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Adolescents 360

An approach to adolescent sexual and reproductive health (ASRH) that integrates public health, adolescent developmental science, cultural anthropology, social marketing, meaningful youth engagement, and human centered design

How can we increase the demand for, and voluntary uptake of, modern contraceptives among adolescent girls 15-19-years-old across Nigeria, Tanzania and Ethiopia?

The Story

Adolescents 360 is a consortium of organizations, including PSI, IDEO.org, Society for Family Health Nigeria, Center for Developing Adolescent and Triggerise. A360 is being evaluated by Itad, with evaluation partners Avenir Health and the London School of Hygiene and Tropical Medicine (LSHTM). The initiative is funded by the Bill & Melinda Gates Foundation, and The Children’s Investment Fund Foundation.

While many organizations have contributed to the evidence-base of best practices for adolescent girls to uptake modern contraception, there remains an unmet need for modern contraception across developing countries, and scalable solutions remain elusive.

Adolescents 360 is unique in its use of a transdisciplinary approach, integrating best practices in ASRHR with larger public health, adolescent developmental science, cultural anthropology, social marketing, meaningful youth engagement, and human centered design (HCD) lense to generate four interventions across three countries. Each discipline fused to form a foundational core experience across the three countries, informing a transformative contraceptive user journey for girls:

  • Adolescent developmental science brings understanding of adolescents’ cognitive and hormonal development and resulting evolving motivations.
  • Cultural anthropology contributes a framework for understanding the societal and cultural influences that shape girls’ self-perception and worldview.
  • Meaningful youth engagement provides a process for engaging young people as core partners and experts of the unique cultural, religious and societal experiences that shape how girls and their influencers view contraceptives, as well as the world around them.
  • Social marketing enables interventions that deliver relevant messaging in ways sensitive to the larger market dynamics in which consumers must access them.
  • Human centered design provides a process for working together to uncover insights and leverage them toward action through ideation, prototyping, iteration and early stages of implementation. HCD helped define three initial interventions.
  • Public health provides the health system lens and systematic scale-up approaches necessary to ensure the interventions are relevant and appropriate to the service delivery context and feasible for delivery at large-scale.

Today, the project applies an adaptive implementation approach using evidence to continually refine these interventions in partnership with youth and local actors, as the interventions are scaled.

Content for this case is adapted from www.a360learninghub.org

Process and Measurement

Amount of Design: End to End

Note: In Tanzania, design research was ethically conducted using informed consent. In Nigeria and Ethiopia, the A360 team received IRB approval for all design work to ensure youth were protected. This has since led to production of an ethics statement on designing with and for youth which has growing global signatories. More information here: https://www.psi.org/news/the-commitment-to-ethics-in-youth-powered-design

Adolescents 360 uses a phased process that includes:
1. Inquiry; in this case, investigating what the findings of 280+ young researchers, designers, and public health experts revealed
2. Insight Synthesis; translating insights into new opportunities for design
3. Prototyping; Learning what worked, and didn’t, from rapid mini-experiments
4. Adaptive Implementation; observing and refining work as it is implemented and scaled up
Detail on the substance of these phases can be found at www.a360learninghub.org

Role of Measurement

Adolescents 360 was designed to integrate measurement from the start. For example, the project was commissioned with an independent evaluation which sought to answer whether an HCD process could deliver a larger program impact than ‘standard normal’ youth programming. This evaluation was led by Itad who partnered with Avenir Health and LSHTM. It was designed to be theory-based, with three core components: a cost-effectiveness, outcome and process evaluation. In addition, the process evaluation provided rapid ‘deep dives’ to allow insights that enabled A360 to course correct to improve program impact. Examples include participatory action research conducted with service providers to assess bias (towards service prevision to adolescents and of longer-term family planning methods).

PSI and its implementing partners also integrated measurement (i.e., monitoring and documentation of project activities) to track program activities and outputs during implementation and assess the overall effectiveness of the implementation. They also documented the design process (e.g., introducing prototyping report cards). At a later stage, they introduced an adaptive management and learning approach (“Adaptive Implementation”) that encouraged continued iteration and optimization of the full-scale interventions based on periodic data collected using a standard set of questions addressed to adolescent girls, health workers, and other stakeholders and triangulating different data sources. Data review was held to reflect on learning and decide on the necessity of course corrections and to support real-time problem-solving in partnership with PSI country teams leading on implementation and scale. PSI notes that the partnership between the formal evaluation team and the implementers has been crucial to ensuring the designed interventions deliver the value intended for girls and has helped implementers know where and why to adapt once the design phase ended.

In sum, measurement was intended to inform implementation and enable timely and evidence-based course corrections, assess program impact, generate learning on how to reach adolescent girls at scale, cost-effectively, and to learn about how design works in practice. Although each element of the measurement strategy was guided by a specific set of questions, broadly, the comprehensive measurement strategy (monitoring and learning by PSI as well as the independent evaluation conducted by Itad and partners) set out to answer the following questions:

  • How did the design process work? What was the quality of the insights generated? On what basis did the project advance certain prototypes from simple to refined?
  • Is the program strategy taking hold; is it driving change as expected?
  • Did the intervention improve uptake of contraceptives among adolescent girls and reduce unintended pregnancies? Is the intervention cost-effective?
  • What role did social design play in program implementation and impact?

Team Structure and Dynamics

A cross disciplinary team engaged with a group of over 280 adolescent young women, a consortium of five organizations and two funders.


Geography and Reach

Click to view the A360 Country Solutions up-to-date dashboard.

Objectives

Increase the demand for and voluntary uptake of modern contraceptives among adolescent girls 15-19-years-old across Nigeria, Tanzania, and Ethiopia.

The Adolescents 360 (A360) project uses a developmentally and anthropologically in-formed, youth participatory user-centered design process to support health systems to implement high-performing adolescent contraceptive service delivery interventions.

Outcomes

Data from each country are drawn from service statistics (administrative data).

Tanzania

49% of girls aged 15-19 who interact with A360 Tanzania voluntarily opt for a long-acting method (LARC), a number that exceeds Tanzania’s national average of 20% LARC uptake among the same age group. (Source: DHS)

Data pending corrections noted by A360.

Northern Nigeria

In Northern Nigeria, A360’s Matasa Matan Arewa (MMA) engages married girls and their husbands, using mentorship programs to support girls to learn knowledge and skills for family and financial health, and engage in contraceptive counseling and services. MMA is the first replication of A360, an adapted intervention suited to the northern Nigerian context.

Data pending corrections noted by A360.

Southern Nigeria

In Southern Nigeria and parts of Northern Nigeria, A360’s 9ja Girls intervention supports the health system to reach unmarried girls aged 15-19 through a forum to support their knowledge, skills, and confidence to plan for and begin to achieve their goals. As the 9ja Girls mantra reflects, girls know “My life is mine to make. I’m a 9ja Girl; I’m awake.” (9ja Girls is implemented in Nigeria by PSI independent network member SFH/Nigeria.)

Data pending corrections noted by A360.

Ethiopia

Young Ethiopian couples want their children to have better quality lives—a factor that leads them to respond positively to the “Smart Start” intervention’s focus on supporting married girls’ and couples’ goals for a stable future—beginning with financial and family planning. Smart Start supports Ethiopia’s Health Extension Workers to introduce targeted financial counseling as part of outreach and contraceptive service delivery to rural Ethiopian married girls aged 15-19 and their husbands.

Data pending corrections noted by A360.

Dashboard and Documentation

Links to resources in the main visual:
Check out resources used by A360 to guide its inquiry phase.
Click here to review all the emerging insights from A360’s design process
Watch this video for a sample of the prototyping process for one of A360’s interventions.
Synthesize prototypes tested into prototype report cards for each A360 country
Adaptive implementation as the tool for continuous program improvement during implementation.
Develop transdisciplinary adaptation guidelines as a resource for decision-making.
Consolidate information into the A360 Blueprint for Change
Example of adaptive implementation was used to promote sustainable sacale-up in one of A360’s countries.

Next Steps

A360 is in its final year of implementation and will be completed in 2020. The integrated team continues its learning about A360. Itad, the evaluation lead, will publish initial findings and observations soon.