The original abstract was published on USAID’s mHealth Compendium, Fifth Edition. To read the full report, click here.
During the Ebola outbreak of 2014, UNICEF identified a need to improve information communication flows between relevant government ministries and the affected communities.This need was identified in Nigeria, where U-Report already existed as a general SMS-based youth engagement platform, as well as in countries where it did not exist, such as Liberia and Sierra Leone.
Once the need was identified, U-Report was used as an innovative solution that could be implemented relatively quickly and be community-led while supporting governments to combat the disease. In partnership with governments, the tool was used to understand knowledge gaps and provide necessary information to fill them, as had previously been done during Ebola outbreaks in Uganda in 2012. The application of lessons learned combined with the improved transferable SMS RapidPro technology underlying U-Report enabled swift implementation.
U-Report is a social monitoring tool designed for youth and other community members to strengthen community- led development and citizen engagement. It uses community communication to identify health needs, raise awareness, identify health sector gaps, and establish a strong long- term system post-emergency. It provides a forum for youth empowerment, sends alerts to key stakeholders about the issues being faced in their communities, and feeds back useful information to the U-Reporters, so they are empowered to work for change and improvements in their localities.
As of April 2015, U-Report has been launched in 12 countries with over 650,000 young people participating as U-Reporters in Burundi, Democratic Republic of Congo, Indonesia, Liberia, Mali, Nigeria, Sierra Leone, Swaziland, Uganda, Zambia, Zimbabwe, and Central African Republic.
Application of the program to Ebola-affected countries included a twin strategy: (1) Utilize U-Report in Nigeria where over 100,000 young people were already engaged and some Ebola cases had been recorded; and (2) set up new U-Report programs in Liberia and Sierra Leone, build a user base (called U-Reporters), and empower it with relevant information to combat the disease.
In Nigeria, the existing U-Report community was engaged to understand the level of knowledge around Ebola prevention. For example, the following SMS was sent to 46,000 people: “Do you know how to prevent yourself from getting Ebola?” Eight thousand people responded, 3,000 of whom had no knowledge. The results were mapped, providing UNICEF and the government with an approximate picture of where knowledge on Ebola prevention was most lacking. UNICEF was also able to assess which tactics the commu- nity thought were working best and worst in combating Ebola: 59 percent said raising awareness was working well and that hand sanitizers had a perceived minimal effect. All U-Reporters subsequently received advice on how to prevent Ebola from spreading.
In Liberia and Sierra Leone, the approach was different as the system had to first be set up and U-Reporters needed to be recruited. The UNICEF team, in partnership with the respective government ministries responsible for health, was able to get the programs live within four weeks. This includ- ed acquiring short codes, agreements with telecommunica- tions networks, coordination with ministries, staff recruit- ment, technical implementation, and forming partnerships with local organizations.
In Liberia, the program is being used to deal with the impact of the Ebola crisis on children as low school attendance is still being observed.
Evaluation and Results
During the course of the Ebola efforts to date, over 320,000 SMS messages have been sent aimed at understanding the needs of young people and providing them with information. Over the same period, UNICEF has received over 86,000 messages about Ebola, each one the voice of a young person contributing to a community-based effort to stop the disease.
- It is important to have young people write the outgoing SMS questions so they are understood. In Liberia, an SMS framed as, “Are you aware of the Ebola disease?” becomes “do pple no abt Ebola?” In order to resonate with young people at scale, they must be part of the process.
- Media-based recruitment activities will skew male in the aforementioned countries unless there is a strategic approach that targets gender-based issues specifically.
- It is possible to launch a program in emergency circumstances and start engaging with communities within four weeks.
- While launching during an emergency is possible, and sometimes necessary, having the infrastructure in place before a crisis strikes makes it more farreaching, and therefore arguably more impactful, when a health emergency takes place.
The key element that all U-Report programs have in common is sustainability before, during, and after a crisis.
By approaching young people, mothers, and children as a whole, U-Report stays engaging and can be used for long-term strategic planning by government ministries to strengthen systems post-crisis around a variety of issues. Involving young people at scale in government decision-making processes reduces the gaps between the voices of the people and their representatives. As a direct consequence, young people can have input into development planning, and in return receive important information that they need to fill knowledge gaps.
The programs in Liberia and Sierra Leone jointly engage over 33,000 young people, and there were over 170,000 U- Reporters in Nigeria as of March 2015. Liberia is one of the fastest growing U-Report programs in existence with 20,000 people signing up over a 10-day period in early 2015, demon- strating demand for the service that UNICEF has seen in other countries across the continent.
Response rates remain strong, with 23 percent responding to the most recent polls in Liberia and 19 percent responding in Sierra Leone—both above the international benchmark of 15 percent for response to quantitative questions. All countries have subsequently diversified youth engagement topics to work on areas including child protection, education, and fighting other diseases such as HIV/AIDS. Gender representation isn’t equal but is in line with mobile phone ownership. Where countries skew to over 60 percent male, the recruitment strategy for U-Report requires adjustment to ensure female U-Reporters have an equal voice.
Geographic Coverage: Global Implementation Partners: UNICEF Donor: UNICEF
Contact Information: Kidus Asfaw, Product Manager, UNICEF, firstname.lastname@example.org