Driving Change, Empowering Lives: The Role of Digital Technologies and Accelerators in Adolescent-Friendly Health Services

In a ground-breaking collaboration, the African Union High-Level Panel on Emerging Technologies (APET) and Accelerate Hub have joined efforts to explore the transformative potential of inclusive digital technologies as a development accelerator for enhancing adolescent-friendly health services in Africa. Access to adolescent-friendly health services is essential for the well-being and development of this important demographic dividend.[1]

Digital technology offers huge potential for addressing healthcare challenges across the continent and promoting holistic development and achievement of the African Union’s Agenda 2063 and the Sustainable Development Goals (SDGs). Governments, researchers and development agencies such as the United Nations Development Programme (UNDP), have been working to identify development accelerators - interventions that can advance progress across multiple SDGs[2]. Research from across Africa shows that accelerators such as social protection, safe schools, parenting programmes, youth-friendly health services and digital technologies can bring about improved outcomes for adolescents, including improved mental health, reduced transactional sex and violence, enhanced HIV prevention and treatment, along with other Agenda 2063 results.[3] This blog explores the potential of digital technology and mHealth to be considered as development accelerators which can galvanise progress on adolescent health and wellbeing, as well as other development goals.

Achieving global and regional development goals will not be realised without responding to the needs of adolescents and young people. The formative period spanning 10 to 24 years is a critical opportunity to invest in human development.[4] With a global population of 1.21 billion, projected to reach 1.29 billion by 2030, older adolescents and young adults aged 15-24 years represent 15.5% of the total population.[5] Support for young people during this phase of the life course can not only support safe transitions to adulthood but also influence long-term health and well-being in adulthood.

Sub-Saharan Africa faces significant challenges in ensuring the well-being of its growing adolescent population. In sub-Saharan Africa, the likelihood of a 10-year-old dying before reaching the age of 24 was approximately six times greater compared to North America and Europe.[6] Adolescents are disproportionately affected by mental health disorders and injuries. Adolescent girls and young women also experience a high incidence of HIV infections, in many countries, and the consequences of early marriage and pregnancies. Girls and young women are also particularly vulnerable to sexual abuse, exploitation and harassment which can result in severe physical, emotional, and psychological consequences.[7]

Furthermore, adolescents face numerous barriers to accessing services including limited access to life-skills education and stigma when accessing sexual and reproductive health services which can contribute to their poor health outcomes. In addition, gender-specific barriers further compound the difficulties faced by adolescent girls and young women, including harmful gender norms which can restrict their choice and agency in accessing services.[8] The most vulnerable adolescents, such as refugees, orphans, those living with disabilities, out-of-school adolescents, and those in extreme poverty, face heightened challenges.

Recognising the healthcare needs of African adolescents, adolescent-friendly health services play a crucial role in achieving multiple SDGs and Agenda 2063. Improving age-appropriate access to quality healthcare will empower young individuals to make informed decisions, lead healthy lives, and contribute to their communities.[9] African adolescents require tailored approaches that consider their physical, mental, and social well-being. These include the provision of gender-specific health considerations including comprehensive sexuality education which ensures patient confidentiality and non-stigmatising health care.

Adolescent-friendly health services have a significant impact on healthcare outcomes particularly in promoting SDG 3 (Good Health and Well-being) and addressing mental health concerns. In addition, these services can support broader socio-economic development, including reducing early and unintended pregnancy allowing girls to continue their education and avoid early marriages which may limit their economic opportunities.

In today's rapidly evolving world, digital technologies have revolutionised various aspects of our lives, including healthcare. One such transformative innovation is Mobile Health, often referred to as mHealth. With an estimated 600 million mobile phone subscribers projected by 2025 in Sub-Saharan Africa (SSA)[10], accounting for nearly half of the region's population, the utilisation of mHealth innovations has emerged as a viable solution to enhance accessibility and utilisation of healthcare services among the underserved populations, particularly in regions with inadequate healthcare infrastructure[11]. mHealth is a medical and public health approach that leverages mobile phones, tablets, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices to support healthcare delivery.

There is already growing interest and investment in digital technology for broader health outcomes. For instance, in Senegal, the "mDiabetes" initiative employed SMS messaging to deliver diabetes-related health information to people in remote areas, including adolescents.[12] This approach was found to be successful in promoting awareness and self-management of diabetes, demonstrating the potential of simple text-based interventions in bridging the digital gap.

In Ghana, Mobile Midwife, an SMS-based health information service is designed to support pregnant women and new mothers in underserved communities. The service sends timely and relevant health information to women, guiding them throughout their pregnancy journey and the early stages of motherhood. By promoting maternal health and proper infant care practices, Mobile Midwife has contributed to reducing maternal and infant mortality rates in Ghana's remote areas.[13]

Drones are also increasingly being utilised to deliver medication and medical supplies to remote and inaccessible areas. For example, in Rwanda, Zipline, a drone delivery company, transports blood products to hospitals and clinics in rural regions, ensuring timely delivery of life-saving supplies.[14] These examples highlight the transformative potential of mHealth and emerging technologies in improving healthcare access and outcomes in Africa.

The role of digital technology in improving health and well-being for adolescents

mHealth presents unprecedented opportunities to improve health outcomes, promote well-being, and advance development goals for Africa’s adolescents. The integration of mobile technology can ensure young people receive vital health information and services essential to their well-being and decision-making. Through mHealth applications and services, young individuals can access vital health information, access remote consultations and receive medication reminders, and even engage in remote consultations, thereby facilitating timely and convenient healthcare delivery. mHealth also has the capacity to provide timely, precise, and non-judgmental Sexual and Reproductive Health (SRH) information and services to adolescents[15]. With the increasing availability of mobile devices, even in rural and remote areas, many young people can now access essential health information and services conveniently and confidentially.[16] By considering the role of digital technologies both as interventions and delivery mechanisms, we can better understand their transformative potential in improving youth and adolescent-friendly health services in Africa.

In Mozambique, Pathfinder developed mCenas, a text message-based programme targeting adolescents and youth aged 15-24, with or without children. This interactive two-way SMS system presents role model stories where characters overcome contraceptive use barriers faced by young people. It also offers an informational menu-based messaging system to increase knowledge about contraceptive methods and dispel myths, aiming to reduce barriers to contraceptive use and empower youth in making informed reproductive health choices.[17]

Adolescent-friendly health services delivered through mHealth also play a crucial role in preventing violence among adolescents in Africa. mHealth can contribute to reducing violence and promoting safer communities for adolescents through both direct support and system strengthening. For example, UNICEF’s Safeguarding chatbot programmes are being refined to capture trigger words like “rape” or “suicide” in messaging services – flagging violations to local helplines.[18] Interactive Apps like “Pocket Guide” have also informed humanitarian responses to gender-based violence through training and supporting first responders.[19]

Zambia: An opportunity to implement accelerators with and through digital technologies

Adolescent girls and young women living with HIV (YWHIV) are at increased risk of violence from intimate partners as well as family members, and these risks may increase in moments of stress - such as when a young woman discloses her HIV status to a partner for the first time. In Zambia, nearly two-thirds of YWHIV have experienced sexual violence from their intimate partners. High rates of early marriage and early motherhood, underpinned by inequitable gender norms, can pose additional challenges for YWHIV. However, there is evidence that embedding peer support for YWHIV in clinical settings can be a way to identify young women who are at risk of or already experiencing violence and respond to their immediate needs.[20]

The Screen & Support package was co-developed with peer supporters based at one health facility outside of Lusaka, Zambia, in partnership with local community-based organisation Kabangwe Creative Initiative Association (KCIA) and regional organisation Paediatric-Adolescent Treatment Africa (PATA). Screen & Support mapped existing services, and tested ways of screening YWHIV for violence and related factors (such as mental health symptoms, risky sexual behaviours, and substance use). Increasing digital coverage, via mobile phones and social media, has allowed increased reach and inclusion of adolescents and young people – especially those commonly left behind. For example, to facilitate remote-based engagement and submit screening data securely, peer supporters used digital tablets to undergo online training modules with the multi-national team and to collect data using a digital screening questionnaire while engaging YWHIV in person.

Emerging findings show that young women experiencing early motherhood and/or any mental health symptoms were more likely to screen for other risk factors; screening young mothers provided an opportunity to provide multi-sectoral support to young people. However, they are often left behind because health services and investments tend to be disproportionately skewed towards adults and elderly populations.[21] This case study does demonstrate how a combination of digital technology used for screening and peer-led forums can increase achievement towards multiple SDGs for both YWHIV and their male peers.

Love Matters Africa, an mHealth platform, is also promoting violence prevention among African adolescents. This platform provides comprehensive and evidence-based information on sexual and reproductive health, relationships, and well-being. By addressing topics such as consent, healthy relationships, and understanding boundaries, Love Matters Africa empowers young people to recognise and prevent violence in their lives. The platform also offers confidential access to counsellors through text messaging, providing vital support to adolescents facing violence or abuse.[22]

In addition, mHealth initiatives like the SMS helplines for GBV (e.g., Help, developed with support from UNHCR South Africa) have been implemented to combat violence[23]. By offering a safe and confidential platform to seek help, this initiative empowers adolescents and young people to act against violence and access the assistance they need.

Child marriage is a significant form of violence experienced by adolescent girls across Africa. Girls Not Brides, the global partnership to end child marriage, have organised coordinated digital campaigns to galvanise community, national and global support to disseminate information on the detrimental effects of early marriage and the importance of education and empowerment for girls. Through awareness campaigns, this initiative aims to change cultural norms surrounding child marriage and promote violence prevention by addressing a key underlying factor.[24]

In low-resource settings and in humanitarian contexts, where access to healthcare is often severely constrained, mHealth also has the potential to be transformative, tackle health inequalities and ensure that young people receive the care they urgently need[25]. However, to realise the potential of this technology, efforts need to be made to address the digital divide. Whilst there has been remarkable progress in improving internet and mobile coverage this has not been matched by progress in overcoming inequalities in usage; sub-Saharan Africa is notably affected by a digital divide – estimates indicate that 67% of the world’s population that is not covered by mobile broadband live in Africa, most living in Central African countries.[26]

Despite the increased internet penetration in Africa, the usage gap has widened from 36% in 2014 to 53% in 2020. [27] While smartphone ownership is ubiquitous in many middle-income countries and urban areas, there are many settings where smartphone ownership among young people may be limited.[28] It is also important to acknowledge that many young people cannot afford airtime. Addressing these challenges is essential to ensure that mHealth interventions reach and benefit all adolescents in these challenging environments, leaving no one behind. As such, mHealth interventions need to be tailored to reach adolescents with varying levels of access to technology.[29] and there are opportunities for governments to support partnerships with the private sector to ensure more affordable access to airtime.

Innovative initiatives like "U-Report" have proven successful in addressing the digital divide in Africa. The platform, established by UNICEF, allows young people to participate in polls, receive information, and engage with social issues via basic mobile phones and social messaging applications. By using diverse communication channels, "U-Report" overcomes the limitations of smartphone ownership, allowing a broader audience of adolescents to access critical health information and participate in health-related discussions.[30]

Another key concern of the scale-up of digital technologies has been the need to prevent harm, especially in relation to online bullying and sexual exploitation. Programmes such as UNICEF’s “Disrupting Harm” project have shed light on the drivers of online risks across Africa and identified opportunities to collaborate with the private sector, particularly telecommunication companies. This collaboration aims to improve regulation, fortify legal systems to address online abuse and strengthen the capacity of frontline workers to respond effectively to the unique threats that adolescents face.[31] By taking proactive measures to address these challenges, interventions can safeguard the well-being and safety of African adolescents in the digital space.

Collaborative solutions for empowering African adolescents

The power of digital technologies along with other accelerators for improving access to healthcare for African adolescents cannot be understated. mHealth has the potential to bridge healthcare gaps, provide more responsive and confidential health services, and empower young people to take control of their health and ultimately improve health outcomes for the next generation. In line with the goal of empowering African adolescents and improving their health outcomes, it is essential to adopt evidence-based cross-cutting solutions that address the multiple dimensions of their lives. Below we set out four key considerations for policymakers and programmers based on the emerging evidence of mHealth for promoting adolescent well-being:

Multi-sectoral collaboration: Foster collaboration among various sectors, including health, education, social welfare, child protection and private sector network providers to promote adolescent health and wellbeing and address economic and psychosocial determinants of health.[32] These collaborations can provide a holistic approach to adolescent-friendly health services, combining medical care, behaviour change communications, mental health support, peer education, and social services.

Adolescent engagement and participation: Involve young people in all their diversity in the design, implementation, and evaluation of policies and programmes that directly affect them. This can be achieved through youth-led organisations, adolescent advisory groups, and platforms for participatory decision-making.[33] By actively involving adolescents, young men and women, policymakers and programme implementers gain valuable insights into the realities and preferences of adolescents, enabling them to tailor interventions that are more responsive, relevant, and effective.

Scale up digital innovations and technology: Embrace the potential of digital innovations and technology to improve adolescent-friendly health services and overall well-being.[34] Develop and scale up digital platforms, mobile applications, and online resources that provide young people with accessible and confidential information, counselling, and support. Ensure that these technologies are inclusive, reaching young people from diverse backgrounds and marginalised communities. Explore partnerships with the private sector to provide free or affordable airtime to young people as part of their corporate responsibility.

Equip young people with skills to navigate online platforms safely: As access to online platforms increases, it will be essential to equip young people with the necessary skills to navigate and benefit from digital health services and resources and protect them from the risks of online sexual exploitation and poor mental health. It is also important to put in place regulatory systems to monitor and remove harmful online content that may have an adverse impact on young people.[35]

New technologies, particularly mHealth, have huge potential as a development accelerator to improve adolescent health and well-being. Investment in research, infrastructure, and capacity building in the field of digital health will be vital to ensure that African adolescents have access to high-quality, safe and comprehensive healthcare services. By embracing inclusive technologies and other development accelerators, we can empower African adolescents and contribute to the achievement of sustainable development goals and growth in Africa. Through these concerted efforts, we can create a future where every young person in Africa has equal access to the healthcare they need, enabling them to thrive, contribute to society and shape a brighter future for themselves and their communities.

Bloggers:

AUDA-NEPAD

Justina Dugbazah

Nhlawulo Shikwambane

University of Oxford/University of Cape Town/Accelerate Hub

Rachel Yates

Mona Ibrahim

David Chipanta

Christina Laurenzi

Chipo Mutambo

[1]Pinxteren, et al (2021) Barriers and opportunities to using health information in policy implementation: The case of adolescent and youth friendly health services in the Western Cape

[2] United Nations Development Programme (2017) SDG Accelerator and Bottleneck Assessment