Background: As of 2013, Ethiopia had an HIV prevalence rate of around 1.3% with around 760,000 million people living with HIV in the country (UNICEF, 2013). The HIV/AIDS Prevention and Control Office (FHAPCO) in Ethiopia claimed that adult HIV prevalence level had fallen from 2.1% in 2011 to 1.3% in 2013 due to a strong push on procurement of HIV-related supplies, procedures of quality assurances and policy on HIV prevention, treatment, care and support (HAPCO, 2013). m4Youth was one such programme aimed at improving access to information on sexual and reproductive health in institutions of higher learning in Ethiopia.
Ethiopia currently has over 30 higher education learning facilities with enrollments increasing every year. However, many of these young students lack access to vital information to protect themselves against HIV infections and many female students face a higher burden of the epidemic, including issues such unwanted pregnancy, unsafe abortion and may face sexual and gender-based violence.
To address these issues, Pathfinder International developed and implemented m4Youth from 2014-2015. m4Youth was a free, menu-based SMS service provided through the Integrated Family Health Program (IFHP), in partnership with John Snow, Inc., and supported by USAID. The goal of m4Youth was to impact positively on students’ knowledge of sexual and reproductive health, thereby increasing their utilization of relevant and safe services.
Target Population: Young People, University Campus Students, Male and Female, 16-25 years.
Technology: m4Youth used the RapidSMS application— a flexible, open-source platform designed to quickly bring mobile services to scale—to exchange information. The information circuit moved between users and the local server, where RapidSMS was installed. Click here for full technical details.
Technology Use: m4Youth provided tailored sexual and reproductive health information to university students at Adama Science and Technology University via SMS. Students could text a keyword to the toll-free shortcode 8990, and receive messages containing menus on key sexual and reproductive health topics. They could then request information from the menu, texting a number that corresponds to the topic of their interest, and the information was sent to their phone.
When students texted, they were offered a range of information from six key topic menus including:
• “HIV and sexually transmitted infections” – information about common misconceptions and stigma, in addition to prevention, testing, and linkages to treatment facilities.
• “Contraceptive methods”- information on a full range of methods, with dual method use (a condom plus another method) being encouraged.
• “Sexuality” – the most commonly accessed menu to date, possibly indicating students’ desire for a broad range of information on sexual life.
• “Unsafe abortion”
• “Healthy versus abusive relationships”
• “Where to find services” – contact information for sexual and reproductive health services available on and off campus.
Each topic and SMS message was chosen after a baseline survey and discussions with students highlighted issues students felt they lacked information on. Messages were pre-tested to check for accuracy, comprehension and cultural appropriateness. Messages were written in English and Oromifa – a local language.
The service was advertised widely throughout campus with billboard posters. M4Youth also trained peer educators in various sexual and reproductive health issues in order to spur discussion and dialogue amongst the students.
Organization and Partnerships: Pathfinder International is a US-based global non-profit organization that focuses on reproductive health, family planning, HIV/AIDS prevention and care, and maternal health in 19 countries. Pathfinder International partners with local governments, communities, and health systems. John Snow, Inc. (JSI) is a US-based public health research and consulting firm dedicated to improving the health of individuals and communities in the US and around the Globe.
Challenges and Lessons Learned: An Integrated Family Health Program (IFHP) evaluation found that the SMS services were strengthened when they were promoted as a part of a wider supportive sexual and reproductive health campaign – such as the training peer of educators and the establishment of youth-friendly health facilities. During the first nine weeks of implementation, the menus most accessed by students were: ‘Sexuality’ (39%) and ‘Contraceptive methods’ (20%), followed by ‘Sexually transmitted infections/ HIV’ (15%), ‘Healthy vs abusive relationships’ (12%), ‘Where to find services’ (8%), and ‘Unsafe abortion’ (6%).” Within the first 13 months of the project implementation, 26 gender-based violence cases were brought forward to the university’s gender office. In previous years, no such cases were reported to this office. The number of condoms taken from the University Youth Friendly Services also increased by 33.3%. During these 13 months, over 10,500 information requests were made to the central server. The requests were made primarily for English and Oromifa contents.
In 2014, the project conducted a baseline survey to measure students’ knowledge of sexual and reproductive health issues and their willingness to receive information via SMS. However, despite positive changes in sexual and reproductive knowledge and practice of students, there was no statistically significant difference between the baseline and endline surveys.
Utilizing SMS had advantages of information being saved but also the ability to be deleted for privacy. As one male student said, “Some students save copies on their cell phones for later use, and in case there is no network service later. Others delete it so that no one sees it later” (ResearchGate, 2017)
According to the IFHP team, one of the biggest challenges with the project was around the delivery of SMS due to shortcode and network failures. During the project implementation period, the shortcode failed for more than eight weeks. Network failure also seriously affected peer educators and students use of the m4Youth service. This affected the trust of users in the dependability of the system as a reliable source of information -“There is a network problem. Students are discouraged by it. Even when I try to use it in my dorm, my dormmates told me that the network is poor and sending a text and trying to get a response is just a waste of time. So, I just left it alone. I stopped using the service’’ (higher education student).
This case study was compiled using sources from PathFinder International:
- Statistics Ethiopia (2013). Retrieved from https://www.unicef.org/infobycountry/ethiopia_statistics.html. Accessed on 22 March 2017.
- HIV Prevalence level shows a drastic Fall in Ethiopia.
Retrieved from http://www.hapco.gov.et/index.php/media-room/news/item/12-hiv-prevalence-level-shows-a-drastic-fall-in-ethiopia. Accessed on 22 March 2017.
- Mobile for Youth (m4Youth): IFHP’s experience providing SRH information through Short Message Service (2017). Retrieved from https://www.researchgate.net/publication/313109364_Mobile_for_Youth_m4Youth_IFHP’s_experience_providing_SRH_Information_through_Short_Message_Services_SMS. Accessed on 22 March 2017.