Dashboard East Africa: Demand Generation Social and Behavior Change

East Africa Toolkit: AYSRH Demand Generation

Social and Behavior Change

The approach provides a guide on how to engage adolescents and youth to access sexual and reproductive health services (SRH). Social and behavior change interventions (SBC) have been designed to address and decrease barriers, transform social and gender norms, and create an enabling environment that supports and promotes positive sexual reproductive health (SRH).

This tool will help in:

Engaging adolescents and young people as users of SRH products and services
Facilitation and promotion of changes in knowledge, attitudes, norms, beliefs and behaviors about SRH services among adolescents and youth and their influencers
Creating informed and voluntary demand for SRH products and services
Implementing different interventions to support and encourage positive SRH behaviors

In order to generate demand, adolescents and young people need to be informed about the availability of services through a range of channels. This information needs to include not only details about the availability of the services (when and where), but also information about why young people should use the services, and information to allay their anxieties about using them.

Examples of interventions that have worked promote and sustain use of adolescents and youth SRH products and services before, during or after service delivery. SBC can be used to increase the demand for (before) and utilization of SRH products and services (during), and improve the long-term maintenance of behaviors (after).

SBC includes approaches such as interpersonal communication (IPC), community mobilization, multimedia and mass media campaigns. This should be linked to all other approaches such as interpersonal counselling, branding health facilities, and training and youth-friendly service delivery points for greater impact.

Adolescents and youth face many challenges as well as consequences in accessing and using family planning services. Incorporating a strong community component encourages individual behavior shifts by either changing norms or knowledge and attitudes. A comprehensive SBC approach seeks to maximize broad engagement with individuals, decision makers and leaders to better understand SRH from an individual, family or group perspective.

Why Use SBC in AYSRH?

Reaches adolescents and youth who do not engage with the health systems
Attracts a large number of young people as they are drawn to entertainment more than information
Educates adolescents and youth on positive SRH behaviors

Evidence

The communications group Well Told Story incorporated information about sexual & reproductive health (SRH) into its Shujaaz comic book to motivate young people to use contraception. Shujaaz linked financial success to good planning, particularly for marriage and parenthood. This SRH strategy is set within the authentic & trustworthy 360-degree media space, where Shujaaz fans engage with fictional characters and with each other to discuss difficult issues, share ideas, and provide support.

Several longitudinal studies showed the effectiveness of Shujaaz in creating large-scale positive changes among youth. These studies found that youth exposed to Shujaaz are significantly more likely than youth not exposed to delay sexual debut, use contraceptives, delay childbirth, have independent income and earn more than they spend. Shujaaz’s SRH strategy is successful because it offers solutions to youth’s immediate needs, transforming the perception of social norms through characters and fiction, and accelerating social change through curated collective conversations.

Guidance: How to Implement SBC

As with other service interventions, adolescents and youth should be deeply engaged in the development of SBC interventions to inform the content and the delivery mechanism. The geography health promotion or community strategist focal person should engage adolescents and youth throughout the design process and incorporate their feedback.

1. Adapt the MoH Promotion strategy for engaging adolescents and youth. The strategy will guide the promotion intervention, setting the tone and direction, so that all activities, messages and materials work together to achieve the desired change in utilization of SRH products and services.

In 2014, four Tupange-supported youth groups in Nairobi (Shangilia Youth to Youth Network, Tuungane Youth Initiative, Taiwe Foundation and Zindua Jamii) were selected to produce short television dramas about family planning that were broadcast in video dens during World Cup matches.

	Effective Promotion Strategies
Interpersonal Communication	Engage the adolescents and youth in personalized discussions about the benefits of SRH products and services including family planning and contraception Address the barriers to behavior adoption that are inherently personal and require tailored messages Reach out to populations that are not exposed to other media
Media	With the help of the community health strategist or promotion focal person, identify youth groups to work with Train the selected group(s) in the basics of family planning and promotional skills. This includes training on interpersonal communication, drama, and messaging about family planning Engage the youth in dialogue through interactive media (i.e., radio call-in shows, television talk shows, etc.) and linkages to digital health platforms (i.e., hotlines, Facebook pages, etc.) Adapt radio programs produced by Tupange (24-part Jongo Love drama series recordings and Jongo Love flyer and Matatu TV programs) Allow for repeated exposure to and reinforcement of the same health messages or information (media campaign) thru radio spots, pamphlets, billboards, drama groups, magazine advertisements in print media
Social/community mobilization	Engage adolescents and youth in mobilization activities to allow them to identify their own SRH priorities, mobilize resources, and develop and implement solutions. For example, use youth groups to conduct drama/skit performances on gender, sexuality and family planning Allow youth champions to share their personal experiences with positive SRH behaviors including contraception Monitor and provide supportive supervision during the first few activities and provide feedback
Digital platforms	Use interactive platforms such as SMS/text messaging, websites, blogs, social networking sites such as Facebook or available hotlines to engage adolescents and youth, Once established, the platforms can be used to provide information on positive SRH behaviors, mobilize youth to events and evaluate AYSRH services Ensure you respond to any questions that come through

2. Identify and engage with intended audiences early in the design process to decide on the most appropriate content, mode for engagement and how best to use it. Segmenting the primary and secondary audiences into smaller, more-distinct groups that share similar interests, attitudes and needs relative to the SRH product or service being promoted leads to more successful targeting of messages and channels.

Build strong and consistent support systems around young people from community leaders, families and health workers. In order to increase demand for and use of SRH products and services. Promotional strategies and activities should strive to be gender transformative to address and change gender norms that create unequal access to and utilization of SRH products and service.

3. Reproduce or adapt information, education, and communication (IEC) material for use during activities such as outreaches.

4. Determine and select the best platform to reach the intended audiences for disseminating information, i.e., where and when they are most receptive to messages. Determining the right channel mix will be informed by the program objectives, the local context and the audience analysis. This will include a review of format (e.g., text or audio), language, and frequency and dose of messaging.

In the Tupange program in Kenya, community radio stations in each of the core cities were an important feature in demand creation. Well Told Story created the radio drama Jongo Love to encourage contraceptive use among youths living in urban slums. An evaluation found that exposure to Jongo Love was significantly associated with contraceptive acceptance. However, the proportion of the total urban population exposed was small (less than 10%). To reach more young people and maximize its effectiveness, Well Told Story also utilized the Shujaaz comic book and social media platforms to successfully reach youth with SRH messaging.

5. Capitalize on unique opportunities and approaches for addressing barriers and motivating adolescents and youth to take action. For example:

Brand SRH products and services
Allow youth to share their personal stories. With consent, document the testimonies for wider sharing
Use peers for mobilization

6. Monitor and provide supportive supervision during implementation of the activities. Throughout design and implementation, routinely analyze and assess whether messages, approaches and activities are in the interest of getting adolescents and youth to use products and services and incorporate feedback.

Monitoring Process

Monitor increase in the number of new adolescent and youth users of family planning
Assess the knowledge of adolescent and youth users on availability of AYSRH services
Monitor the effectiveness of engaging families, communities and health care providers in AYSRH
Community/Promotion focal person at geography level should track activities
Supervisors should participate in the activities regularly

Success Indicators

Positive SRH behaviors and contraception among adolescents and youth
Increased use of AYSRH services among those who recall the SBC messages
Message recall and intended behavior change

Cost

Demand generation material (IEC) designing, pre-testing, printing/reprinting and distribution
Training manual printing
Broadcast cost
Cost of community-based activities
Supervision (transport and travel allowances)
Printing monitoring and evaluation tools

Sustainability

Incorporate these activities into geography health promotion strategies and budgets to ensure their continuation
Advocate for support for resource from geography Management Team