New Technologies at the Service of Young People in Ivory Coast for Better Management of Their Health and Psychosocial Well-Being
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BACKGROUND: YOUTH HEALTH IN IVORY COAST
In Ivory Coast, where 38.4 per cent of the population is under 15 years old, young people face particular health risks. People in this age group often avoid attending health centres due to lack of trust, as services are often unsuitable for their needs (there is a lack of anonymity and confidentiality, and a risk of stigmatisation), especially when it comes to sexual and reproductive health. Access to counselling, health information and psychosocial support is only available to a limited extent as part of school and university health services that are less frequented by out-of-school youth or by young people with reproductive health needs. Yet today, in Ivory Coast, 31.9 per cent of 20 to 24 year-olds have had a child before the age of 18, and 20 per cent of women and 14 per cent of men have sex before the age of 15. Contraceptive prevalence among young people does not exceed 13.9 per cent. Frequent pregnancies and pre-mature births, low utilisation of family planning services, pre- and post-natal consultations, and low rates of assisted deliveries are among the leading causes of death, especially among pregnant adolescents. It is estimated that 75 per cent of unwanted pregnancies result in illegal abortions with 15 per cent of deaths related to post-abortion complications. There is also a 50 per cent higher rate of neonatal deaths among children of teenage mothers.
ACTION AGAINST HUNGER’S STRATEGY TO IMPROVE THE MANAGEMENT OF YOUTH HEALTH
Action Against Hunger, working in close collaboration with the National Programme in charge of Youth and Adolescent Health (PNSSU-SAJ), provides an adapted and innovative response to the health-related information and communication needs of young people. It does this by employing three complementary approaches and facilitating referral to appropriate support when needed.
Teenage classes have been established since 2017 to meet the specific needs of young people in the poorer neighbourhoods of Abidjan where Action Against Hunger works. Indeed, young people have expressed the wish to have a specific space for dialogue to address their issues of concern. Since their inception, 205 classes have been completed reaching a total of 3,750 young people and adolescents within their neighbourhoods.
Four friendly spaces dedicated to young people to ensure listening, guidance and support for addressing their specific needs were opened in December 2018. They were rehabilitated and equipped to receive young people in a welcoming environment, with a psychosocial listening point. Six training sessions on adolescent health and psychology were organised and benefited 60 health workers, 35 young peer educators and 33 community members.
A mobile application was created with a working group made up of young people, health staff, lawyers, competent authorities, and the support of an information system consultant and a web development firm. This mobile phone platform aims to respond to youth health issues in real time through a chat with health professionals, create discussions and transmit messages of prevention without taboos. Anonymity and confidentiality are preserved through encrypted conversations. The service is free and the application is downloadable online.
The hypothesis is that by offering information and a space for dialogue with health professionals through different channels (a mobile application providing confidential and easy-to-access virtual support, as well as physical spaces of meeting and exchange), young people have access to the information they want and can be accompanied in an informed and autonomous decision-making process. This allows them to act at their own pace and according to their particular needs, as well as develop a sense of self-confidence to better envision the future. Thus, the health of young people is improved and they benefit from greater psychosocial well-being.
Finally, a partnership with the youth civil society and the Association of Women Lawyers of Ivory Coast helps to empower young people and ensure that they can exercise their rights. Indeed, with support from this association, young people are not only empowered to visit health centres to be advised and supported if necessary, but also to provide input into national decision-making frameworks and programmes, particularly regarding advocacy towards free reproductive health for adolescents.
ADDRESSING KEY CHALLENGES
Although this programme has had key successes, it has also encountered various challenges that deserve special attention. Some of these challenges, as well as the steps taken to mitigate them, include:
- The mobile application development process is lengthy and required expertise in information systems. The project therefore drew upon the expertise of additional developers to enable a technical audit and improved application functionality for the scaling up of the project. A test phase with young beta testers is still underway to address all their expectations.
- Particular attention has been paid to the protection of personal data, an important issue when rolling out any type of e-service. To address this, the National Coordination of Information and Communications Technology for Health (the technical authority in the field of e-health) supervised the process of obtaining authorisations from the Telecommunications Regulatory Agency of Côte d’Ivoire and access to the secure state data housing of the National Society of IT Development: host of Government data.
- The referral system, integrating a database of referral structures and professionals in case of specialised health needs (medical, psychosocial, legal) must be defined and implemented with the relevant authorities and technical partners, particularly for psychosocial distress and gender-based violence. Action Against Hunger is working closely with the Mental Health Office in the Ministry of Health, the Ministry of Family, the PNSSU-SAJ and the Association des Femmes Juristes de Côte d’Ivoire to clarify these lines of referral and ensure the functionality of a multi-sectorial platform to address gender-based violence.
- This approach to health, which involves addressing young people’s sexual and reproductive health, integrating the theme of gender-based violence, and drawing on expertise in information systems and web / mobile development is not part of Action Against Hunger’s “classical” intervention strategy. As a result, support and expertise were not always available internally, and the project had to find external support. In addition, some members of the organisation regard this youth health project as moving away from Action Against Hunger’s nutrition mandate. Given the rates of neonatal deaths in children of teenage mothers in Ivory Coast, however, we must advocate for these types of initiatives as preventative measures for tackling malnutrition.
NEXT STEPS AND ADVICE FOR FUTURE PROGRAMMES
A full review of key lessons learned (including compiling best practices, practical guidelines, technical aspects that future programmes must consider, and an evaluation) must be conducted in 2019 in order to measure the impact of the project on young people’s health-care seeking practices and access to health care. This process can be used to inform the development of similar tools in other contexts.
Based on the experience of the Ivory Coast office, if other Action Against Hunger offices are interested in implementing similar projects, they should consider the following:
- Plan for a minimum 3-year programme, since establishing technical solutions requires a long set-up process.
- Hire an experienced firm for the app development and seek strong IT support (this could draw on some of the development that has been done in Ivory Coast already, adapted for other offices).
- Involve the youth from the start in order to ensure their needs from the service are addressed.
- Pay specific attention to personal data protection and required legal frameworks.