Engaging Youth to Improve Adolescent Health servic

Encompassing a substantial proportion of the population over 35 million adolescents and young adults aged from 15-35, the significance of addressing such rights for this target population is inadequately represented in Bangladesh. During the adolescent/ puberty time, they may undergo some physical changes and start developing sexual desires. At this crucial stage, they are at higher risk of engaging themselves in unsafe sexual activities, contracting sexually transmitted Diseases and STDs, bearing the consequence of unsafe abortion, becoming the victims of early marriage and pregnancy, and being more susceptible to experiencing sexual violence. As a result, most people find it uncomfortable to discuss their sexual and reproductive health, particularly adolescents. Due to taboo and societal stigma, the parents and families along with the community also lack proper access to information and understanding of SRHR. 

In order to address the aforementioned issues, under initiatives such as The National Strategy for Adolescent Health 2017–2030 and the National Plan of Action for Adolescent Health Strategy (2019), the DGFP has established 1253 Adolescent Friendly Health Corners (AFHCs) across the country. However, many people, including adolescents, are unaware that these health facilities exist. Besides that, some youths do not feel comfortable when they go to take services at AFHCs due to the lack of a friendly environment as there is an age difference between these young service seekers and service providers (the Medical Officer (MCWC), and SACMO, FWV/A). 

Though the DGFP has established 1356 Adolescent Friendly Health Corners (AFHCs) across the country, however, many people, including adolescents, are taking the services and according to the last 21 months' register data, the service and client flow have increased. However, the data are not included in the MIS on time which can also impact the policy system to make the right decision on time. 

In order to address the aforementioned issues, under the Directorate General of Family Planning (DGFP), a Management Information Systems (MIS) Unit was established in 1979 to track advancements. A routine system of data gathering and reporting on the effectiveness of national programs for family planning, reproductive health, and maternal and child health services was created by the MIS Unit. However, certain adjustments still need to be made in order to swiftly gather and enter data while utilizing technology, since it is currently done by hand. With regard to the difficult-to-reach regions, this innovation will provide the MIS Unit of DGFP and DGHS with technical support. It will implement frequent Data Quality Assessments (DQAs) as part of its support for system enhancement in order to bolster the DGFP MIS. As there is no auditing process to assess the quality of the reported data/statistics and strengthen the data management system, there is a gap in evidence generation. Production of high-quality data depends on systematic data assessment and that is the biggest limitation of accession data on time as data input takes time from the ground level as it has happened manually.

Our approach involves implementing state-of-the-art technology in the realm of teenage healthcare through the creation of an intuitive mobile application that might significantly improve the services offered at Adolescent Friendly Health Centers (AFHCs). This mobile application will be helpful in streamlining the process of gathering and organizing health information for teenagers/adolescents seeking care in medical facilities, where access to contemporary devices like computers and laptops is restricted/limited. The primary users of the application will be Volunteers and Service Providers.

The pilot project was tested in 20 selected AFHCs in 4 districts and integrated the Volunteer Peer Leader (VPL) model in adolescent health centers to create a friendly environment and enhance service quality. These VPLs aged 15 to 24, involved themselves in community and school-based campaigns to educate and motivate adolescents to access information about sexual and reproductive health services and family planning from nearby AFCHs. Also, the presence of both males and females ensured gender sensitive information delivery increasing trust in the targeted population as the VPLs belong to the same age group when it comes to discussing sensitive issues like sexual and reproductive health. In addition to bringing changes in social norms, the traditional SBCC materials were improvised with a modern approach in regional language such as ballad songs with entertainment-based health and educational content. VPLs also collected feedback from service recipients at the AFHCs to support the improvement of service quality at these facilities. This approach has already received great acceptance and accolades from the government and experts. The concept lacked one feature and adding the mobile app to equip the providers and volunteer peer leaders will boost the information delivery, counseling, and recording the real-time data that will feed back in the national database as well as keep a ready record of SRH, nutrition, and family planning data. 

The traditional data entry process is done manually at the healthcare facilities, without a handful of centers that have digital equipment in place. It is essential to record accurate information efficiently to provide them with the right care and assess the needs and gaps in the trends. This procedure will be simplified by the introduction of this mobile app as providers will be able to record the data of adolescent visitors, keeping track of their communication channels, referral information, and any gaps. Ultimately, it will enhance the standard of care while also saving time. The app will have a user-friendly interface, making it easy for service providers to input information quickly. Based on the data acquired, the application will automatically (using AI) recommend which services adolescents should be referred to, making the provider's job easier. This app will be integrated with the Management Information System (MIS) of the Directorate General of Family Planning (DGFP) to further improve the government's database on adolescents. Apart from efficient data integration with the central database, this mobile application has the potential to improve the way that healthcare is provided in remote areas by volunteer peer leaders and service providers at adolescent health facilities.

The target population is the adolescents aged 10-19 living in the 20 selected geographies adjacent to the government run adolescent friendly health service centers in 4 districts. Also the volunteer peer leaders (VPLs) and service providers at the health facilities are also in . The proposed solution aims to simplify  the accessibility of essential information and data related to adolescent and youth sexual and reproductive health (AYSRH) through developing a mobile application. With this solution, the AFHCs will serve as youth service and information hubs at community and local level, where young people can seek advice and information on FP/SRH without any biases/feeling uncomfortable from the recommended services through the mobile application. The VPLs engagement will also help to further ensure that the services offered through the application to these young service seekers will be in line with their requirements and done in a friendly manner. As the application system will be developed tailored to the needs and information of Adolescent and Youth Sexual and Reproductive Health. 

Along with the VPLs under the direct supervision of the AFHC center in-charges (medical officer/SACMO/FWA/FWV), The Department of Family Planning (DGFP) and the Directorate General of Health Services (DGHS) are working together on community and school level to enhance the youth mobilization programs as part of this initiative.  This solution will address adolescents that have limited access to resources but have a dire need of it. By developing this mobile application, our solution will be able to reach those adolescents very easily as nowadays mobile phones are accessible to everyone. This software will aid in the collection and organization of health data for adolescents visiting medical facilities with restricted access to contemporary technology like computers and laptops. This software is designed primarily for usage by service providers and volunteers. So the adolescents' information will also be kept confidential and will be maintained properly, not like the traditional manual way in which data or information doesn’t get updated for years which results in improper service delivery. 

This application will help the target population through using recommendation and referral mechanisms which will direct them towards a path of getting better health care service. Over a period of 18 months, 40 volunteers will be deployed in 20 Adolescent Friendly Health Centers to support the service providers as first stop facilitators for the visiting adolescents and also to generate demand for services and information through school/college and community based outreach campaigns to support mass media collaborating. They will make all this relevant information accessible through the mobile-based application. Through evaluation form the satisfactions of the youths will be recorded which will possibly help to improve the quality of services. The project aims to validate the demands of the youths and adolescents by engaging youth volunteers as a core support mechanism of AFHCs which will generate evidence of best practice to replicate similar programs in other areas.

SERAC-Bangladesh has a track record of successfully implementing a similar project, known as ‘Shukhi Jibon’ under a Fixed Award Agreement initiative funded by USAID. In this project, a VPL model involved 40 Volunteer Peer Leaders (VPLs) across 20 selected Adolescent Friendly Health Centers (AFHCs) in Dhaka, Narayanganj, Mymensingh, and Netrokona. The VPLs serve as a referral mechanism that connects the community with healthcare services/workers. They assist adolescents in accessing healthcare services and provide counseling services to their peers through this application. In order to facilitate the effective dissemination of knowledge and encourage active participation of community youths and adolescents in this initiative, awareness campaigns, different quiz programs, and competitions have been arranged through this application as well.

Up until now, the initiative has managed to have an impact through digital platforms on approximately 400,000 people such as social media engagement, and 17,541 individuals through SRH services provided at the facilities. With a proven track record of achievements, SERAC-Bangladesh has the expertise in implementing innovative tech-based strategies to deliver an effective solution in order to address the particular challenges relating to sexual and reproductive health in Bangladesh through local and national-level community engagement through digital platforms. Moreover, SERAC has a dedicated PMEL team comprising 4 people (1 full-time, 2 part-time), and is led by the head of the organization to improve and ensure the data quality of the organization that can make an impact on the program design and implementation according to the field demand. Furthermore, there is a youth-minded IT expert in the organization who focuses and works according to youth demand that catalyzes the impact of the digital platform's more cognitive and flexible usage. 

• 6 people are now working on this project intervention directly connected with this. 
• 40 volunteer peer leaders are part-time job holders.
• 500,000 people direct beneficiaries of the adolescent-friendly health centers, and digital platforms. 

Our solution is innovative because it takes an approach to make the traditional way of storing information into a digital way which will make it easy to reach, access, and change. Getting the right information at the right time is the most important thing when it comes to adolescents' health. Handling the information manually was time-consuming and couldn’t give a time-appropriate solution as information had not been upgraded for years. Our solution will break that backwardness of information and will help the youth to march forward for future development.
This smartphone app will make this process easier. It will save time and raise the caliber of treatment provided. Because of the app's intuitiveness, service providers will find it simple to enter data rapidly. The program will automatically suggest which services teenagers should think about based on the data they enter, where to find the services, and who to get in touch with to get them. In order to ensure that service seekers are connected to the appropriate resources for services, the app will function as a referral system. To further enhance government operations, this app will be connected with the Directorate General of Family Planning (DGFP) Management Information System (MIS). This ensures efficient data integration since any data uploaded into our app will automatically register into the DGFP MIS. Our mobile application has the potential to improve the way that healthcare is provided in remote areas for volunteer peer leaders and service providers in adolescent health facilities.

As this is an approved initiative by the DGFP to integrate young people into the adolescent-friendly health center, it is high time to show the impact of generating concrete evidence, formed by volunteer peer leaders of easy access to adolescent health services. This will assist the policymakers in transforming any changes in the existing intervention with an innovative approach and co-creating the program process to make it more sustainable in the whole adolescent program.
Apart from this VPL program, parallel advocacy has led the government to modify and include this technology into the DGFP's current MIS as well as the fifth-year sector plan with money from its own resources after the project's completion. The continuous process of enhancing MIS through evidence obtained from VPLs will increase demand when it comes to stakeholder accessibility for the design and execution of the next step program.
Nevertheless, this application will assist the Ministry of Health in monitoring data, including it in the population census, and holding it responsible to all pertinent stakeholders and policymakers for updating the health policy while taking the needs of young people and adolescents into consideration. Further, this innovation will assist future academics in reconsidering how high-quality evidence-related health information is generated in order to collaborate on the development of community- and healthcare facility-based programs and initiatives. Additionally, through this innovation, we will improve the ability of the service providers to use technology more skillfully and productively in order to keep up with the newer generation. All stakeholders involved, including those who live distant from the remote medical facilities, will have access to the data.

The theory of change will be to develop an intuitive smartphone application that might greatly enhance the services provided at adolescent-friendly health facilities, therefore introducing modern technologies to the field of adolescent healthcare. In medical institutions where adolescents are receiving treatment and have limited access to modern equipment like computers and laptops, this mobile application will assist in expediting the process of collecting and arranging health information. Volunteers and service providers will be the application's main users.

• Outcome 1- 40 volunteer peer leaders aged between 15-30 recruited in 20 centers (4 at each center and 10 AFH centers per division) will be skilled in application conduction to spread information throughout the community for adolescents and young people to ensure quality information as well as services of youth in improving adolescent friendly health service centers facilities.
• Outcome 2- Information and data accessibility of the AFHC for the data expert of the MIS officials of the DGFP will be ensured by putting them under direct supervision of the AFHC center in-charges (medical officer/SACMO/FWV) and making available for all relevant stakeholders in local level management and decision-making officials and personals as an integral part of the facility and service quality monitoring mechanism.
• Outcome 3- Transforming and improving the data for future research and evidence generator regarding the quality assurance of AFHCs by tagging with DGFP and DGHS field service delivery and MCH units to co-create the interventions more friendly and technology based on the adolescent-friendly health centers.

The staff positions below carry out the project activities as planned. 

1. Project Advisor (1)

2. Project Manager (1)

3. Program Associate (2)

4. IT Expert (1)

5. PMEL Associate (1)

6. Finance and Admin Associate (1)

With the VPL model since May 2021, we have been trying to accommodate the findings and evidence of strengthening the Management information system (MIS) by data collection and registering through the volunteers in the centers. Apart from this, one of the advocacy objectives was to initiate this from the next level. As this is already in an advocacy process to integrate this innovation into the existing operational plan of DGFP-MIS, this piloting of the technology innovation also will assist the DGFP officials in understanding the field findings, especially the needs of the service providers.

Gender equality is a lens to all our works, and we have integrated three approaches to make gender issues a real lively determinant of the programming and operations in the country context.

• GESI - Gender Equality and Social Inclusion

• GTA -Gender Transformative Approach

• VCAT -Value Clarification and Attitude Transformation

These approaches guide our MIS and IT experts to reallocate data and make a bridge with the existing MIS from local, to national levels. How gender inclusive data are integrated and inputted into the application, will help to segregate the data and assist in taking necessary steps to program designing and implementation. Additionally, it will also create employment in the whole process for the gender-diversified people as well, as we will try to notch more multi-background people in the process so that all data are valued and included equally. Noting that gender roles are dominated by the pre-existing social determinants, as well as institutional approaches that also go down to the family and community levels. We have created a gender-inclusive and transformative method to support designing our programs and this is key to the strategic plan of the selected Adolescent Friendly Health Centers (AFHCs) to incorporate gender considerations. Moreover, through this application, we will collect the value transformation data in the process, which may help to redesign and reshape the program structure for the community people through policy approaches.

The technology-based innovation is bringing cutting-edge technology to the field of adolescent healthcare by developing a user-friendly mobile application that might greatly enhance the services provided by adolescent-friendly health facilities. This smartphone application will assist in expediting the process of compiling and organizing health records for adolescents and young adults seeking care in hospitals, where access to modern technology such as laptops and desktops is limited. Volunteers and service providers will be the application's main users.

• First of all, this innovative application will help the Ministry of Health to track the data and also include it in the population statistics and make it accountable to all relevant stakeholders and policymakers to upgrade the health policy, considering the youth and adolescents’ demands. 

• Secondly, it will help future researchers to rethink the generation of quality evidence-related health information to co-create the programs and interventions for the community and health facilities. 

• Thirdly, it will enhance the capacity of the service providers to utilize the technology more effectively and efficiently to walk with the upgraded generation. Data will be available for all the stakeholders who are far away from the remote health facilities as well. 

The volunteer Peer Leader (VPL) model has already been introduced and approved by the Directorate General of Family Planning (DGFP) and 40 VPLs are currently working in 20 selected government-run adolescent-friendly health centers (AFHCs) in Dhaka, Narayanganj, Mymensingh, and Netrokona districts of Bangladesh. Since the VPLs have deployed at government authorization under this initiative, a parallel advocacy has guided the government to adapt and integrate this technology in the existing MIS of DGFP and also in the 5th-year sector plan with own funding beyond the project period. As this MIS strengthening process is ongoing by having evidence through VPLs, it will strengthen the demand considering the stakeholder accessibility of the next step of program planning and implementation. As the government (DGFP) has already agreed to consider evidence of this project, this new version of the solution will definitely strengthen the rationale for scaling up this model with the government’s own resources making this a sustainable product for impact in adolescent health care in Bangladesh.