Background: In Ghana, an estimated 270,000 people were infected with HIV in 2015 (UNAIDS, 2015) with a prevalence rate for HIV at around 1.6%. HIV prevalence has declined in recent years, highlighting the success of HIV prevention programmes in the country.
In 2012, the Association of Church-based NGOs in Northern Ghana (ACDEP) started implementing ICT-based programmes to improve healthcare in rural areas of northern Ghana. One of the first programmes was set up to address the poor communication and information flow among health workers and key departments within health facilities by using mobile technology. The project was intended to facilitate two-way feedback between community health workers, traditional birth attendants (TBAs), traditional medicine practitioners (TMPs), peer educators and community members to provide useful information for future decisions and community health planning.
The programme was expanded to include sexual and reproductive health messaging for peer-educators in schools across the target geographic areas. Peer educators received a curriculum of sexual health and HIV informational messaging on their phones once a week. These peer educators were then expected to discuss the content of the SMS messages during regular health club meetings held in schools. The geographical scope of the project covered areas of northern Ghana such as Salaga and Loloto in the East Gonja District and Kpandai District respectively. Walewale in the West Mamprusi District; Langbensi and Nalerigu in the East Mamprusi District, and Garu in the Garu-Tempane District.
Target Population: Youth, Male and Female, Rural, 15-19 years
Technology: In 2013, TTC Mobile (then Text to Change) in partnership with the Praekelt Foundation developed a global text messaging platform, called Vusion. This platform was designed from the ground up to be a flexible, scalable and easy-to-use SMS platform. Click here for full technical details.
Technology Use: Under the programme, mobile phones were used as a medium for disseminating SMS messages to peer educators in hard-to-reach communities in northern Ghana to share knowledge about sexual reproductive health, including HIV/AIDS amongst adolescents.
In mid-2013, an interactive voice response solution was built into the programming to reach low literacy populations in addition to Peer Educator programme. At the end of 2013, ACDEP launched an SMS quiz on sexual reproductive health. The aim of the SMS quiz was to inform adolescents in a fun and interactive way about their sexuality. This proved to be particularly vital as some 75% of the adolescents questioned during ACDEP’s research on sexual and reproductive health (SRH) did not know that they could get pregnant if contraception wasn’t used, and only less than half knew that you couldn’t determine someone’s HIV status just by looking at them.
Using the keyword WAD2013, participants could opt into the interactive quiz and answer questions on sexual and reproductive health. After subscribing, participants received 14 questions on their mobile phone – e.g. “I’ve got no symptoms so I can’t have a Sexually Transmitted Infection (STI); 1) True 2) False”. In just six weeks prior to World Aids Day held annually on 1 December, ACDEP received over 1500 subscribing participants to the quiz. ACDEP mHealth implementer, Norbert Apentibadek, believed that this reach was far greater than expected because adolescents tend to share information with their peers.
As a reward for answering all the quiz questions, participants received a free ticket to the local World Aids Day Event held in Tamale with entertainment from local musicians and dancers, and dramas and educational workshops designed to increase HIV/AIDS awareness.
Organization and Partners: ACDEP, established in 1977, is a consortium of church-based NGOs involved in the sustainable socio-economic development of the people in Northern Ghana. ACDEPs focus is on agriculture, health and nutrition, finance services and climate change adaptation projects spread around the Northern, Upper East and Upper West Regions and some parts of the Brong-Ahafo region. The World Aids Day campaign was made possible by ACDEP partners including Connect4Change, Curious Minds, dance4life, Ghana Health Service, Ghana Aids Commission, Planned Parenthood Association of Ghana, Text to Change (TTC), Theatre for a Change and Vodafone Foundation.
TTC Mobile (previously Text to Change) sets up flexible SMS projects in Africa, Asia and South America focused on sending out and receiving information to educate, engage, and empower people on wellbeing related issues. In these campaigns, members of the local community are involved at no or reduced costs based on the usage of toll-free SMS shortcodes. TTC works in most countries with a centrally, cloud-hosted, web-based platform which results in lower costs on maintenance and support and a better control on central software updates and security and privacy settings. This makes it possible to scale the programmes that are running without incurring extra costs for software.
Challenges and Lessons Learned: The major challenges to the project were the low-literacy rate of the target population as well as low technical literacy rates. Certain target groups were unable to navigate through their phones to read SMS or choose options within an IVR menu. Another major issue was low rates of phone charging which meant that the target population often did not receive the IVR messages and often did not read the SMS messages either. Lastly, while the project was run on toll-free shortcodes on certain networks in Ghana, these networks had low coverage rates in the target areas for the project. As such, some lessons learned from this project include building content and technology to the requirements.
This case study was compiled with interviews and information from ACDEP (http://rsr.akvo.org/en/project/385/) and TTC Mobile as well as the following online sources:
- Ghana HIV and AIDS estimates (2015). Retrieved from http://www.unaids.org/en/regionscountries/countries/ghana. Accessed on 21 March 2017.
Image sources: https://ghanabakwamena.wordpress.com/2013/11/10/free-sms-quiz-on-sexual-reproductive-health-launched/ and https://www.modernghana.com/news/496793/1/acdep-launches-free-sms-quiz-on-sexual-reproductiv.html