HUMAN-CENTERED DESIGN IN PRACTICE

DESIGNING WITH PASTORALIST GIRLS IN AFAR

PSI Ethiopia is working to adapt Smart Start to the Afar region. Smart Start serves married girls 15–19 and their husbands and helps them see how family planning can be an asset to securing a brighter future. Smart Start was developed in the agrarian regions of Ethiopia, but as the program goes to scale PSI wants it to work for all married girls in Ethiopia.

To do this, we are undertaking human-centered design progress in the Afar region and working with girls and their families to develop an effective intervention.

KEY FEATURES

• Initial focus on Afar

• Working closely with the Regional Health Bureau

• Afari Young Designers are leading testing. Young Designers are students who have completed 10th grade, and who are leading on translation and helping to make sure we understand the cultural nuances in Afar. They help us to get the images right and report back on how the community members reacted to prototypes.

• Designs have focused on demand-side interventions, identifying what will make contraception relevant to married girls.

• Designs have sought to reach girls, traditional birth attendants (Ullatinas), husbands, and religious leaders.

• The design team has consulted with AMREF, EngenderHealth, Family Guidance Association Ethiopia, CARE, and GAGE about their work in the region.

One key opportunity we have identified is that Ullatinas (traditional birth attendants) in Afar are trusted by girls and the community. Could they be upskilled to teach girls about the health benefits of family planning? The team has completed two rounds of prototype testing to test whether Ullatinas might be powerful change agents in the community. Anchored around the idea of a “Motherhood Coaching Club” for Ullatians the team has tested parts of the club.

Prototype 1

A club where Ulllatinas discuss and learn about family planning and SRH issues of young mothers. They receive information and guidance on these topics and training on how to work with young women. They refer young mothers, as needed, to the Health Extension Workers and Health Post.

Prototype 2

Provide Ullatinas a visual, low-literacy tool that combines information on the health and financial benefits of spacing children. Rapidly train Ullatinas to counsel girls on the benefits of using modern contraception to space children. Ullatinas provide interested girls with a referral card to the health post to speak with the HEW about contraceptive options.

This test was very positive, so the team evolved the concept, made the visuals higher quality, and taught a few Ullatinas the key messages. We then arranged for them to speak with girls in their community.

THESE ARE THE MAIN RESULTS WE HAVE SEEN

• Ullatinas were willing to speak and give married adolescent girls referral cards for modern family planning

• Ullatinas were quick to understand the challenges facing young mothers in Afar and want to help them

• Girls view Ullatinas as close to them — they know their lifestyle and believe they are trustworthy.

• Girls were willing to take the referral card but said they’d have to talk to their husband first before going to the HEW.

• Girls were focusing on the health aspect of family planning and spacing, rather than on the potential economic benefits

“Ullatinas are the best option to teach us because they can share their own experience and they already know us. We are familiar with them.” –Married girl

We are not finished yet! We are currently synthesizing findings from this latest test and looking for how we can make the service more effective. At this stage, we are also beginning to assess the feasibility of the idea at a larger scale, considering questions like how would the Ullatians be trained? Are there enough of them to reach the married girls in question? What other interventions are required to create a supportive environment for girls (i.e. husband counseling as well).