By Emma Beck, Associate Communications Manager, PSI
Semeni Likulo hovers her finger over her clipboard, landing on the address of the next door to knock on.
She smiles. It’s been a good week.
“In Tanzania, talking to young people about contraception has never been easy work,” says Likulo. “It requires good techniques to engage young people and understand how they perceive and interact with the world around them.”
Likulo is one of 150 healthcare educators supporting PSI’s youth-powered sexual and reproductive health (SRH) project, deployed to reach girls aged 15-19 with contraceptive pre-counseling.
It’s a tall task: in an environment in which young Tanzanian girls hold deep misperceptions about contraception, Likulo must find ways to meet consumers where they are—and with what they need—to make contraception relevant, accessible and valuable for young girls.
“Girls worry about what impact contraception may have on their bodies and their fertilities,” Likulo pauses. “We see the implications of those beliefs in practice: at times, we’ve gone a whole month without referring a single girl to the clinic.”
But that’s now changing.
By working in partnership with young people, PSI, across its global network, is driving new ways of designing and delivering reproductive health solutions—and with it, tapping into digital technologies like Mjanja Connect to power frontline educators like Likulo with targeted tools they need to reach the girls they serve.
Flipping the Script
In Tanzania, one of the countries in which PSI’s flagship youth-powered SRH project Adolescents 360 (A360) operates, there are 2.3 million girls aged 15-19. More than half of the girls in this age group are sexually active, but one in four does not use modern contraception. That same number is already pregnant.
To resolve these gaps, PSI is doing things differently.
Through A360, co-funded by the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation, PSI fuses a diverse team of disciplines—cultural anthropology, social marketing, adolescent developmental science, adolescent and youth SRH and human-centered design—all in partnership with young people. The approach allows the team to step deep into consumers’ lives to understand what young people need, today.
And as Likulo says: it works.
From implementation launch in January 2018 through March 2019, A360 Tanzania’s combined mobilization, outreach and service delivery activities have served more than 70,000 girls with modern contraception.
Nine in 10 girls who engage with A360 Tanzania voluntarily take up a method. Six in 10 girls choose a long-acting reversible contraceptive.
How Might We Appeal to Girls?
“If you don’t address girls’ fears, you won’t see them coming in for services,” says Edwin Mtei, PSI Tanzania’s A360 Project Director.
Indeed, girls in Tanzania told PSI’s A360 team that they dreamt of starting businesses, of finishing school and of becoming mothers—when they are ready. But with fears that contraception could lead to serious side effects, and with entrenched misconceptions about any changes to menstruation, adolescent girls had long classified contraception as “not relevant for me.”
That’s in part because the conversation around contraception was following a one-size-fits-all approach.
“Frontline workers were using tools for women to reach girls with services,” says Rosemary Nazar, an A360 Young Designer involved in Mjanja Connect’s creation. “But you can’t use the same engagement tool for mothers that you use for girls.”
Before A360, health educators like Likulo engaged consumers with pre-counseling using a flip chart, intended to guide the conversation around contraception. But the chart featured photos of adults with babies that didn’t resonate for girls who didn’t have children. It also presented contraceptive methods by length of effectiveness, an inclusion that often turned off young girls who fear that a long-lasting method could harm their dreams of motherhood.
There needed to be a focus on the client experience. And it needed to be streamlined so health workers could effectively engage clients, and then track their pathway to care.
Bringing Girls’ Dreams into the Conversation
A young woman opens the door. “Karibu,” Likulo says warmly.
“My name is Semeni.” She points to an Android tablet. “I’m here to talk about your health.”
The girl shakes Likulo’s hand with a boldness. She grabs a beaded purse from the ledge by her front door, before stepping outside of her house. “I’m Amina.”
Likulo adjusts her grip as she turns the tablet around to give Amina a full view of the screen. Likulo presses play. A ringing chorus of girls’ voices fills the space, all coming from the app in Likulo’s hands.
This is Mjanja Connect, an interactive tablet-based technology driven by girls’ insights gleaned from A360 and delivered by educators at the helm of mobilizing girls to care. Developed with support from the Vodafone Foundation, Mjanja Connect delivers PSI Tanzania a new way of reaching girls with SRH information, and then tracking how and when they engage with the health clinic for contraceptive services. Mjanja Connect changes the conversation around contraception—leading with what matters to girls now and into the future.
Amina leans into the tablet as she bounces her head in sync with Mjanja Connect’s opening music video, known by the team as Sisi Nanasi, or “I am a Pineapple” in Kiswahili.
The video’s inclusion emerged during a design sprint focused on what it would take to make girls feel that this tool was something for them. A360 young designers shared that opening with a music video could pull A360 Tanzania’s girl-defined branding—visuals of pineapples to symbolize sweetness and crowns to celebrate strength—that young girls could relate to folded into girl-powered music they could connect with. Sisi Nanasi makes no mention of contraception, but rather spotlights bold young girls who prompt viewers to consider what it means to be young and achieve dreams.
A digital quiz appears after the music video closes.
“Where do you want to be in five years?”
Amina lifts her beaded purse. “I make and sell these bags to girls in my community. I dream of making my business huge,” Amina smiles widely. “I want to contribute to my family.”
Likulo nods encouragingly. “That is good, Amina. The steps you take today to plan for the future you want will enable you to achieve your goal of setting up that business.”
Likulo flips to the screen’s next slide, “True or False? A period is the body getting rid of toxic blood.”
“Go ahead,” Likulo says. It’s a nod to encourage Amina to dig into, and then debunk the myths surrounding contraceptive side effects, like changes to menstruation
The quiz helps segment girls into categories: younger girls with less knowledge about their bodies, and older girls who may already be sexually active. Understanding the audience ensures the right message—and the right options—are then delivered.
Based on quiz answers, the app presents two method recommendations for girls to compare side-by-side, and they can watch video testimonials delivered by “girls like me” to hear first-hand from peers about why they selected the method, what they can expect when they receive it at the clinic and what side effects may come from the contraceptive chosen.
All messaging leads with a return to fertility, speaking directly to girls’ primary, expressed concern.
If a girl opts for a method, the app provides a referral which girls can redeem at a PSI Tanzania clinic. The process ensures no information is lost nor duplicated between clinic visits, while allowing healthcare educators like Likulo to follow-up with their clients, like Amina.
“Mjanja Connect shows that technology can be a powerful tool to increase the reach and impact of SRH education among young people today,” says Lee Wells, Head of Health Programs for the Vodafone Foundation. “Mjanja Connect gathers and shares complex contraceptive information for each user to offer guidance that is engaging, personalized and relevant to their needs.”
As Wells says, technology is key in delivering this level of service at scale.
“We hope Mjanja Connect will encourage young people to take action with their SRH, by putting reliable information and the ability to make informed choices about their future in their hands,” Wells adds.
Reaching Girls. Supporting Health Systems.
“Mjanja Connect is a game changer,” Likulo says. “It makes the narrative consistent, it builds trust among girls and has lightened the tenuous paperwork that we used to fill out to track girls’ pathway to care.”
Likulo eyes her clipboard. She’s got another house to visit.
“I no longer have to carry a flip chart, method bags, notebook and pens. I now just need to carry my tablet. It makes me more effective.”
Since integrating Mjanja Connect, Likulo now refers about six girls to the clinic per week. That’s up from the average of one she was referring before.
—With contribution from Gaston Shayo, Marketing & Communications Specialist, PSI Tanzania. Banner image courtesy of TBWA/Khanga Rue.
This article first appeared in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.
Will you be at WD2019 this June? Don’t miss your chance to come dance with us! Join PSI at the Sisi Nanasi video screening during the Women Deliver Film Festival on Tuesday, June 4 at 6:30 p.m. at the VCC West Exhibition Hall.
Where else will A360 be at WD2019? We’ve got you covered, here.