TRANSFORMING HEALTH OUTCOMES FOR ADOLESCENT GIRLS IN RURAL ETHIOPIA THROUGH DIGITAL HEALTH TOOLS
Author: Yonas Zula, Sr. Program Manager, PSI Ethiopia and Fana Abay, Marketing and Communications Director, PSI Ethiopia
Imagine a world where everyone has the same chance to thrive in the digital age. Unfortunately, that is not yet the case. Globally, women and girls are underrepresented when it comes to access and use of technology. This lack of access hinders their empowerment and diminishes the transformative potential of technology, resulting in a loss of $1 trillion in GDP in low- and middle-income countries over the past decade. Beyond the economic benefits, women’s equal access to digital technology opens up opportunities to address development challenges, create innovative solutions that meet women’s needs and can increase their ability. (UN Women, 2023)
Ethiopia, a country of more than 120 million people, is the second largest country in Africa with nearly 40% comprised of youth. However, Ethiopia only ranks 54th in the number of internet users. Mobile connectivity stands at 53.5% (66.80 million), with only 16.7% (20.86 million) accessing the internet via mobile devices (2023 Data Report). This digital gap disproportionately affects rural communities and youth due to poor infrastructure, geographic challenges, and economic disparities. In the context of public health, this gap becomes a barrier, blocking access to vital information and important health services. Digital technology can help health workers with limited training, skills, and time provide higher-quality health services. At the same time, digital technology allows young women and girls quick access to critical health information to make informed decisions about the health services they seek.
The Smart Start Digital Journey
Despite limited access to digital technologies in Ethiopia, the Federal Ministry of Health is committed to improving access by developing a comprehensive digital health strategy. This strategy is implemented through the Ministry’s Health Sector Transformation Plan II. PSI Ethiopia’s (PSI/E) digital interventions are aligned with this strategy and It believes in the potential of digital technology to transform the health sector. PSI/E envisions a future where high-quality information, products, and services are accessible to individuals throughout their lives using digital technology. In 2021, with funding from Global Affairs Canada, PSI/E began laying the groundwork to achieve this vision through the Owning Their Future project by digitizing the Smart Start Counseling Tool.
Smart Start, developed under PSI‘s flagship Adolescents 360 Program, uses an innovative and high-impact approach to counsel rural married girls and their husbands on achieving their family’s financial and life goals through family planning. PSI/E has embarked on a transformative journey, using rigorous, human-centered design processes to help health workers connect with their clients and deliver consistent, accurate, and engaging sexual and reproductive health information and services that leave clients excited, confident, and prepared.
Smart Start’s digital counseling app benefits include:
- Standardization of financial and family planning messages.
- Additional reproductive health information, such as safe abortion and post-abortion care, and gender-based violence.
- Interactive features such as games, music, and videos and testimonials.
- Integrated data collection linked to DHIS2.
These efforts culminated in a field test that yielded promising results. The pilot results show that the digital tool is more engaging, interesting, informative, and desirable. Both clients and healthcare providers find it easier to use and report higher satisfaction. The digital tool resulted in a higher rate of contraceptive method adoption than the paper-based manual Smart Start counseling tool (74% vs. 64%), coupled with a preference for long-acting methods (89% vs. 71%). Read more about the Smart Start Digital tool development process and results here.
Encouraged by these positive results, PSI/E plans to expand the Smart Start Digital job aid to 22 woredas in four regions by 2023 to reach 50,000 adolescent girls, young women, and couples.
Smart Start Digital Counseling in Action: Smart Start Navigator’s experience in Kucha Woreda
Let us go to the heart of Kucha Woreda in Ethiopia’s Gamo Zone of the Southern Nations, Nationalities and People’s region (SNNPR). Here, a remarkable woman named Birtukan Seba, a PSI Ethiopia Smart Start Navigator is creating powerful change through door-to-door Smart Start counseling. On the day of our visit, Birtukan was conducting Smart Start counseling in Zulo Gamo Kebele, about thirty-five kilometers from Kucha Woreda. The journey to Zulo Gamo Kebele is difficult because the roads are in poor condition. Nevertheless, Birtukan is determined to reach adolescent girls and couples with Smart Start messaging.
During one of her home visits, Birtukan met Asirat Dossa, an 18-year-old married woman with an eighth-grade education. Asirat married her husband, Alem, at the age of sixteen. They are the parents of a young child, and as with many families in Ethiopia, their main source of income is farming.
After a counseling session with Birtukan, Asirat was excited to receive her first digital counseling in her native Gamo language from her home. She said, “I learned how family planning can help us achieve our financial goals and aspirations. I was also introduced to the legal aspects of abortion, of which I was unaware of. I also learned that there are medical abortion services available at the local health center.” Interestingly, Asirat’s husband was not present at her first counseling session. Still, when Asirat realized how important his involvement was, she asked Birtukan to come back for another visit when her husband could be present.
The next day, Birtukan visited the couple again. Using the Smart Start Digital tools, she guided the couple through a comprehensive, customized financial and family planning session, including contraceptive counseling to help them use their voice, choice, and decision-making power to choose a contraceptive method that meets their needs. The session ended with the couple deciding to postpone their next pregnancy for three years.
When asked how digital Smart Start aids in Birtukan’s work, she said, “Smart Start’s digital counseling saves me time and energy during home visits. It’s a user-friendly and interactive tool that appeals to clients and is easy to understand because it is also in their local language.”
Despite the hurdles posed by poor road conditions, Birtukan remains committed to providing vital sexual reproductive health information to women, girls, and couples in her community. Through her commitment, technology’s true potential is coming to light, enabling remote communities, adolescent girls, and young women to benefit from digital technology through an intermediary.
WHAT IS NEXT?
Given the positive outcomes and success digital health tools offer, PSI Ethiopia is actively monitoring the rollout and looking for opportunities to expand Smart Start’s digital counseling app for married adolescent girls, young women, and couples. As of June 2023, we reached 25,741 adolescent girls and young women with the Smart Start digital counseling app. In addition, efforts are underway to fundraise and form partnerships that allow the Smart Start digital counseling app to be institutionalized within the Ministry of Health’s digital platform to ensure the positive change initiated by Birtukan, and its digital counseling efforts continues.
