate, on what topics, and whether this induces actions. With the proliferation of new social tools, individuals engage in information exchange in more ways than ever before, and this has implications on political beliefs, take up of social policies, preferences related to care seeking behaviors, among other areas.
This research project will therefore investigate whether disseminating social messages on Twitter and direct text messages (SMS) can have a positive and significant impact on take-up of socially positive behaviors, such as immunization seeking behaviors.