Framing the Unknown – A Baseline Study for Digital Citizen Engagement in Sexual Reproductive Health Services

By Caroline Khene and Clement Simuja

There has been a significant rise in the use of different forms of ICT in the past 20 years among the youth in Southern African Countries, especially mobile devices.  More specifically, the youth are now using mobile phones more than any other modern and traditional ICT. As a result, there have been ongoing trends associated with the use of mobile devices for youth participation in sexual reproductive health services (Gonsalves et al., 2015). However, a lack of understanding of the contextual environment can lead to mobile technology-based initiatives merely appearing as ‘beautiful’ solutions, without understanding the complexities of the problems they aim to address. Key to the success of such initiatives is appropriate problem identification and demarcation – especially to build capacity, motivation to use the technology for social accountability monitoring, and buy-in for government responsiveness. Furthermore, examining contexts also requires identifying ways to increase the participation of adolescent youth in sexual reproductive health services. Therefore, a Baseline Study is constituted to assess the contextual status of selected SADC countries and its readiness to uptake the SAfAIDS-MobiSAM (Mobile Social Accountability Monitoring) initiative. The concept of social accountability requires that one understands the key perspectives of the main beneficiaries – in this project the main beneficiaries are the youth (as citizens) and local government.

The Baseline Study reflects on two assumptions: that the youths, SAfAIDS staff, and local government staff can provide necessary information to support the development and implementation of a mobile SRHS technology, and that the proposed SRHS technology would be sufficiently sensitive to that feedback to improve SRH services delivery. Therefore, the baseline study is conducted in this project to gain an understanding of the existing context of each pilot country for digital citizen engagement in sexual reproductive health services – in relation to information and communication needs, key agents needed to support social accountability and government responsiveness, existing resources available, and monitoring and enforcement mechanisms. This will inform the strategy and implementation constraints to address towards the development of a mobile social accountability application for reporting on SRH services by adolescent youth. Furthermore, a Baseline Study is the first domain to be implemented using a comprehensive evaluation approach that will be applied throughout the life of the project.

The Baseline Study is guided by objectives informed by existing literature, for example on ICT-facilitated accountability and engagement in health systems, lessons learned from the MobiSAM Makana Municipality Baseline Study, and engagement with SAfAIDS staff on key aspects to consider in social accountability and access to adolescent SRH services. The objectives are:

1. To understand the knowledge and attitudes towards social accountability by citizens, service providers, and oversight bodies.
2. To understand the information and communication needs to support social accountability and citizen engagement in SRH service delivery.
3. To identify and initiate/establish relationships with key agents needed to support social accountability (citizen engagement) and government responsiveness in SRH service delivery.
4. To explore existing resources or resource constraints in targeted communities to support digital citizen engagement in SRH service delivery. This will be holistic and not only technology focused e.g. ICTs and media, communication ecologies, capacity (among agents and citizens), finances and policy, etc.
5. Within the scope of digital citizen engagement and evidence-based data engagement:
   1. To explore monitoring mechanisms that exist in the communities to support social accountability in SRH service delivery.
   2. To explore existing enforcement mechanisms to ensure that the agents meet the standards required for SRH service delivery and evaluate their application in the communities.

The Methodology

The research design applied in the Baseline Study uses a Mixed Methods approach embedded in a Pragmatist philosophy. A mixed method approach uses both qualitative and quantitative approaches for data collection and analysis, triangulating evidence that explains the status of selected pilot communities in each of the 6 countries. Given that each country’s context is unique, the pragmatist approach allows researchers to focus their attention on understanding each country’s context using various methods of data collection. Each data collection approach will be re-evaluated for its suitability in the context especially when it becomes a challenge to implement the tools. The pragmatist approach allows for contextualization or re-evaluation of tools to support effective data collection

The assessment will target the following subject groups in each pilot country: SAFAIDS staff (regional and headquarters), citizens (youth, parents), provincial/national government, local government staff, youth-led CSOs, and youth liaisons. These groups are targeted on the assumption that they amply represent the diverse views, values and perceptions relating to adolescent sexual reproductive health services. The research strategy applied will therefore be a multi-case study analysis involving six countries: Zimbabwe, Zambia, Malawi, South Africa, Swaziland, and Lesotho.