Nigeria is one of the developing countries that are struggling to address some critical health issues. Notably among the health issues affecting Nigerians include Covid-19, polio, malaria, measles, cholera, HIV/AIDS, obesity, and many other social problems such as drug abuse, teenage pregnancy, and child abuse. These challenges are critical and sometimes do not require clinical intervention but social campaigns to influence people’s behaviours, attitudes, and beliefs to achieve a healthy society. Hence, experts and scholars with expertise in commercial marketing developed a related commercial marketing framework, coined as ‘social marketing’ with a multi-disciplinary approach to address these social and health issues. Given this, the paper reviewed some relevant literature on social marketing, health communication, and public health campaign to support and advance the argument that the social marketing framework is effective in public health campaigns in Nigeria. This position is strongly supported by some studies in Nigeria that focused on social marketing in various health communication interventions.

      A health challenge is one of the major problems faced by many developing nations in the world. It is usually caused by poor environmental and personal hygiene and a lack of an effective health care system. Nigeria is one of the countries that have been battling poor public health management. Several health issues such as HIV, STDs, malaria, measles, polio, and several others pose a serious threat to the well beings of Nigerians. These are diseases that could be managed effectively if proper medication and positive attitudes are given priority. Some health challenges largely require that people are aware and well informed about their state of health to enable them to seek proper medical treatment or counseling. A study conducted by Yahaya [1] explored the reasons people in Northern Nigeria resist polio immunization, following the period in 2003 when polio immunization was brought to a stand-still. The study found that there was an underlying logic to public anxieties often dismissed as ‘anti-vaccination rumors’. This further confirms that there is a need for people to be well informed about health issues that affect them. Efforts have constantly been made by government and non-governmental organizations in form of intervention to bridge the communication gap and improve the well beings of the citizens but this has never been without challenges. Scholars and experts (e.g [2], Healthy People, 2010) have identified health communication as a key area that can address health issues through the application of communication strategies that are effective in disseminating health messages.

      Schiavo ([2], p.7) defines health communication as a multifaceted and multidisciplinary approach to reach different audiences and share health-related information with the goal of infl uencing, engaging, and supporting individuals, communities, health professionals, special groups, policymakers, and the public to champion, introduce, adopt, or sustain a behavior, practice, or policy that will ultimately improve health outcomes.

      This definition points to the imperative need for communication in addressing health challenges. It is so far considered by many scholars to be the most comprehensive definition of health communication. Developing health-related messages that are capable of influencing behavior and practice and improving the welfare of individuals and society as a whole, is the ultimate goal of any health communication.

      In Nigeria, there are serious concerns about HIV stigma; people’s resistance to polio immunization; poor attitude towards malaria prevention, drug abuse, and several others that could largely be addressed through behavioral communication change efforts. The tendency for people to change their behaviors depends more often than not on the persuasive nature, quality, and consistency of the information they received. Thus, this suggests that an effective communication strategy must be used to develop the health-related messages and effectively disseminate them to the target population. One of the effective health communication strategies is perhaps social marketing because it is developed basically to reach people with health-related information that is socially oriented as opposed to commercially oriented information.

      Application of social marketing principles and techniques can benefit society in general and the target audience in particular, in many ways. Four areas have been identified as major areas that social marketing usually focuses its effort on, which include health promotion, injury prevention, environmental protection, and community mobilization [3]. These are areas that concern issues relating to public health. Cheng, Kotler, and Lee (n.d) identified specific related behavioral issues that could be benefited from social marketing strategy in the mentioned areas as follows:

      Health promotion: Use of social marketing to address issues such as tobacco, heavy or binge drinking, obesity, teen pregnancy, HIV/AIDS, fruit and vegetable intake, high cholesterol, immunization, breastfeeding, cancer, birth defect, and eating disorders.

      Injury prevention: Social marketing could be used in this case to change peoples’ behavior or address issues such as drinking and driving, use of car seatbelts, suicide, domestic violence, etc.

      Environmental protection: This relates to behavioral issues that include waste reduction, wildlife protection, water conservation, air pollution, use of toxic fertilizers and pesticides among others.

      Community mobilization: Social marketing could effectively be used for social or community mobilization in areas such as organ donation and blood donation.

      Brown [4] has noted that social marketing which encompasses different communication strategies could be used in addressing diseases such as leprosy in society by hoisting media campaigns, using school-based education, involving community leaders, and integrating and improving leprosy services. Also, Obono ([5], p150) had noted that “different communication techniques including participatory, media advocacy, multi-pronged approaches, and creative media formats are used to influence the behavior of target audiences”. The author further explained that:

      Health campaigns are designed to suit target groups but even within the same broad group, there may be subgroups requiring different communication styles. Variance in group composition requires diverse approaches, hence, integrated communication. This model is important because behavior change generally begins with the individual and requires strategies for modification of personal knowledge, beliefs, attitudes, and practices (p. 151).

      This indicates that public health issues required a robust, consistent, and effective communication intervention, as such campaigns are deemed effective and usually hoisted by responsible agencies of government, activists, Non-Governmental Organisations (NGOs), citizens, and several other stakeholders that believe in information power, to positively change behavior. Weiss and Tschirhart [6] argued that government uses public information campaigns as a policy instrument and if effectively utilized can address the issue it is intended to solve. Part of the public health campaign effort is to ensure that messages are socially oriented, developed, strategized, and disseminated.

      Hence, this paper examines relevant literature to support and advance the argument that social marketing could effectively be utilized for public health campaigns in Nigeria considering its strengths in influencing behavioral and social change. The paper is a conceptual paper that utilized the secondary data using existing literature to interrogate the subject under investigation.

The concept of social marketing

      Social marketing is a popular marketing framework today and also a strategy that is used to deliver messages aimed at changing people’s behavior, attitude, and practice. Kotler and Zaltman [7] were the first to coin the term ‘social marketing’ in 1971 to mean the application of marketing to the solution of social and health problems. The term was used in their seminal article titled, ‘Social marketing: An approach to planned social change,’ published in the Journal of Marketing. Before then businesses had used marketing and the strategy had successfully encouraged people to buy certain products such as Coca-Cola and Nike products. This originally informed the idea of applying the same marketing strategy to social issues to encourage people to change or adopt certain behaviours that will improve their wellbeing as well as their society. The argument then was that brotherhood could be sold to people just like how soap is sold to people as a commodity. This, in their argument, could also be successful if the social campaign follows a similar commercial marketing process [8].

      According to MacFadyen, et al. [8] at a different point in time in history attempts was made to influence and improve the quality of lives of people. This could be traced to the time parliamentary reformers, Luddites, suffragettes, feminists, and many others tried to change the social circumstances of some particular groups as well as society as a whole, with varying degrees of success. Today health promoters, government agencies, and other Non-Governmental Organizations use similar marketing strategies to achieve their goals. This professional effort does not only change an individual citizen but many others that contribute to a healthy society such as policymakers and influential interest groups in their effort to ensure a quality and healthy society. Social marketing has several definitions. However, Stead, Gordon, Angus, and McDermott ([9], p.5) offered Andreasen ([10], p.7)’s definition of social marketing as the most useful. According to Andreasen ([10], p.7) “Social marketing is the application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target audiences to improve their welfare and that of society.” One of the key elements of this definition that draws attention is the ‘voluntary behavior of target audiences’ which implies that target groups or populations are not coerced to change but rather accept to change by will. Social marketing is not enforced.

      Another interesting aspect of the definition which is also a key to understanding its relation to commercial marketing is “the application of commercial marketing technologies”. Typical commercial marketing has some techniques that include consumer-oriented market research, segmentation, targeting, and the marketing mix. One of the modest set of characteristics of social marketing developed by Andreasen [10] that distinguish social marketing about the four elements of the marketing mix (Product, Price, Place, and Promotion) are outlined as follows:

a. Designing a product (i.e. the behavior to be promoted) that is fully responsive to the target consumers “needs and wants”, in other words, that is easy and satisfying;

b. Making the place at which the behavior can be carried out convenient and accessible;

c. Minimizing to the extent possible the economic, social and psychological price of the behavior; and

d. Seeking to promote the behavior with messages through personal or impersonal media appropriate to the target audience’s lifestyle patterns and preferences.

      Walsh, Rudd, Moeykens and Moloney [11] integrated the views and positions of the pioneer scholars on social marketing and presented the following summary description according to different phases:

I. Research planning: This includes elements such as planning, consumer analysis, market analysis and channel analysis.

II. Strategy design: The focus here is on development of marketing mix strategy and communication.

III. Implementation and evaluation: As the last phase of the process, it dwells on implementation, process evaluation and outcome evaluation.

      The marketing mix techniques are very important in public health campaigns but it is worthy to note that the goal of social marketing is not to make a profit but to benefit individuals and society by improving welfare [8,9]. However, despite the potential inherent in social marketing as a similar commercial marketing model for social change, critics during the early development of social marketing have opposed the use of commercial marketing techniques to change social circumstances. According to MacFadyen et al. [8]:

      To many, however, the idea of expanding the application of marketing to social causes was abhorrent. Luck [12] objected because replacing a tangible product with an idea or bundle of values threatened the economic exchange concept. Others feared the power of marketing, misconceiving its potential for social control and propaganda [13]. Despite these concerns, the marketing concept was redefined to include the marketing of ideas and the consideration of its ethical implications (p. 695).

      MacFadyen et al. [8] submit that in practice, social marketing was a collective effort of many contributors at the same time including Paul Bloom, Karen Fox, Dick Manoff, and Bill Novelli. Citing Manoff (1985) and Walsh et al. [11], MacFadyen et al. [8] noted that early practice of social marketing emerged during the 1960s as part of international development efforts in Third World and developing nations. An example was given of family planning programmes in Sri Lanka that moved away from clinical approaches and examined the distribution of contraceptives through pharmacists and small shops.

Public health issues and communication in nigeria

      Previous studies [14,15], have shown that Nigeria has been dealing with so many health issues that certainly necessitated the use of public health campaigns to address them. Muhammad, Abdulkareem, and Chowdhury [16] noted some of the major health issues in Nigeria to include infectious disease, control of some vector diseases, maternal mortality, infant mortality, poor sanitation and hygiene, disease surveillance, non-communicable diseases, and road traffic injuries. The researchers then argued that these numerous health problems led to little improvement in Nigerian health status and therefore Nigeria needs properly designed programs to address these issues.

      Hence, public health communication is a key to solving some of these problems and is being applied in several circumstances, but there is a need to evaluate the nature and effectiveness of the public health communication practice in Nigeria to confirm its workability. According to Muhammad et al. [16], Public health communication aims at improving the health and overall wellbeing of a community or population through communication. Citing O’Sullivan, Yonkler, Morgan, and Meritt (2003), it usually encompasses interpersonal channels (e.g peer to peer, spouse to spouse, or health worker to a client), community-oriented channels (such as through family, religious and traditional leaders, or community-based groups) and mass media channels (e.g television, radio, newspaper, magazine, outdoor media, internet, etc)

      Ofurun and Tob (2016) attempted to analyze some case studies on public health communication strategies in Nigeria to ascertain the efficacy of the public health communication strategies as a tool for healthy living. The study reviewed some relevant studies that covered health issues such as Female Genital Mutilation (FGM) in Lagos (Isiaka and Yusuf, 2013), Polio Public Health Communication Strategies in Northern Nigeria (Nasiru, et al., 2012), Family Planning in Rural Nigeria: The Ebelle Scenerio (Omoera, 2010), The Effectiveness of Sources of HIV/AIDS awareness in a Rural Community in Imo state (Nwagwu, 2008) and Awareness and Uptake of Cervical Cancer Screening among Women in Onitsha (Kawonga, 2003). The findings from this review indicated that the efficacy of public health communication is dependent on the communication strategy adopted. Though strategically mass media has been very important in public health campaigns, it has been less effective in solely enforcing behavioral change because of the socio-cultural environment in which it operates. This further suggests that public health campaign requires a robust and integrated communication framework that encompasses effective strategies, such as social marketing.

      Health issues such as HIV/AIDS, polio, breast cancer or cervical cancer, tuberculosis, kidney infection, cholera, and malaria are some of the problems that are top on the list of health issues in Nigeria. It is argued in this paper that these are problems that do not only affect an individual’s life but could be extended to the larger society, especially those diseases or ailments that are known to be contagious. Therefore, their prevention and eradication do not solely depend on clinical treatment but some require maintaining a positive attitude, behavioral change, and change of lifestyle to contend with. It is obvious that some ailments come with the social challenge such as stigma, discrimination, and prejudice which can only be turned positive through proper and persuasive public health communication.

Social marketing as effective tool for public health campaign

      Social marketing has proved to be effective since its early time of development. Andreasen [17] noted some areas that social marketing has been utilized which implied the acceptance and success of the strategy particularly in US:

1. Social marketing approaches have been adopted by a wide range of U.S. federal agencies, most prominently the U.S. Department of Agriculture (5-a-Day program) and the Centers for Disease Control and Prevention, as well as state and local governments and a significant number of nonprofit organizations (see examples at www.social-marketing.org).

2. UNAIDS has invoked social marketing as a primary tool in its fight against AIDS, and the World Bank is regularly conducting distance learning sessions using social marketing concepts.

3. Requests for proposals for social change programs at federal and state levels and by nonprofit organizations now frequently require social marketing components and social marketing capabilities.

4. Several major consulting organizations, most prominently Porter Novelli, Academy for Educational Development, and Prospect Center, have emerged as leading social marketing consultants and have been joined by a growing number of smaller consultancies such as Equals3 and Sutton Social Marketing.

5. Major advertising and public relations organizations such as Fleishman Hillard, Burson Marsteller and Ogilvy Mather now claim specific social marketing capabilities.

      The success of social marketing as indicated in the above-mentioned areas by Andreasen [17] proves the continuous growth and efficacy of social marketing even across the globe. In developing countries and Nigeria in particular, several health intervention efforts have applied social marketing, either directly or indirectly. Walsh et al ([11] submit that early application of social marketing emerged as part of international development effort under the banner of “development communication” in the third old during the 1960s and 1970s to promote immunization, family planning, agricultural reforms, and nutrition.

      Thus, in Nigeria social marketing usually incorporates the use of media campaigns against health issues like polio, malaria, measles, HIV/AIDS, cholera, tuberculosis, leprosy, etc. Media appears to always be at the centre of social marketing strategy. This could be seen in the work of Ezogo and Chukwuemeka [18] who undertook a study to evaluate the impact of a broadcast media campaign on behavioral change of people in the Ebonyi State of Nigeria and found that broadcast media (radio and television) have a positive impact on marketing HIV/AIDS knowledge and information, though the authors noted other possible influence such as families and friends. In other words, media campaigns have appeared to have an impact on the social and behavioral change of Ebonyi people. This study confirms that social marketing is being used in Nigeria as part of an effort to change people’s behavior and lifestyle towards health issues.

      A related study by Akashoro, Adeyemi, and Ganiu (2012) designed to assess the application of social marketing in promoting social ideas in Nigeria also found that campaigns for delayed pre-marital sex for Zip-up campaign had greatly created awareness. The study like other previous studies established the fact that friends, relatives, partners, societal and religious values are also powerful influences on social and behavioral change of the target population.

      Moreover, many actors play significant roles in the health sector in Nigeria and most of which employ social marketing in their campaigns for promoting public health. Government agencies and other stakeholders such as NGOs and activists are the major players in this business. Society for Family Health (SFH) which is a major development partner in Nigeria has employed social marketing in many of its public health campaigns. The organization had successfully executed social marketing campaigns for HIV/AIDS and contraceptives over the years. Similarly, a campaign titled Support for Malaria Programmes funded by UKaid/DFID has also used social marketing to make people adopt the use of Longer-Lasting Insecticidal Nets (LLIN) [19].

      In the same vein, Nigerian Urban Reproductive Health Initiative (NURHI) which was a project designed to reduce barriers to family planning services also utilized social marketing tactics to achieve its objectives in six Nigerian cities [19]. Considering all these efforts towards promoting health through social marketing by development partners and other stakeholders, it is argued here that there is a strong need for government to harness the full potential of social marketing for public health campaigns in Nigeria. As proposed in the work of Mohammed et al [20], social marketing could be effective in reducing other social problems such as road traffic accidents, especially if properly and adequately utilized by agencies like Federal Road Safety Commission. Sharif et al. [20] described the strength of social marketing in achieving such an objective using the marketing mix. The 4Ps comprises Product, Price, Place, and Promotion and are represented in the social marketing process as follows:

1. Product: This concept unlike the commercial marketing is not tangible but simply an idea. In this case, “Safety driving” driving is the product.

2. Price: This is not in form of financial gain as the case with commercial marketing but the benefits that could be enjoyed by target audience in form of incentives- gift, recognition, reduction in social/utility bills or scholarship for those that comply to the rule of ‘safe driving’.

3. Place: This focuses on accessibility to designated centres where people can get information about safer driving.

4. Promotion: Promotion strategy in this case will include not only media but engaging religious and traditional leaders in the campaign for safe driving.

      Sharif et al. [20] proposed use of social marketing in reducing road traffic accidents which can also be applied to various social and health issues in Nigeria as part of a consolidated effort to promote good and healthy living in Nigeria.

      Social marketing is an effective tool in promoting health issues. The development of this framework has proven to be successful in various interventions across the globe, particularly in developing nations like Nigeria. This marketing technique as opposed to commercial marketing is distinct because of its focus on societal and health issues that affect a society. It is recommended to be an effective tool because of its ability to change behaviours and lifestyles of people and society as a whole. This marketing style is multifaceted and integrative. It allows the use of different strategies and tactics such as media campaigns, community mobilization, and engagement of community leaders (religious and traditional leaders). Given all the studies reviewed in this paper, social marketing strongly appears to be an effective, suitable and appropriate framework for developing, strategizing, and executing public health campaigns, which its primary purpose is to influence behaviors of people for a better and healthy society.