INTRODUCTION

A360 Kuwa Mjanja

BackgroundAn estimated 50% of the two million girls in Tanzania age 15-19 are sexually active. Girls are generally at higher risk of HIV than young men, and at 8.6%, use of modern contraceptives is quite low for girls within this age group. Babies born to young mothers face a number of risks, from pre-term births to low birthweight babies. Research shows that Tanzanian girls may see contraceptives as irrelevant, possibly harmful, and at odds with their identity and their dreams of motherhood. In addition, girls have a low level of knowledge of how contraceptives work, and often don’t know where to go to access family planning services because they fear judgment by providers. There are several market-driven barriers to the use of contraceptives by girls, including:

•Girls are unwilling and unempowered to seek and access contraception.•Providers are unwilling or unempowered to serve youth.•Poor public sector supply management means facilities often don’t have the full range of methods. • Lack of product options means not a lot of choice for girls. • NotenoughFPprovidersmeansitishardtofindaplacetogetqualityservices.• Restrictionsforproductdistributionmeanthemostaccessiblechannelsofferthefewestproductoptions.

The Adolescent 360 (A360) project was designed to address these barriers to contraceptive use among young girls. At the time of this evaluation, A360 is midway into its 4.5-year project life. Funded by the Bill & Melinda Gates Foundation (BMGF) and the Children’s Investment Fund Foundation (CIFF), the lead partner, Population Services International (PSI) works with IDEO.org, the University of California at Berkeley Center on the Developing Adolescent, the Society for Family Health in Nigeria, and Triggerise. While the project is implemented in Ethiopia, Nigeria and Tanzania,theworkhighlightedinthiscasestudyfocusesspecificallyonTanzania.

Why we chose A360 • The project brings Human Centered Design (HCD) together with a multi-disciplinary approach that includes adolescent developmental science,

anthropology, public health, social marketing and youth engagement to address a host of structural and individual barriers that girls face in improving their SRH.

• The brand and intervention is a best-in-class example of bringing nuanced and deep insights to drive interventions and achieve project goals. • The application of ‘adaptive implementation’ is a relatively new approach that ensures evolving insights and information generated through HCD

principles continue to inform program implementation throughout the life of the project.

INTRODUCTION

Findings

• The team took a psycho-behavioral approach to audience segmentation, going beyond socio-economic factors to include rich insights that enabled the team to identify two priority audience segments. A360 developed a segmentation strategy based on a girl’s life trajectory, rather than socio-economic factors. This strategy led to two primary target audience archetypes with “separate and shared moments,” which maximized target audience relevance.

• The Kuwa Mjanja brand identity is more than a simple logo. The brand assets carry deep emotional meaning, are thoughtfully connected to the brand vision, and are used consistently to help identify and reinforce the brand and what it represents.

•Kuwa Mjanja has the potential to support a broad portfolio of behaviors for adolescent girls. While the project is focused on contraception and SRH, it is also much larger. By authentically engaging young girls through elements that are both aspirational and relevant, Kuwa Mjanja is capable of supporting a broad range of healthy behaviors and activities that help girls achieve their dreams.

•Adaptive implementation is a natural partner to HCD (Human Centered Design) that enables the team to continuously learn and improve. During the implementation phase, the design teams shifted to provide program oversight and management, applying HCD skills to improve program performance through feedback loops. For example, high performers among outreach workers or teams were studied to understand their success, with lessons learned then applied to lower performers, while interventions were viewed through the eyes of the user.

•Co-designing with the target audience ensures authenticity, resonance, and believability. Girls co-designed the program and supported continuous learning through adaptive implementation techniques.

• TheHumanCenteredDesignprocessenabledhighengagementfromemployees.Goingintothefieldandlearningfromgirlsenabledemployeesto develop deep empathy for the audience and to ensure that everything they do is in service to the target audience.

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1. IDENTIFY THE AUDIENCE AND BEHAVIOR CHANGE OBJECTIVE

A360conductedarobustaudiencesegmentationandidentifiedtwoprimaryaudiencesegmentsbasedontheriskofpregnancy:Farida (younger, sexually active, less experienced) and Bahati (older, sexually active, more socially independent). The behavior change objective was to use contraception, which required changing girls’ attitudes toward contraception (to make it relevant and valuable). In addition to the behavior change that the program sought for girls, it also sought behavior change at the broader environmental level, making service delivery appropriate and accessible for girls, improving supply, etc.

AUDIENCE SEGMENTATION PRIMARY AUDIENCE IDENTIFICATION

Foursegmentsthatdifferon(a)theirpsycho-socialdevelopment and (b) whether they are sexually active. Farida and Bahati are priority segments due to risk of pregnancy.

Primary Segments

Farida Bahati

Behavior Change Objective

Use contraception. Change attitude toward contraception – make it relevant and valuable

“Know your Body” (use menarche and puberty as an entry point) and then introduce “Know your Path”

“Know your Path” (inspire girls to dream, know what’s possible, and take action, including contraception)

Intervention Focus

Kuwa Mjanja Marketing Plan from A360 - unpublished

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2. UNDERSTAND THE AUDIENCE

The A360 team developed deep audience understanding using an iterative, human centered design approach grounded in three core principles: understand me, identify with me, and serve me, detailed below. The audience understanding is strong in that the team identifiedunderlyingmotivationsnotonlyaboutcontraception,butalsoaboutgirls’hopesfortheirfuture.

KEY COMPONENTS TO AUDIENCE UNDERSTANDING HIGHLIGHTS FROM AUDIENCE UNDERSTANDING

1. Understand Me: Tailor programing to where girls are, developmentally and socially, meeting them where they are on their ‘life trajectory’ to identify their dreams.

2. Identify with Me: Girls are brought in as design and implementation partners and focus on relevance of interventions to girls.

3. ServeMe:Girl-definedandgirl-designedservices and messages, when and where they need them.

•Girls feel a sense of isolation after marriage related to restrictions and redefiningsocialroles-theirdreamsgoneglected.

•Girls see having a child as an ‘attainable joy’ – a source of happiness in reach of even the poorest girls. Perceptions that using contraceptionbeforeafirstbirthwillleadtosterilityplacethatattainable joy at risk.

•Many girls do not perceive themselves to be sexually active, even though they have had sex.

•Girls have a number of competing priorities to health, including the largerimperativeofmakingendsmeetfinancially.

•They are navigating and exploring interests and goals.

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3. ARTICULATE AN INSIGHT

Based on robust audience understanding about girls’ priorities, their beliefs about contraception, and even the stories they told themselves about their own sexual activity, the team was able to craft a highly relevant brand and initiative. The insight has tension between the way girls perceive contraceptives (taboo, harmful) and the reality that contraceptives can actually help them. It is true, but not obvious to the audience; it strikes an emotional chord because it is grounded in girls’ hopes and dreams – both of having a babyandofachievingotherlifegoals;andfinally,ithasthepotentialtoinspiregirlstothinkandfeeldifferentlyaboutcontraceptives.

INSIGHT:

Girls see contraceptives as a risk that will prevent their dream of having a baby; however, not using contraceptives is a risk that will prevent their dream of achieving life goals.

BAM360 team criteria for an audience insightIt has tension It is true but not

obvious It strikes an emotional

chord

It inspires the audience to think or feel differently

Yes Yes Yes Yes

“A360-Tanzania Married Adolescent Insights – Insight for Design”

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4. DEFINE THE BRAND VISION – CLARITY & RELEVANCE

The brand vision is a response to the audience understanding and insight – it sets up Kuwa Mjanja as a place where girls can get inspired and take action toward achieving their dreams.

A360 Marketing Plan 2018 (unpublished)

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5. DEVELOP THE BRAND IDENTITY

A360 Kuwa Mjanja draws on an iconic symbol – the pineapple – that serves both as a visual cue to girls (pineapples are ubiquitous) and a strong symbol (stand tall, wear your crown, sweet on the inside). The bright, vibrant color pallet of rich pastels; elegant font style; and photography contribute to create a positive and inspiring look and feel that celebrates girls.

Distinctive: When evaluated against other brands that focus on adolescent girls in Tanzania, Kuwa Mjanja distinguishes itself by its overall positive messaging conveyed in warm, inspirational tones. This is a lifestyle brand that inspires girls to do more.

Has a Personality: The Kuwa Mjanja personality is sassy, feminine, inspirational, and fun.

Reflects brand vision: The pineapple symbol is intended to inspire each girl to stand tall, wear her crown, and be beautiful on the inside as she works toward a dream she deserves. The examples below from the Kuwa Mjanja campaign highlight the empowering messages.

Executed consistently: Kuwa Mjanja is consistent across channels through use of color, imagery, graphical elements, photography of girls, and the pineapple symbol.

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6. COMMUNICATE A BENEFIT

Kuwa Mjanja Brand Campaign:Thebenefit–“youcanachieveyourdreams”–isclearanditresonateswiththeaudience.Throughthe use of IPC, mobilizers ensured believability by tailoring messaging and addressing questions and concerns. For example, mobilizers presented Kuwa Mjanja to Faridas (younger, less experienced girls) through “Know Your Body” messaging, which focuses on menarche and puberty, while they introduced the brand to Bahatis (older, more experienced girls) through “Know Your Path” messaging, which focuses on life goals and developing a plan to achieve those goals.

Overall message invites girls to achieve their dreams

Mobilizers target messaging based on a girl’s life stage

“know your body” and “know your path” messaging reinforces believability

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7. TOUCH THE HEART, OPEN THE MIND

Kuwa Mjanja Brand Campaign: In a culture where there is limited focus on girls and the dreams they carry, Kuwa Mjanja is heart and mind opening. It speaks to girls on their terms and inspires them to believe in themselves. The entry point -- through a girl’s heart -- speaks with her in language she can understand. The project’s messaging and services speak to girls on their terms, to keep them engaged through uptake of family planning, but always focused on supporting a girl to attain her dreams.

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INSUFFICIENT DATA

8. SELECT THE RIGHT MARKETING VEHICLES AND ENSURE MESSAGE CONTINUITY

Kuwa Mjanja Brand Campaign: Kuwa Mjanja uses a fairly limited approach to its marketing vehicles. The primary campaign relies on interpersonal communication, community events, and service provision to engage the target audience and to achieve the intended behavior. The A360 team follows users along a trajectory of engagement, from unaware/rejecter through to user and eventually advocate. Each of these stages implies a deeper level of engagement with the brand as shown below. Given the short duration of the campaign, we did not score this best practice.

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9. DELIGHT THE AUDIENCE

Kuwa Mjanja Brand Campaign:KuwaMjanjadelightstheaudiencethroughthebrandimagery,ameaningfulandinspiringbenefit,and delightful programming.

The brand creates a delightful experience – the imagery is symbolic, beautiful, and shareable

Thebenefit–youcanachieveyourdreams – is delightful

Girl-centered community events feature inspirational stories, entrepreneurship training, and contraceptive services

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10. INSPIRE AUDIENCE ENGAGEMENT

Kuwa Mjanja Brand Campaign: A360’s has focused on interpersonal communication, which has resulted in a high level of touchpoints with the target audience and a high level of conversion (adoption of a method), but lesser reach and higher overall project cost. Shifting to scale will require greater use of media for greater reach at a lower cost. Engagement has been positive but directed from A360 to girls and their direct experience. It hasn’t yet demonstrated an ability to create conversations beyond its direct engagement.

GOOD

Mjanja Connect is a mobile app that provides an interactive counseling tool to support community health workers to deliver targeted messaging (& stay on brand), connect with and refer girls to services. This helps to maintain consistency with brand messaging and also supports the program to register, track referrals and service uptake, and provide follow up support to a client through her journey with the program.

Personality “quizzes” help to understand the client segment and then provide tailored messages.

Games and exercises focus on knowing your body. Method selection aids are supported by testimonials, quizzes and games to help girls determine the best methodtofittheirlifestyle.

Clinic & Community “pop-ups” start with inspiration and lead to opt-out counseling and service provision.

Work in Progress – A360 is building out an ‘ecosystem’ to initiate contact, track referrals and map girls’ pathways to services and beyond to support method continuation.

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11. TEST MESSAGE EFFECTIVENESS

Theteamusesadaptiveimplementation,aprocessforcontinuousprogrammonitoringandrefinement.Forexample,whentheteampartnered with teachers as a way to reach girls, they quickly learned that teachers were inserting their own messages (e.g., “learn how to avoid temptation”) that were inconsistent with Kuwa Mjanja. The team developed and implemented an onboarding program to ensure that mobilization partners fully understood and supported the Kuwa Mjanja brand.

https://www.a360learninghub.org/open-source/adaptive-implementation/adaptive-implementation-featured/

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12. EVALUATE PROGRAM RESULTS

TZA360exceededtargetsestablishedwiththedonorandprogramteamsbyasignificantmargin.Thetargetnumberofadopterswas approximately 20,000, but A360 achieved over 50,000 adopters of modern methods in the period from January to October 2018. ThemethodmixdiffersamongtheA360targetpopulationcomparedtothenationalaverage(2015/16DHS).Incomparisontothenational method mix, Kuwa Mjanja participants have a much higher rate of use of implants (50% versus 18% in DHS) and much lower use of Injectables (8% versus 32% in DHS). Kuwa Mjanja participants have a slightly higher rate of use of LARCs in comparison to the national average, which is a notable accomplishment as younger girls are less likely to use LARCs in general. We scored A360 as “good” rather than “excellent” given that their reported results are largely based on service delivery data, and there has been no statistically validated evaluation to-date.

http://a360learninghub.org/open-source/ A360 program data

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13. MEASURE BRAND PERFORMANCE

No available data. Best practice not evaluated.

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14. EVALUATE MARKETING VEHICLE EFFECTIVENESS

While the project envisions mass media, the current focus has been on events, interpersonal communication, and service provision. Assuch,theteamfocusedonmeasuringcostanddrivingefficiencythrougheffortsthatimprovedconversionrates,increasedthenumberofeventsperteamandtheaveragenumberofadoptersperteam.Theseeffortsreducedthecostperadopterfrom$184/adopterto$40.Wescoredthisbestpracticeas“good”astheteamfocusedonoptimizingthecurrentmarketingvehicles,butdidnotassesstheeffectivenessofspecificvehiclesandchannels(eventsvs.interpersonalcommunication,etc.).

http://a360learninghub.org/open-source/ A360 program data

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15. ORGANIZATIONAL STRUCTURE // 16. PROCESS & DECISION-MAKING // 17. PEOPLE & CAPACITY // 18. REWARDS & INCENTIVES

ELEMENT DESCRIPTION

Organizational Structure The collaborative HCD process relied on multiple disciplines and organizations, seamlessly drawing on perspectives and talent in multiple organizations. This included adolescent developmental science, anthropology, public health, social marketing, meaningful youth engagement, and Ministry of Health personnel.

Process & Decision-making Adaptive Implementation facilitated processes and decision-making. Adaptive Implementation aimstocontinuouslyfocusonopportunitiestoimproveefficienciesandeffectiveness,andtoincrease programmatic impact. High performers among outreach workers or teams were studied to understand their success. The lessons learned were then applied to lower performers. Adaptive implementation is designed to be integrated into routine managerial decision-making processes sothatitbecomessecondnaturefortheteams.Theprojectbenefitedfromacleartimelinetodesign, pilot, and scale. While the design stage was complicated, a disciplined and deliberate process brought clarity. The A360 team stated that the ‘playbook’ developed with this process allowedformoreeffectivereplicationofsuccessfulpractices.PSIastheoverallprojectleadhadfinalsay,withawell-developedmanagementstructurethatfacilitatedcleardecisionmaking.

People & Capacity Early partnerships with IDEO and a strong grounding in HCD were complemented by a strong, dedicated design team already in place. The PSI team worked to bring along other key partners suchastheirmediateam,andnationalandlocalgovernment.Thedesignteam,specificallygirls, transitioned to supervisory and feedback roles to serve as custodians of the brand’s truth. Theprojectstaffisencouragedtoimmersethemselvesinthelivesofthegirlstheyserve.Thisisachieved through human-centered design as well as A360’s adaptive implementation principles.

Rewards & Incentives Theprojecthasawell-definedTheoryofChangeframeworkandmetricsthatpushtheteamstowardscaleandcosteffectiveness.

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