Intended for healthcare professionals

Observations Medicine and the media

The soap opera that saves lives

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39570.422778.3A (Published 15 May 2008) Cite this as: BMJ 2008;336:1102
  1. Jane Cassidy, freelance journalist
  1. janecassi@yahoo.co.uk

A “public health” soap opera has such a large number of fans in South Africa that it is now being rolled out to neighbouring countries. Jane Cassidy reports

A soap opera on South African television that is run by public health activists is now to be screened across eight neighbouring countries, with the help of a £14m (€18m; $27m) grant from the UK government. Soul City is watched by more than 34 million people in South Africa, over 70% of the population. In tackling a range of gritty health and social issues, from HIV and AIDS to rape, the drama doesn’t pull its punches.

In a country where more than one in 10 people has HIV or AIDS, “edutainment” can play a big role in encouraging people to change their behaviour and in helping to save lives, says the UK Department for International Development, which has supported the shows for the past 13 years.

The Soul City phenomenon has spread from television to radio and spawned information booklets, advertising campaigns, and a young people’s spin-off series called Soul Buddyz, with 3600 Soul Buddyz clubs nationwide. There is a Soul City Institute and a behaviour change communication campaign that sets targets for achieving safer sex practices, higher numbers of people going for an HIV test, greater awareness of management of tuberculosis and HIV, and reducing stigmatising attitudes.

A similar television series in the United Kingdom funded by the NHS, Kismet Road—a soap opera that aimed to promote public health issues to the UK’s south Asian population—bombed when television companies refused to broadcast it (BMJ 2003;326:110 doi: 10.1136/bmj.326.7380.110). So why has Soul City succeeded where Kismet Road failed?

Doug Storey, associate director of the Center for Communication Programs at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, says that Soul City is one of the best examples of entertainment education in the world. He said, “The strategy behind successful entertainment education programmes lies in bringing scientists and artists together so that they learn to speak each other’s language. As a story script develops, it should be informed by science. Soul City does this beautifully; it has mastered the process.”

This synergy can produce results in developing and developed countries. Dr Storey worked on the Radio Community Project in Nepal, which had a big effect on family planning and was one of the first evaluations of an entertainment education project to show population level effects on behaviour.1 He is also one of a team of researchers convened by the National Cancer Institute in the United States to study how narrative forms of communication are emerging as important tools for cancer prevention and control.2

The Health Communication Partnership at Johns Hopkins has worked with several South African research partners, including the Soul City Institute, to measure exposure to all major radio and television programming on HIV and AIDS to determine how the broadcasting has affected behaviour. A survey conducted by the partnership found that 87% of the 7006 men and women surveyed had some exposure to at least one of six main programmes. It found a relation between condom use and exposure to such programmes in the mass media, with condom use ranging from 19% among those with no exposure to any programme to 70% among those with high levels of exposure.3

Soul City spokesman John Molefe described the painstaking research undertaken before filming starts to give the programme credibility. This involves teams of local researchers talking to people and grassroots groups about topical issues of concern to communities. Their results are fed back to scriptwriters, who produce storylines that are then tested on viewers to see whether they can relate to the characters, plots, and underlying health messages. The scripts are refined by the best talent from South Africa’s television industry before filming starts. “We don’t start out by saying we’re TV producers,” said Molefe. “We aren’t—we’re public health activists. We wanted to use the media to impact on people’s behaviour.”

Before a controversial topic is tackled, programme makers are careful to prepare for any potential public reaction. So in 1999, before a storyline on domestic violence was screened, Soul City worked with charities that support abused women, bracing themselves for a big response from women victims influenced by the drama. A helpline was set up, and training programmes were run for court officials and police to bring them up to speed with legislation that strengthened the right of women to take action against abusive partners. The Stop Women Abuse helpline received 180 000 calls while the programme was on air.

Conny Setjeo is perhaps the soap’s most famous actor. After watching one episode before she joined the programme she went for an HIV test and discovered that she was HIV positive, infected by her former husband. She joined the series after asking programme makers why they were using actors instead of real people. Her experiences were dramatised in episodes screened in 2005 and 2006.

So, why should the UK government help finance the roll-out of the Soul City package across countries in the region, including Mozambique, Namibia, Zimbabwe, Lesotho, Botswana, Malawi, Zambia, and Swaziland? A study on achieving the millennium development goals for health, funded by the World Health Organization, concluded that the “best buys” in HIV prevention included mass media campaigns.4 South Africa’s Department of Health last year reported a fall in the number of under 20s infected with HIV, from 16.1% in 2004 to 13.7% in 2006, and a similar fall occurred among 20-24 year olds, indicating that a sustained change in behaviour is taking place among younger people with regard to safer sex practices.5

Melinda Simmons, head of the UK Department for International Development’s office for Southern Africa, says that the show works because it’s realistic: “It’s not preachy, unlike a lot of initiatives around HIV/AIDS and health. Soul City doesn’t draw any conclusions, it simply tells people’s stories really well.”

References

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