RESUMEN

Adolescents 360 (A360) was a 4.5-year project working directly with young people to increase demand for, and voluntary uptake of, modern contraception among adolescent girls aged 15 to 19 years. A360 utilized human centered design (HCD) to create four adolescent sexual and reproductive health (ASRH) interventions across three countries - Smart Start in Ethiopia, Kuwa Mjanja in Tanzania, Matasa Matan Arewa (MMA) in northern Nigeria, and 9ja Girls in southern Nigeria. A360's interventions tap into girls' aspirations and position contraception as a tool that can support them in pursuing their life goals. As A360 transitioned from its first program phase into its follow-on in 2020, the project examined what it had accomplished, where it had failed, and what it had learned in the process, with the goal of contributing to the global evidence base and building on these lessons in its follow-on program. A360 draws out five key lessons in this publication. These lessons speak to 1) the value of A360's aspirational program components and the need to meaningfully support girls to pursue their life goals holistically; 2) the necessity of taking a consistent and rigorous approach to improving the enabling environment for contraceptive use to promote transformative change; 3) the need to find program and measurement approaches that respond to girls' unique patterns of sexual activity, and support contraceptive continuation; 4) the usefulness of continuous program improvement during implementation to maintain a user-centered focus and create a culture of curiosity and innovation; and 5) the tension between designing for users and beginning with program sustainability in mind from the outset. A360 continues to grow in its understanding of what it takes to support sustained, transformative, holistic change for adolescent girls and commits to openness and transparency regarding successes and failures during its next project phase.

RESUMEN

BACKGROUND: Human-centered design (HCD) is increasingly being used as a complementary approach to traditional global health methods due to its ability to bring new ideas to entrenched problems, integrate multiple stakeholder perspectives, and bring in a strong human lens among other advantages. To reap these benefits, public health and design practitioners in global health programs can learn from the early experiences of integrating HCD to advance these efforts. OBJECTIVE: This article distills lessons gathered from 3 programs leveraging HCD to advance global health programming: (1) the "V" program which used an HCD approach to reframe the once-a-day HIV prevention pill from a potentially stigmatizing medicine into empowering self-care; (2) the Adolescents 360 program which integrated HCD to create a service for adolescent girls to access contraception in Ethiopia and to scale this offering nationwide; and (3) Reimagining TA which used HCD to help shift perceptions around traditional technical assistance models to one of co-creation, defining a new approach for non-financial support for health systems strengthening. FINDINGS: To inform global health programs that are considering employing an HCD approach, lessons learned are distilled into 3 categories: (1) planning: considerations for problem definition and project scoping to allow for flexibility and selection of appropriate methods; (2) engaging: reflections on the means to productively engage different stakeholder groups to build alignment, understanding, and buy-in; (3) applying: adoption of new ways of working during implementation to best take advantage of the benefits of HCD while promoting long-term program sustainability and learning. CONCLUSION: These lessons represent an important step on the pathway to demonstrate the contributions of HCD to improving the effectiveness of health programs at a time when the global health community needs the most robust set of tools possible to meet the demands of our current pandemic context and beyond.

Asunto(s)

Salud Global , Adolescente , Etiopía , Femenino , Humanos , Evaluación de Programas y Proyectos de Salud

RESUMEN

Background: Adolescents 360 (A360) implements the Smart Start (SS) programme through Ethiopia's Health Extension Programme (HEP). SS is premised on financial planning as an entry point to discuss family planning (FP) with newly married couples and central to its delivery are the health extension workers (HEW). This article evaluates the A360 experience and learning from the process evaluation implemented by Itad to understand contextual barriers and enablers from the perspective of the HEW. Methods: A purposive sampling strategy was employed whereby 27 key stakeholders were identified from Oromia, Addis Ababa and Amhara, based on exposure to the SS programme. Findings from the action research were shared with A360 through a one day sounding workshop. Results: Findings revealed that many local government and communal respondents do not view adolescent pregnancy as a problem, unless out of wedlock, and adolescent pregnancy is closely linked to early marriage. As a result, some providers, including HEWs, acknowledged that married adolescent girls were previously 'neglected' by them, while husbands indicated that they had not previously been included in FP counselling. Findings also revealed some challenges with SS implementation as HEWs were 'deprioritizing' the intervention and many HEWs had been in situ for several years and were overworked and frustrated. Against this backdrop, A360 was viewed as adding to the HEW workload. While the programme design was focused on adolescent users, there was increasing recognition that HEWs also needed to be at the centre of solution design. Conclusions: Despite challenges associated with the HEP, Ethiopia FP2020 plans to support the 'next generation' of HEWs, including a focus on adolescents and youth. To gain deeper insight and put the HEW at the centre of design, A360 will continue to work with the process evaluation to understand contextual barriers and enablers from the perspective of the HEW.