Background: In Zambia, the prevalence of HIV among adults aged 15-49 is 14.3% with females bearing a higher burden of the disease at 16.1% prevalence compared to men at 12.3% prevalence (UNICEF, 2017). According to UNICEF, every hour, about three young people across Zambia aged 15-24 years old get infected with HIV. Young people tend to be more vulnerable in the face of limited information and access to preventative services such as condoms, HIV testing etc.
In response to this growing epidemic, UNICEF re-purposed their already existing platform called U-Report in 2012 to provide counselling services around HIV prevention. U-Report is an innovative, user-centered social monitoring and messaging tool based on simple Short Message Service (SMS) messages (poll questions, results, and sharing of useful information) designed to strengthen community-led development, citizen engagement and positive change.
Zambia’s U-Report platform provides free, confidential, individualized and interactive counselling services on HIV and STIs to adolescents and youth. The platform has over 100,000 U-Reporters who have voluntarily opted into the service. Youth throughout Zambia can opt into the platform by sending an SMS with the word “JOIN” to the shortcode 878. Of these 100,000 U-Reporters, 70% have begun conversations with counsellors by asking questions and sending queries to them. Subscriber phone numbers are not accessible to the counsellors or programme managers, making the platform strictly confidential.
According to UNICEF, Zambia U-Report has two components: a Knowledge Bank, and Poll/Campaign. The Knowledge Bank is a dynamic repository of up-to-date information on HIV and STIs. It is accessible to the SMS counsellors as a resource to provide accurate information to adolescents and young people through interactions over SMS. The platform also enables youth to access customized SMS for information on available services, and referral to the U-Reporter’s closest location for HIV Testing and Counseling, Voluntary Medicalised Male Circumcision and Anti-Retroviral Treatment.
The Poll/Campaign module serves two purposes:
- polling opinions of young people on HIV and STIs issues to inform policy dialogue and programmatic decisions. These polls are conducted periodically to get the opinions of young people. U-Report then analyzes incoming SMS traffic to track and report periodically on key knowledge gaps and emerging issues related to HIV and STIs among young people.
- to help to establish a baseline on knowledge, access and utilization of high impact HIV prevention services for young people. The information received from the baseline will be used in reiterating customized behaviour- change communication messages, which will continue to be sent to young people through the SMS, but will also be disseminated through other mass media such as radio, TV and social media to complement the SMS service. These linkages with other forms of media are necessary to ensure inclusivity in access to information for young people who do not own a mobile phone and young people with disabilities.
Target Population: Adolescents and Young People, Male and Female, Urban and Rural, Aged 15-24 years
Technology: RapidSMS is a free and open-source framework for rapidly building mobile communication programmes for scale. It is a toolset for building SMS (text message) services for data collection, 2-way communication, group coordination etc. using basic mobile phones. Information and data are collected in real-time. RapidSMS is built with Python and Django and is designed for building customizable mobile services, complete with web-based dashboards. Data analysis can be conducted automatically based on incoming, real-time data. Click here for full technical details.
Technology Use: U-Report is an opt-in initiative, so youth decide if they want to join and they can opt out anytime. To become a U-Reporter, they send via SMS the word “JOIN” free of charge to 878 (U-Report’s number in Zambia). Once they have joined, U-Report collects some demographic information on the user, including age, location, and gender. This allows U-Report to understand the demographics of participants, as well as to graphically map information. U-Report also provides referrals and linkages to other toll-free platforms including the National Aids Council (990 voice) and the toll-free Childline (116) for gender-based violence.
U-Report was developed by the UNICEF Innovation unit and runs through the RapidPro framework, another tool developed by UNICEF that enables the international development community to have an exchange and flow of information through mobile technology. The RapidPro software allows development officers to collect information through SMS, manage contacts, visually map the information, and send messages in multiple languages.
Organization and Partners: UNICEF is a United Nations programme with headquarters in New York and offices around the world that strives to promote the rights and well-being of every child through developmental and humanitarian assistance. UNICEF has also made a big push in recent years towards innovation and the use of ICT in their programming. U-Report is one such successful initiative. UNICEF Innovation online can be accessed at https://www.facebook.com/unicef.innovation/.
A Zambian NGO called CHAMP (The Community Health and AIDS Mitigation Project) provided the SMS counselling component. Founded in 2002 to tackle the growing HIV epidemic in Zambia, CHAMP focuses on the workplace policies and programmes of private and public sector organizations – giving particular emphasis to care, support and access to treatment. CHAMP provides all the counsellors for the project while UNICEF managed the overall platform, campaign messages, and data analyses.
Challenges and Lessons Learned: Zambia U-Report was developed through a participatory process including a two-day design workshop involving young people and programme experts from National AIDs Council, Ministries of Health, Education, Youth and Sports, local NGOs, representatives from mobile companies and IT and software developers. The workshop was also facilitated by a programme officer from UNICEF Uganda where U-Report was first implemented.
From an analysis of thematic issues from 13,000 SMS requests sent by U-reporters in Zambia (Dec 2012-May 2013), most questions were on the symptoms of HIV and AIDs (19%), closely followed by modes of transmission (18%) with 12% related directly to Voluntary Medical Male Circumcision (VMMC). (UNICEF, 2013). Prevention of mother-to-child transmission, masturbation, and condom use were also amongst the most frequently queried topics. UNICEF had also analyzed the SMS received about VMMC, which reveals 44% of responders were interested in the effectiveness of VMMC against HIV/AIDS, 18% were interested in healing times and 15% in the effectiveness against other STI’s.
In terms of lessons learned, UNICEF found that inviting young people during the formative phases of the project is key to its success. Youth Ambassadors, now the front-line U-Reporters have been able to bring in their skills from working on previous UNICEF projects to help mould the messaging and work plan in the most engaging way, and make U-Report their own. U-Reporters also stressed the importance of branding material such as t-shirts and armbands attracting attention and increasing sign-ups and engagement with the service. However, this branding material should also reflect local languages within the country, and not just common languages such as English as the message is likely to be lost again.
In terms of challenges, UNICEF found it challenging to send SMS in vernacular languages. As such, one such solution is having a toll-free phone line to engage in an audio conversation where such barriers can be averted, given that counsellors usually speak at least one of the seven national languages. Furthermore, in addition to challenges with texting in local languages, “Text Speak” also proved to be an area where counsellors experienced difficulty in deciphering the language people would write in. Finally, the volume of messages proved to be quite exhausting for counsellors, and UNICEF advised creating standardized templates for the most frequently asked questions.
This case study was compiled using the following online UNICEF sources:
- U-Report Zambia site: www.zambiaureport.org/
- UNICEF HIV and AIDS. Retrieved from https://www.unicef.org/zambia/5109_8459.html. Accessed on 22 March 2017.
- A Youth-led HIV Response Initiative using Short-Message Service (SMS) in Zambia. Retrieved from http://www.zambiaureport.org/media/downloads/Zambia_U-Report_initial_concept_note_Sept_2012.pdf. Accessed on 22 March 2017.
- PROMISING PRACTICE: UNICEF Zambia U Report SMS pilot. Retrieved from http://www.zambiaureport.org/media/downloads/PP_Zambia_UNICEF_U-Report_SMS_pilot_MR260813.pdf. Accessed o 22 March 2017.
Image source: Zambia U-Report (@ZambiaUReport) | Twitter