Improving quality of care and access to health services for Tanzanian youth
FUNDER: USAID Tanzania
PARTNERS: T-MARC Tanzania, Care Tanzania, Tanzania Youth Coalition (TYC)
TIMELINE: October 2022-October 2023
ROLE: Project Lead
Kijana Nahodha, or “The Youth Leader” in Swahili is a youth-driven holistic digital health education and referral tool aimed at increasing the capacity of peer educators (PE) and community health workers (CHW) in three regions across mainland Tanzania and Zanzibar to counsel youth aged 15-25 around sexual reproductive health (SRH), mental health, and nutrition. This project focuses on disadvantaged youth, which includes out-of-school youth, unemployed youth, youth with disabilities, HIV+ youth, and young mothers.
Tanzania has a sizable young population, with around 20% or 12.6 million people aged 15 to 24. These young individuals hold hopeful views about their future in a country that has reached a lower-middle income level and is experiencing rapid economic growth in Africa.
Despite this, Tanzanian youth face significant barriers in meeting their sexual and reproductive health (SRH), mental health, and nutrition-related needs, leading to high rates of teen pregnancies, HIV infections, mental health conditions, and malnutrition. In addition, Tanzanian youth have limited youth-driven digital interventions that uniquely address their challenges based on life stages and age-appropriateness.
This case study reflects the project’s first-year design activities, where in collaboration with T-MARC, and with funding from USAID, an MVP was codesigned and prototyped with the participation of approximately 150 young people, PEs, and CHWs using a youth-driven design approach.
In May 2023, our design team conducted design research sessions with 101 young people, PEs, and CHWs across three regions in Tanzania: Dar es Salaam, Morogoro, and Zanzibar (Unguja and Pemba islands). Our research aimed to understand key factors that contribute to young people’s reproductive health outcomes, mental health awareness, and nutrition needs. We utilized the following research methods:
- Literature review: A comprehensive review and summary of previous research conducted in line with the research topic.
- Expert interviews: Interviews with experts to gather more information on the problem statement and the context of the project.
- In-depth interviews: Interview guides and activities used to understand participants’ experiences, challenges, and ideas around key health topics.
- Focus group discussions: Group interviews and activities used to understand participants’ experiences and perceptions around key health topics.
participatory research activities
We used a variety of creative and interactive techniques to gather information about young people, PE/CHWs, and their environment. We used the following methods:
METHOD #1: PRIORITIZATION
Description: A ranking exercise of people, places, or things to understand how participants prioritize based on their level of importance/value.
How it was used: We asked PE/CHWs to think about the common types of mental health issues they treat in their roles and write their responses on blank cards. We then asked them to rank the mental health issues from most commonly treated to least.
METHOD #2: JOURNEY MAPPING
Description: A visualization of the process and steps that a person goes through to accomplish a goal or task.
How it was used: We asked young people to reflect on the process of visiting a healthcare facility and brainstorm the steps they go through when they need counseling and support around SRH, mental health, and nutrition. Participants shared challenges and opportunities for each step.
METHOD #3: CODESIGN WORKSHOPS
Description: Workshops that gather young people and PE/CHWs to take part in the creative development process of bringing ideas to life.
How it was used: We facilitated codesign workshops where we asked participants to brainstorm ideas to improve a young person’s experience when seeking health information and services in their respective communities.
insights & Design Opportunities
Once data was collected and stored, we engaged in several activities as part of synthesis, which included data analysis and affinity mapping, insights development, persona creation, user needs statements, and opportunity identification.
We identified 5 key insights that summarized our learnings across the three health areas:
- Young people lack the vocabulary, knowledge, and confidence to seek SRH and mental health care.
- Young people want the expertise of in-clinic providers combined with the comfort of family and friends.
- While young people understand the importance of nutrition, they do not have the decision-making power to influence what and how often they eat.
- Young people desire quality care but do not trust PE/CHW’s ability to provide it due to a lack of expertise and confidentiality.
- Young people are forced to navigate stigmatized health conditions alone.
We created personas to represent the different types of participants that might use the end product and service. These fictional representations helped us understand our participants’ needs, experiences, context, behaviours, and goals. We created a total of 5 personas to represent both young people and PE/CHWs, as well as to depict the cultural and religious nuances found in each region of the country. Two examples of personas can be found below.
how might we…
Our team turned design insights into culturally appropriate and holistic health solutions to meet the needs of young people, PEs, and CHWs in Tanzania. We asked ourselves, how might we…
Support young people’s education and awareness of SRH, mental health, and nutrition so they feel empowered and confident to seek care?
Ensure PE/CHWs are equipped with sufficient training and holistic health knowledge to effectively counsel and refer young people?
Normalize conversations about sensitive topics such as contraception and mental health conditions so young people feel more comfortable to speak up?
These design opportunities led us to create a framework for success. We identified that holistic health interventions have the potential to increase provider-adolescent interaction and connectivity, in turn educating and empowering youth to seek care. Young people in Tanzania are more inclined to seek health information and services when 3 key criteria are met:
- Knowledge: Young people seek advice and counseling from PE/CHWs who have reliable health information and the right expertise.
- Trust: Young people open up about their health concerns when they feel PE/CHWs respect their privacy and lived experiences.
- Access: Young people will seek care when PE/CHWs refer them to youth-friendly healthcare services that are nearby.
Using the design opportunities and our framework as a guide, we led ideation workshops to generate a wide set of solutions to meet the needs of young people and their communities and selected 8 ideas to move forward with. We created a rough prototyping plan that outlined how each idea could fail, our assumptions about each idea, how we were going to test those assumptions, and testing methods to use.
Rough prototypes were created in both English and Swahili, and they ranged from online solutions such as a database to locate PE/CHWs based on region and district, and a forum where young people can submit questions, to offline ones that included a quarterly festival organized by PE/CHWs for young people and a toolkit and handbook to support PE/CHWs during counseling. Rough prototypes were tested using three key methods:
- STORYBOARDS: Drawings or images displayed in sequence to pre-visualize a new experience or service.
- A/B TESTING: Participants are given different versions of one piece of content, with changes to a single variable to assess their preference.
- WIREFRAMES: Low-fidelity designs of user interfaces that present information and calls to action.
Lastly, we facilitated 8 codesign workshops where young people and providers were asked to create digital solutions to help young people access services and care while considering those with low literacy levels and limited access to digital devices. The results from testing of rough prototypes, learnings from codesign workshops, and evaluation of ideas against a 2 x 2 matrix based on two key criteria: desirability and the potential for impact led us to create a minimum viable product (MVP) for Kijana Nahodha.
minimum viable product (MVP)
To deliver on an MVP, we thought about our overall vision for Kijana Nahodha, branding considerations (how young people and providers want the digital intervention to feel), key principles that would drive product design and development, as well as core features of the platform. Our product vision was that Kijana Nahoda is…
a one-stop-shop website that includes holistic, reliable, and empowering health education while facilitating access to vetted, trained, and local PE/chws and youth-friendly facilities. We envision a world where conversations around SRH, mental health, and nutrition flow openly between young people and pe/chws in safe, trusting, and nurturing spaces.
For the intervention to holistically serve young people and PE/CHWs, core MVP features were associated with one of two focus areas:
- Increase Knowledge: Interactive, engaging content allows PE/CHWs and young people to learn about the most pressing concerns related to SRH, nutrition, gender-based violence (GBV), and mental health.
- Link to Care: PE/CHWs can refer young people to youth-friendly facilities and services, and young people can locate and contact PE/CHWs in their areas for counseling.
Three core features of the platform included:
- Video Testimonials: A series of bite-sized video testimonials from young people and PE/CHWs that reflect real-life experiences and stories. These videos address topics that are top of mind for young people and their communities.
- Assessment Quizzes: Short, engaging quizzes used to assess young people and PE/CHW’s knowledge around mental health, GBV, and contraception, with recommendations and actionable next steps tailored to individual responses.
- Referral & Facility Finder: When referring young people for additional services and care, PE/CHWs will use a form and submit it online. They will utilize the health facility finder to locate trained and vetted youth-friendly facilities to refer young people to.
Since October 2023, the team has moved into live prototyping, a method of testing and refining solution ideas. Key flows of the MVP features were designed and tested, keeping in mind 4 key scoring criteria:
- Desirability: Do young people, PE/CHWs, and community members like these ideas? Are the ideas culturally relevant and do they represent solutions to challenges we heard?
- Feasibility Do we have the resources and logistical capacity to see the ideas come to fruition? Do we have the necessary support of community stakeholders? How are technological scalability and sustainability considered?
- Ease of Implementation: What are the challenges, opportunities, and trade-offs of implementing these ideas in the community? Do these ideas complement existing ones in Tanzania? How will we track and monitor usage and traffic of the intervention over time?
- Potential for Impact: Do these ideas adequately represent solutions to key challenges faced by young people and PE/CHWs, across regions? How do these ideas increase education and care-seeking behaviors among young people?
With feedback from our users and observations from the field, the team will finalize the list of core features for the MVP and move into product development. Kijana Nahodha is meant to launch in 2024 and aims to reach 40,000 youth directly and 200,000 youth indirectly, and build the capacity of 250 PE/CHWs.